Housing Opportunities for People with Disabilities Policy Developments NCSHA Annual Conference October 20, 2014 Henry Korman, Partner Klein Hornig LLP

Overview: Housing Opportunities for People with Disabilit 2 Housing for people with disabilities as a civil rights issue. Medicaid as the primary national tool for fulfilling Olmstead. HUD Civil Rights-Related Program Requirements Section 811 PRA Proposed Rules

Housing for People with Disabilities: The Civil Rights Lens Section 504 and the ADA incorporate two key principles that inform the delivery of housing services to people with disabilities (including elders with disabilities): Public services (including housing) must be made available in the most integrated setting appropriate to the needs of the individual. It is discrimination to provide different or separate services to people with disabilities, except when necessary to assure equal opportunity. 3

Housing for People with Disabilities: Medicaid as the Federal Integration Tool Olmstead v. L.C. (1999) Challenged state use of Medicaid funds to improperly institutionalize people with significant disabilities. Established the concept that institutionalization and segregation of people with disabilities is a violation of the “most integrated setting rule.” Transformed MA by redirecting services for people in and at risk of institutionalization to community-based settings. 4

Housing for People with Disabilities: Medicaid as the Federal Integration Tool Olmstead made operational through long-term care that target services to categories of people with disabilities (including frail elders) in community-based settings through waiver of the comparability rule: (c) HCBS Waivers Money Follows the Person Targeted Case Management Community First Choice Attendant Services Self-directed Personal Assistance Rehabilitation Services Health Homes Targeted Managed Care HCBS Option 1115 Demonstrations

Housing for People with Disabilities: Medicaid as the Federal Integration Tool Medicaid “Community-Based Setting” Integrated Selected by the individual Privacy & autonomy Facilitates choice in services Tenancy rights Separate, lockable dwelling Freedom to come & go and host visitors Choice of roommates Not a nursing home, ICFMR, facility for people with mental illnesses, long-term care facility or on or near the grounds of an institution 6

Housing for People with Disabilities: HUD Civil Rights-Related Program Requirements Public Housing, HCV & PBRA: Preferences for disabled families but not by category of disability PIH (HA): Preferences for MFP, persons in or at risk of institutionalization, as part of Section 811 PRA leveraging, or by category under an OGC-approved “remedial action” to further state Olmstead plans 7

Housing for People with Disabilities: HUD Civil Rights-Related Program Requirements PBV: No waiver of HCV rule; preferences based on need for services; limited to disabled families facing barriers to housing where housing cannot be supplied in a “non-segregated setting;” services are voluntary; marketing to target group permitted; housing must serve all who qualify for the services. HOME: Same; based on need identified in ConPlan; targeting permitted if housing involves other forms of targeted financing (HOPWA, Continuum of Care, Section 811) 8

Housing for People with Disabilities: Melville Act & Section 811/202 Reform HUD Notice of Proposed Rulemaking Section 811 & 202 Reforms 79 Fed. Reg (October 7, 2014) Section 202: Unit set-aside for frail elders Assisted Living Conversion Program Senior Preservation Rental Assistance Contracts for units converted to assisted living or service-enriched housing 9

Housing for People with Disabilities: Melville Act & Section 811/202 Reform HUD Notice of Proposed Rulemaking Section 202 & 811: ePRAC (Enhanced PRAC) pays for debt service in connection with leveraging TA grants to support funding applications Codification of AHEO and Section 202 Act of 2010 (direct loan prepayment and refinancing “old program” Section 202 properties) 10

Housing for People with Disabilities: Melville Act & Section 811/202 Reform HUD Notice of Proposed Rulemaking Section 811 PRA: Grants to HFAs and housing credit agencies Interagency partnerships with Title XIX agencies No capital advance Extremely low-income disabled families receiving supports under interagency partnership; 25% per project set-aside limit Leveraging LIHTC, HOME and other resources 11

Housing for People with Disabilities: Melville Act & Section 811/202 Reform HUD Notice of Proposed Rulemaking Section 811 (General Provisions & Non-PRA): Disabled family is > 18 and < 62 years Group homes, ILC and multifamily still eligible 25% per project set-aside limit for supportive housing units in multifamily HOME program cost limits (except group homes) Leveraging incentives (i.e., ePRAC) Leasing protections (i.e., HOME program) Targeting only to disabled families that can benefit from services offered; other occupancy requirements approved by HUD Conversion to non-811 housing 12

Housing for People with Disabilities: Resources Medicaid HCBS: Center for Medicare & Medicaid Services: Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community- Based-Services.html Community Integration Center at TAC: HUD CRRPR: PIH (HA), Assisted housing for persons with disabilities under Olmstead Section 202 and 811 Proposed Rule: 79 Fed. Reg (October 7, 2014) 13