April 26, 2011 Hospital to Home Call 6

WORKGROUP GOALS Develop sustainable models for providing services in Permanent Supportive Housing Strengthen partnerships between housing, outreach and health care providers Build the health integration playbook Generate policy recommendations

Introductions Health Care Reform – Goals, key expansions and status – Benefits for people experiencing homelessness – Implications for outreach and housing providers Successes at Local and State Levels How to move forward in your community AGENDA

INTRODUCING FACULTY Catherine Craig Health Integration, Common Ground National Programs Catherine has 13 years of experience in hospital- and community- based social work, mental health research, and systems improvement. Her role with the 100,000 Homes Campaign is to identify successful models that bring together health care, outreach and housing providers; pinpoint sustainable funding streams for services in housing; demonstrate the health impact of housing; and help communities to learn from each other’s successes.

INTRODUCING FACULTY Barbara DiPietro, PhD Policy Director, National Health Care for the Homeless Council The National HCH Council strives to prevent and end homelessness through technical assistance to HCH grantees and other homeless service providers, research, policy analysis and advocacy. As Policy Director, Barbara educates administrators, clinicians and consumers about the impact of health reform and advocates for effective implementation strategies that will address the needs of highly vulnerable populations.

INTRODUCING FACULTY Peggy Bailey Senior Policy Advisor, Corporation for Supportive Housing Peggy has over 10 years experience in health and human services financing policy. At CSH, she helps identify opportunities for local jurisdictions and states, such as connecting with health system partners and strengthening Medicaid, to sustain funding for services in supportive housing.

INTRODUCING FACULTY Lisa Stand, JD Senior Policy Analyst, National Alliance to End Homelessness The Alliance identifies and advocates for proven solutions to homelessness in policy and practice. Lisa brings a health care perspective to meet the Alliance’s goals, especially for people who have experienced chronic homelessness. She has background in health law, advocacy, education, and community engagement.

HEALTH CARE REFORM: Goals Patient Protection and Affordable Care Act (PPACA) Goals: Increase access and quality Promote integration of services Reduce cost and disparities

HEALTH CARE REFORM: Expansions Two major expansions targeted to low-income populations: Medicaid Expansion Health Center Expansion

HEALTH CARE REFORM: Medicaid Expands Medicaid to 138% FPL for all single adults $15,000/year for individual 16 million new enrollees anticipated Federal match to states (100%  90%) Maintenance of effort requirement Enrollment to be simplified ** Effective in 2014, or earlier at state option

HEALTH CARE REFORM: Medicaid Benchmark Benefits Ambulatory patient services Emergency and hospital services Maternity and newborn care Mental health and substance abuse disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services (to include oral and vision care) ** Yet to be determined: scope, amount, duration, etc.

HEALTH CARE REFORM: Medicaid Community-based, in-home services are mainstream for seniors and individuals with disabilities More flexible options are now possible

HEALTH CARE REFORM: Medicaid Our vision: Medicaid payments for outreach and services in permanent supportive housing (PSH) Recommendation: States should maximize opportunities to achieve 3 goals: Reduce homelessness Decrease health spending Improve individual and community health

HEALTH CARE REFORM: Health Centers Goal: Double health center volume by million  40 million people Community health centers are key community partners For service collaboration As venues of integrated care, “Health Home” Health Care of the Homeless as a unique resource Invests $11 billion over 5 years $9.5 billion for new locations and services $1.5 billion for capital

HEALTH CARE REFORM: Federal Status Administrative: Full speed ahead Planning and implementation grants Demonstration projects Rules and regulations TA to states Oversight/research capability Congressional: Complications Continued controversy De-fund, block, or repeal Judicial: Contradictions

HEALTH CARE REFORM: State Status States Are: Balancing fiscal crisis with plans for Medicaid expansion Establishing state-level Exchanges Applying for demonstration & planning grants Developing needs assessment & decision-making processes ** Political culture will impact planning

Implications for Outreach Providers Health center expansion = increased community capacity for services Tangible benefit to offer clients Use as engagement tool; removes a barrier to services Unifying element across all types of outreach specialties Opportunity to re-examine how outreach workers partner together

Implications for Outreach Providers Some outreach services may become Medicaid billable Transportation Life skills/health education Case management Peer support Presumptive eligibility determination at hospitals Workforce development initiatives peer navigators, community health workers

Implications for Outreach Providers Outreach & enrollment are keys to national success 32 million people anticipated to gain insurance (about half from Medicaid) 23 million people remain uninsured after 2016: 8.4 million (37%): Medicaid eligible 5.6 million (25%): Undocumented/ineligible 5.2 million (23%): Affordable option (w/ or w/o Exchange) 3.7 million (16%): Affordability exemption Source: Buettgens, M. and Hall, M. (March 2011.) Who Will be Uninsured After Health Insurance Reform? Robert Wood Johnson Foundation.

Health Care System Helps End Homelessness Stable, longer-term services funding Combines primary care, behavioral health & social supports Greater access to Medicaid  more services deeper engagement better health More team models  better services Better health + care + more resources  Preventing & Ending Homelessness

Medicaid Challenges States restrict Medicaid-billable providers General Reimbursement - Can be slow - May not support team-oriented care Requires strong administrative infrastructure Does not cover all PSH services - Experts estimate that Medicaid can fund 80 – 90% of PSH services -Housing search, move-in expenses, and related case management are not usually covered - Gap between what Medicaid currently covers and it’s full potential ** this can be fixed and Health Care Reform helps

Housing is a Resource for Health & Health Care For those Currently Medicaid-Eligible, PSH helps to: Reduce health care costs Tenants engage in primary and outpatient care, avoiding high cost of hospital-based and long term care (emergency rooms, inpatient care & nursing homes) Promote healthy behaviors Tenants self-manage: eat better and more regularly, take medication, reduce risky behavior & are better able to keep appointments Support engagement in health care PSH service providers can coordinate with health care providers & assist tenants to understand the treatment plan

Housing is a Resource for Health & Health Care And For Newly-Medicaid Eligible in 2014, PSH Can: Assist with outreach and enrollment Traditionally difficult-to-reach population Substance use, childless adults, non-disabled adults Control costs Increased initial federal match can be used to improve future system

State-Level Advocacy Here’s how to advocate: Engage your state Medicaid office Compare current Medicaid benefits with PSH Services & highlight the potential for reimbursement Break down language barriers Identify gaps – this will determine which health reform measures will benefit your state CA, CT, IL, and IN (among others) are in various stages of making these connections

The Westside Collaborative, Chicago Kathy Booton-Wilson Chief Operating Officer, Deborah’s Place

Health Reform - A tool to end homelessness Implications for Housing Solutions Potential to boost supportive housing as strategy to end homelessness, especially for individuals with multiple co-occurring conditions It is up to homeless advocates to drive these policy changes and shape effective systems Together we can end homelessness

Action Steps Assign a health care “lead” in your organization or network Tell your story, share your vision – concrete, visible, and compelling Know your audience: Mainstream housing (for-profit developers, PHAs) Healthcare partners (local reform coalitions, nonprofit hospitals, clinics) Public agencies (health, housing, social services) Safety net advocates and providers Local and state legislators Add your unique voice to support Medicaid funding

HOUSING: Health Care Translation Talking Points Medicaid helps end homelessness by providing access to primary care and coordinating key services PSH + Medicaid can be cost-effective for communities Housing and health pieces can fit together to improve lives and make a stronger safety net

WHERE TO NOW? Which local hospital is a natural partner? Who are you not yet linked with? What about community health centers?

YOUR STATE BUDGET Is your state leadership working to balance the budget? What cuts do you anticipate? What ’ s your next step in connecting with state leadership?

HOMELESSNESS & HOUSING What messages have your State Medicaid office and local health care providers not heard yet about homelessness and housing?

RESOURCES

LOCAL CAMPAIGN RESOURCES Campaign Endorsers in Healthcare National Association of Public Hospitals and Health Systemswww.naph.orgwww.naph.org National Association of Community Health Centers National Healthcare for the Homeless Council National Alliance on Mental Illness To partner With a public hospital, community health clinic, or mental health resource in your community, contact Catherine Craig