Funding for Housing Services Great Lakes Indian Housing Association 11.2019 1
YOUR PRESENTER Ashley Hesse Senior Consultant/ Policy Director 2
Our Purpose We are on a mission to create health equity for American Indians and Alaska Natives In One Generation. 3
WHO WE ARE + + 4
STRATEGY – SERVICE DEVELOPMENT 4 Peaks - How We Work A Guided Journey to Enhance Indigenous Health Models Vision Design Deploy Sustain Your tribal culture Indigenous pact consultancy Indigenous pact collaboratives Outcome: Healthier Lives for Increased Financial Improved Community for Citizens, Families, and Performance to Strengthened Future Generations Non Natives Sovereignty 5
OVERVIEW SLIDE / TABLE OF CONTENTS Current state-Tribal housing needs Housing Instability and SDOH Housing as Health Housing & support services Funding: Supportive Services Future State- Tribal housing 6
CURRENT STATE OF HOUSING IN INDIAN COUNTRY What have we learned about Tribal housing needs Planning Rules and Processes Regulations Capacity Funding ‘road maps’ HUD Housing Needs Study 2011 7
CAPACITY What Is: A need for capacity building at the Tribal level in many areas. • Enhancements of general administrative abilities • A need for specialized training in such areas as finance and environmental monitoring • Grant writing technical assistance and technical knowledge to secure federal funding • Stronger energy use assessment, planning, and visioning 8
PLANNING PROCESSES What Is: A need for Tribes to have more comprehensive planning processes. • Focus on such issues as prioritization of housing services needs • Increase health prevention and mitigation activities • Develop comprehensive energy planning • Build capacity for the efforts mentioned 9
FUNDING RESOURCES What Is: Tribes need to develop “road maps” that can give guidance regarding funding resources. • Information about the availability of non-federal funding • Funding resources for supportive housing services* • Develop comprehensive plan and a united effort to draw from breadth of resources 10
REGULATION AND PROCESS What Is: There is a need to simplify and make more consistent the regulations of the various federal and state programs that provide funding and services in Indian Country. • Conflicting rules and regulations effectively limit housing development. • Various application processes can make it difficult for Tribes to effectively access many available resources. 11
HOUSING INSTABILITY & HOMELESSNESS Self-Actualization Self-fulfillment, achieve individual potential Esteem Self-esteem, respect from others Belongingness Love, family, friendship Safety and Security Physiological Needs Air, water, food, shelter 12
Discrimination Homeless veterans Job loss and unemployment Persons with HIV/AIDS Homeless adults Victims of domestic violence Many reasons for housing insecurity and Incarceration Alcohol and drug addiction homelessness Homeless adults with children Fire, Flood and other natural (families) disasters Physical or developmental Serious and persistent mental disabilities illness 13
HOW DOES HOUSING AFFECT HEALTH? 3 Primary Interrelated aspects that affect health: Neighborhood & Environment Social & Communit Health y Context Care Conditions in the The physical neighborhoods Housing conditions within surrounding affordability homes homes Social These factors not only shape home and neighborhood Determinants conditions but also affects the overall ability of of Health families to make healthy choices. Economic Education Stability Housing impacts all SDOH domains 14
SUPPORTIVE AND PERMANENT SUPPORTIVE HOUSING In general the nature of supportive housing is to provide housing options and supportive services to homeless individuals and families transitioning from homelessness into transitional and permanent housing with the goal of living as independently as possible. 15
NO CLEAR PATH OR SINGULAR SOLUTION HUD ONAP Federal Programs including HUD/ ONAP/DOI/USDA-RD/EDA/RCAC//USDA- RUS/DOJ/USDA/DHS/FEMA/SAMHSA and HUD-VASH DOI other programs Indian Housing Block Grant Competitive • Grant NGO USDA-RU Indian Housing Block Grant • Indian Community Development Block • Grant DOJ EDA Section 184 Home Loan Guarantee • Tribe Title VI Leveraging • Tribal HUD-VASH USDA-RUS SAMHSA • Hawaiian Programs • State Programs RCAC STATE Private and Corporate Foundations NGOs Medicaid Waivers/ Demonstrations FEMA USDA Etc … DHS 16
MEDICAID WAIVER & SUPPORTIVE SERVICES Medicaid waiver is an agreement that allows states to waive certain Medicaid program requirements Medicaid is a Home & Community-Based Services 1915(c)(i)(j)(k) – shared State- Waivers: variety of unlimited state tailored services to meet Federal health care needs of targeted groups (age, diagnosis, HIV/AIDS, etc.) Can provide medical and non-medical services. States can propose program with broad ‘other’ types of services to assist in diverting or transitioning people from institutional settings into their home of reaching and community. varied services and 1115 Demonstration Waivers: Gives Secretary of HHS programs authority to approve experimental, pilot, demonstration projects that promote the objectives of Medicaid. 17
GENERAL SUPPORTIVE SERVICES (HOUSING) 4.1. General Supportive Services Name of Service On-site or State Provider (*Tribal Off-Site Medicaid or Non-Tribal program Legal Entity) equivalent (Yes/No- details) Tenant orientation/move-in assistance Tenant’s rights education/tenants council Case management Coordination of all resident services Psychosocial assessment Individualized service planning Individual counseling and support Referrals to other services and programs Crisis intervention Peer mentoring Support groups (list below) - Life Skills Recreational/socialization opportunities Legal assistance Transportation Meals Other nutritional services Emergency financial assistance (specify) Including but not limited to: Assistance with obtaining identification Bus Passes (as necessary) Co-pay for prescriptions (as necessary) Furnishings Other (specify): 18
MA SPECIALIZED TRANSPORTATION (WAIVER): State Medicaid Name of Service program Examples of Services and Y – Currently Provide Cost to Provide Provider (*Tribal or On-site or 4.1. General Supportive Services equivalent Supports for this category N – Do Not Provide Non-Tribal (If Known) Off-Site (Yes/No- Legal Entity) details) MA Specialized Transportation Tenant orientation/move-in assistance Tenant’s rights education/tenants council Service offered in order to enable individuals Case management Pre-purchase or provision of to gain access to community services, Coordination of all resident services tickets, passes, vouchers, or activities, and resources specified by the plan Psychosocial assessment other fare medium Individualized service planning of care. Specialized transportation services Individual counseling and support include those services that assist in Referrals to other services and programs improving the person’s general mobility in Crisis intervention the community, increase independence and Peer mentoring participation, and prevent Support groups (list below) - Life Skills Direct payment to providers institutionalization. Recreational/socialization opportunities covering the cost of transport Legal assistance Transportation services shall be offered in Transportation accordance with the individual’s plan of care. Meals Other nutritional services Specialized transportation services may Emergency financial assistance (specify) consist of material benefits such as tickets, or Including but not limited to: other fare medium, or a payment covering all Assistance with obtaining identification Other services not listed Bus Passes (as necessary) costs associated with the conveyance of Co-pay for prescriptions (as necessary) program participants and their attendants. Furnishings Other (specify): 19
INDEPENDENT LIVING SKILLS (HOUSING) 4.2. Independent Living Skills Name of Service On-site or State Provider (*Tribal Off-Site Medicaid or Non-Tribal program Legal Entity) equivalent Communication skills Conflict resolution/mediation training Personal financial management & budgeting Credit counseling Representative payee Entitlement assistance/benefits counseling Training in cooking/meal preparation Training in personal hygiene and self-care Training in housekeeping Training in use of public transportation Assistance with activities of daily living Other (specify): 20
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