AIDS Issues Update Blog

Dispatches from the fight against homelessness and AIDS


Posted by Tim Murphy , September 20, 2013


Medicaid Redesign is turning around these dismal stats. Bravo!

For years, Housing Works has been saying the same mantra: Housing is Health Care! When people with special health conditions like HIV/AIDS, mental illness or addiction are stably and safely housed, they are in a better position to manage their self-care and enjoy better health outcomes. Ample research backs this up.

We’re happy to see that New York State, amid its landmark Medicaid redesign to find savings in the program and redirect them toward programs that improve health outcomes, is finally on the same page with us. Last week, Governor Cuomo announced that the state’s Medicaid Redesign Team (MRT) Supportive Housing initiative would “undertake significant investments to create new affordable housing units and provide needed support to nearly 5,000 high-need individuals.” This initiative, the state reported, came “following significant Medicaid savings totaling more than $4 billion achieved over the last year under the MRT initiative. Additionally, over the next five years, the State is on track to save a combined $34.3 billion.”

“Under the Supportive Housing Initiative, the State is making major investments in affordable housing so that New Yorkers who are most in need have a stable and healthier environment to call home,” said the Governor. “In the long run, this will mean better health outcomes for vulnerable New Yorkers and savings in the State’s health care system. This is yet another example of New York State leading the nation in effective and efficient health care reform.”

The MRT Supportive Housing Initiative is essential for New York State to achieve the “Triple Aim” of better health, better care, and lower costs for traditionally underserved populations. When phase one of the initiative is fully implemented, it will provide nearly 5,000 individuals with access to supportive housing through capital investments to construct new supportive housing units, and rental subsidies and service supports for New York’s high-need Medicaid members.

To date, this first phase includes a commitment of $46.7 million in capital funds to construct 12 new buildings in the next 24 to 36 months that will create 483 new supportive housing units, as well as $27.9 million in rent subsidies and services to support 4,355 individuals. The buildings will be located at the following locations throughout the state:

* Creston Avenue (Bronx) * Coler-Goldwater/Metropolitan Hospital (Manhattan) * Redemption Plaza (Bronx) * Savanna Hall (Manhattan) * Boston Road (Bronx) * 6469 Broadway (Bronx) * 3362 Third Avenue (Bronx) * Providence Housing Development Corporation (Monroe) * Opportunities for Broome (Broome) * Polish Community Center (Erie) * Mercy Haven (Suffolk) * Finger Lakes United Cerebral Palsy (Finger Lakes)

“A critical component to improving the health of New Yorkers and containing health care costs is to ensure that an individual’s housing needs are also met,” State Health Commissioner Nirav R. Shah M.D., M.P.H said. “By increasing the availability of supportive housing for high-need Medicaid beneficiaries, we will be able to reduce Medicaid costs and improve the quality of care for these individuals.”

“There is compelling evidence, both in New York and nationally, that for people coping with chronic illness or disability and behavioral health challenges, the lack of stable housing often results in avoidable health care utilization and, in turn, avoidable Medicaid expenses,” said Jason Helgerson, New York’s Medicaid Director. “There is a growing national recognition that addressing the social determinants of health is critical for improving health while reducing health care costs. This is most evident in the matter of housing.”

The Affordable Housing work group, which was created in Phase 2 of the MRT initiative, is comprised of more than 40 stakeholders. The investments in new housing units and rental subsidies will increase housing options for vulnerable residents receiving Medicaid, including frail elderly New Yorkers living in the community, individuals with serious mental health and substance abuse disorders, those living with HIV and AIDS, individuals with developmental disabilities, and the chronic homeless. To evaluate the program’s effectiveness in reducing Medicaid costs, the State Health Department will use a supportive housing data collection tool to track users of all the MRT Supportive Housing programs.

Established in 2011 by Executive Order by Governor Cuomo, MRT was comprised of stakeholders and experts throughout the state who worked cooperatively to reform the state’s health care system and reduce costs. The MRT has become a national reform model for cost-effective, high-quality and patient-centered health care. In the past year alone, New York has saved $4.6 billion, while adding 154,000 people to the Medicaid rolls and improving health outcomes. For more information on MRT, go here.

Housing Works is very excited about these developments. In the coming weeks, we will be breaking down some of the different pilots within this initiative, such as the one for people with HIV/AIDS and the one for moving people out of homeless shelters. Another exciting pilot is the Health Homes Supportive Housing Pilot. This pilot will award 500 rent and service subsidies to experienced supportive housing providers to house and serve high cost Medicaid recipients in scattered-site market-rate rental apartments. Components of this pilot will include:

o Enhanced “housing first,” harm reduction supportive housing model to house and serve persons referred by Health Homes.

o Services will be offered in an ongoing effort to link and transition tenants to community-based care, services and supports.

o Person-centered, wrap-around services aimed at increasing independence and housing stability, augmented with Health Home Care Coordination. This will provide a new overlay of assistance aimed at helping tenants re-organize medical care to reduce use of emergency systems and improve use of preventive and primary care.

o Scattered Site units available to Health Homes across state

o Housing providers applying in partnership with Health Homes will be allowed to bid to the state for funding for operation and services

o Contracts of 25 to 50 units would be held by experienced supportive housing providers, managed by the Office of Temporary Disability Assistance

o Contracts will provide $20,000 per individual per year to cover rental costs, service and support staff

o Government agency (NYC HRA, DOH, OMH SPOA) would certify eligibility

o Health Homes would manage referral process and prioritize clients for housing

o Health Home care coordination is conducted directly by the housing provider, or through explicit Health Home-Supportive Housing Provider

agreements that spell out how care coordination will be integrated with housing-based services

o Specific diagnoses will not be a criteria for eligibility

o Once placed in housing, tenants will receive person-centered, wraparound case management services aimed at increasing independence and

housing stability

o Active, collaborative, real-time evaluation and data collection.

In the Health Homes pilot, supportive housing providers will combine the current housing-stabilization case management model with a new overlay of assistance aimed at realigning a tenant’s medical care. This will involve reducing preventable hospitalizations and use of other medical emergency services, while improving tenants’ preventive and primary healthcare.

This support will include on-site medication counseling and monitoring, help scheduling and attending appointments (including escorts, when necessary), instruction on adopting healthy behaviors, guidance on navigating specialty care, on-site assistance/advocacy to help tenants minimize hospital stays, and overall assistance with program compliance in the face of mental health and addiction challenges.

The total cost of this program is estimated at $10 million, serving 500 high-cost Medicaid recipients at $20,000 each per fiscal year 2013-14.

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