Health + Housing: Unlocking Potential in New York State Presentation to National Academy for State Health Policy July 24, 2017
• Rethinking Care for Medicaid's Highest-Need, Highest- Cost Populations • Addressing the Social Determinants of Health • Housing is Health Care! • Targeting “high - cost” Medicaid members • Demonstrating the cost-effectiveness of supportive housing 2
Medicaid Redesign Team Supportive Housing Initiative Capital • Medicaid Redesign Investment: $641 Million over 7 years. • Funding is targeted to high-cost Rent Medicaid members. • MRT Supportive Housing investment targets capital construction, rental Support Services subsidies and supports, and operating dollars. Service and Operating • Outcomes, measures, research and evaluation are key components. Tracking and Evaluation
MRT Supportive Housing: High Cost Medicaid Members Individuals transitioning out of nursing homes Chronic Homeless with Physically HIV/AIDS, Disabled Mental Health Homeless and/or Substance Use Disorders High-Cost Medicaid Members Seniors in Chronically Shelter or low- Addicted income seniors Homeless or at in the risk of community homelessness Developmentally Disabled
MRT Supportive Housing Initiative - Accomplishments • Over the past six years, the MRT Supportive Housing Initiative: • Provided supportive housing units to more populations (“high cost Medicaid users”) throughout the State • Improved coordination across agencies (HCR, OTDA, OMH, OASAS, AIDS Institute, DOH Division of Long Term Care, OPWDD) • Developed 19 rental subsidy and supportive services programs statewide • Added 861 units to the state’s supportive housing inventory, with a projected 621 more units in the pipeline for 2018 • Served over 11,000 high-cost, high-need Medicaid members • Reduced hospital inpatient days by 40% and Medicaid health expenditures by 15%
Clinical Characteristics • 66% have a serious mental illness • 46% have a substance use disorder • 40% are HIV+ • 53% have one or more other chronic medical conditions • 26% have at least three of these diagnosis types Source: McGinnis et al, “Medicaid Redesign Team Supportive Housing Evaluation: Utilization Report 1,” prepared by the SUNY Research Foundation for NYS DOH, May 2017. Note: Not shown are substance use + chronic medical condition (3%) and severe mental illness + HIV (4%). Note: To obtain total percentage of participants with a given diagnosis, sum all percentages that fall into the relevant circle (but may not exactly match text due to rounding). Circles are not sized proportionately.
MRT Supportive Housing Initiative • Medicaid Redesign Investment: $641 Million • $75 million in 2012-13 • $86 million in 2013-14 • $100 million in 2014-15 • $127 million in 2015-16 • $83 million in 2016-17 (+$44m bonded capital) • $63 million in 2017-2018 (+$44m bonded capital) • $107 million in 2018-2019
MRT Capital Projects • 37 funded capital projects • 12 are currently operational
Metro East 99 th Street • 175 units built during the 2013 decommissioning of the Goldwater Hospital as a housing option for physically disabled adults who did not qualify for existing New York City supportive housing programs • Serves elderly or disabled adults referred from the former Coler-Goldwater facility and other nursing homes and hospitals owned by New York City Health + Hospitals • There was a 170% return on investment if Medicaid’s modest, one -time $7.5 million capital investment is amortized over 10 years. In year one, residents’ average Medicaid expenses fell by $11,800 per person.
Access to Home for Medicaid ATH provides grants to eligible applicants to make accessibility modifications to existing owner- occupied or rental dwelling units occupied by persons with disabilities that also receive Medicaid assistance. • Eligibility Criteria • Occupant is on Medicaid • Occupant is physically disabled or has substantial difficulty with activities of daily living (ADL) • Dwelling unit is the occupant’s primary residence or will be the occupant’s primary residence after modifications are completed 10
AIDS Institute Rental Subsidies • Rental subsidies and housing retention services for individuals living with HIV/AIDS in upstate New York • Housing Specialists may receive referrals from Health Home care managers to assist individuals with finding and maintaining housing • Program began in 2013 • 7 current providers with capacity of 200 rental subsidies
Eviction Prevention for Vulnerable Adults • Rental subsidies for elderly or disabled households in New York City who are at risk of eviction • Program began in 2013 • 265 people served to date • Partnership with New York State Office of Temporary and Disability Assistance and New York City Department of Homeless Services
13 Health Homes Rental Subsidy Program • Rental subsidies and services for homeless or unstably housed Medicaid members enrolled in New York State’s Health Home program • Health Home enrollees have two chronic conditions, serious mental illness, or HIV/AIDS • Program began in 2014 • 10 providers statewide have served 445 people to date
Homeless Senior and Disabled Placement Pilot • Rental subsidies for Health Home eligible SSI recipients living in New York City homeless shelters • Program began in 2013 • 231 people served to date • Partnership with New York State Office of Temporary and Disability Assistance and New York City Department of Homeless Services
Mental Health Crisis/Step Down • An option for individuals with mental illness in behavioral health crisis who can be safely diverted from inpatient hospitalization • Step-down services to individuals who are discharged from the hospital but require a higher level of support and services than can be provided in their permanent residence • 10 agencies have up to 3 beds each for short-term stays (<1 month) with 24/7 peer or clinical staffing • Program began in 2015 • 368 people served to date • Partnership with NYS Office of Mental Health
16 Nursing Home to Independent Living • Provides an array of services intended to establish independence, wellness and self- management: o Rental subsidies o Community Transitional Services (CTS) o Environmental modifications o Tenancy sustaining services and preventative health services • Participants are elderly or physically disabled; in a nursing home or eligible for nursing facility level of care; and homeless or unstably housed • Pilot began in 2014 • Two providers serve 230 participants in Syracuse and Long Island
Office of Alcohol and Substance Abuse Services Rental Subsidies and Supports • Rental subsidies on a Housing First basis, intensive case management, and job development and counseling services; funding for clinical supervision of direct service staff • Single adults with a substance use disorder who are homeless, unstably housed, or at risk of homelessness; who are Medicaid enrolled; and who meet frequent utilizer criteria (at least two inpatient hospitalizations, five emergency room visits, or one inpatient hospitalization and four emergency room visits in the previous 12 months) • Program began in 2013 • 18 providers have served 613 clients statewide
Office of Mental Health Rental Subsidies • Rental subsidies and housing case management in scattered-site supportive housing • Serves single, Health-Home-eligible adults with a serious mental illness who are either referred by a Health Home, are a resident in a NYS OMH Psychiatric Center or OMH- operated residential program, or are discharged from an Article 28 or Article 31 hospital. Individuals must also be unstably housed or be individuals for whom housing would assist in a hospital diversion • Program began in 2013 • 39 providers have served 1151 people to date
Office for People with Developmental Disabilities Rental Subsidies • Rental subsidies and services for individuals with intellectual or developmental disabilities who move from certified residential settings with continuous supervision (“supervised” model residences) to more independent, less restrictive housing (supportive model certified residences or uncertified private apartments with support services such as community habilitation and personal care) • Helps the State achieve its Americans with Disabilities Act (ADA)/Olmstead Implementation Plan goals in addition to reducing Medicaid spending • Program began in 2013 • 11 providers have served 70 served people to date
20 Olmstead Housing Subsidy • Provides the following services to help participants live safely and independently in the community: o Rental subsidies o Community Transitional Services (CTS) o Environmental modifications • Serves elderly or chronically disabled adult Medicaid members who have spent at least 120 consecutive days in a nursing home over the most recent two-year period, are homeless or unstably housed, and have the ability to live safely on the community • Program began in 2016 • 50 participants housed to date
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