Slide 1:

Strategies that Work:

“ Improving access to mainstream health and human services that are coordinated with housing for persons who are chronically homeless”

Ann O’Hara
Technical Assistance Collaborative, Inc.

Slide 2:

What Works

• Know your target population and what they need
• Use systematic strategies
• Use permanent housing as a leveraging tool
• Include “mainstream” housing resources as well as HUD McKinney/Vento programs
• Target Medicaid for services
• Leverage state/local planning or system change efforts
• Be successful with initial efforts

Slide 3:

People Who Are Chronically Homeless

• 10-15 percent of homeless people
• Majority are single adults
• Chronic disabilities
  • Mental illness/co-occurring
  • Chronic substance abuse
  • Chronic health conditions
• More likely to be eligible for SSI, Medicaid, Food Stamps, VA services, etc.
• SSI income or below

Slide 4:

SSI Income and Need for Subsidized Housing

• Priced Out in 2002 study
  • SSI housing affordability standard = 30% of income
  • Nationally, 105% of SSI needed to rent a one bedroom unit
  • Nationally, SSI equal to 18% of median income
  • State SSI supplements don’t close housing affordability gap

Slide 5:

State by State – SSI as Percent of Median Income in 2002

• State by state housing affordability “gap”
  • Connecticut – 17.7%
  • District of Columbia – 10.7%
  • Idaho – 22.0%
  • Nebraska – 17.2%
  • Nevada – 16.2%
  • Oklahoma – 25.1%
  • Oregon – 19.2%
  • Virginia – 14.6%
  • Wyoming – 20.2%

Slide 6:

State by State – 30% of SSI Income

• State by State housing affordability “gap”
  • Connecticut - $224
  • District of Columbia - $163
  • Idaho - $179
  • Nebraska - $166
  • Nevada - $163
  • Oklahoma - $179
  • Oregon - $164
  • Virginia - $164
  • Wyoming - $166

Slide 7:

Subsidized Housing Resources

• HUD McKinney/Vento
  • Shelter Plus Care
  • Supportive Housing Program
  • Section 8 SRO
  • Permanent housing bonus – Up to $750,000
• Mainstream housing resources
  • Section 8
  • HOME
  • State/local “bridge subsidies”
• Analysis of resources controlled/influenced at state level

Slide 8:

Two Housing Approaches

• Housing development/rehabilitation
  • Complex activity that takes time, expertise, and multiple sources of funding
  • Creates supply of permanent supportive housing
  • New mixed-income approaches
• Rental assistance
  • Can be done more quickly with rent subsidies and services funding
  • Not as permanent
  • Master leasing, scattered-site models, links to mental health bridge subsidies
• Both approaches are important in a long term plan

Slide 9:

Medicaid

• Must be core component in long-term plan for services
• State Medicaid approaches
  • Rehabilitation option
  • Medicaid waivers
  • Targeting Medicaid for substance abuse services
• Work within budgetary constraints – Lead with your strengths
• Use other services funding (i.e. PATH, SAMHSA block grants) to fill-in gaps

Slide 10:

“Housing First”

• Pathways model
  • Capitalize on value of housing as an outreach/engagement tool
  • Give people what they need first
    • Permanent housing, not transitional or congregate programs
    • SSI, Food Stamps
  • Have sufficient and flexible services available to support the model

Slide 11:

Final Thoughts

• Target state housing resources whenever possible
• Strategize with local Continuums doing a good job
  • Planning
  • Linking with PHAs
  • Linking with VA programs
• Examine Medicaid opportunities
• Make your strategies as specific as possible and outcome focused

Slide 12:

Examples of Successful Efforts

• District of Columbia – Homeless people with mental illness/co-occurring
  • Policy priority for new DMH administration
  • New Medicaid Rehab Option approved
  • Emphasis on consumer choice/permanent housing
  • Rental assistance and housing development strategies
  • Maximizing McKinney/Vento permanent housing
  • Use of bridge subsidies linked to Section 8
  • Involvement of PHA
  • Providers with “housing first” expertise

Slide 13:

Vancouver, Washington

• 5 Year Plan to address homelessness developed in 2001
• Initial focus on rental assistance strategies while building capacity for developing permanent supportive housing
  • One mental health provider willing to work with homeless people with mental illness – McKinney SHP linked with PATH, Medicaid and state-funded mental health services
  • “ Housing first” approach for chronic substance abuse population living on the streets – SHP
  • Partnership with Veterans Administration -124 unit SRO on VA land
  • Partnership with PHA – Section 8 preference for homeless people “graduating” from McKinney/Vento transitional housing
  • Section 8 strategy for people with disabilities at risk of homelessness
• Over 400 new permanent housing resources in 3 years

Slide 14:

Hawaii

• Target population – Homeless people with mental illness/co-occurring
• Mental Health system housing planning process – Housing strategy through 2004
• “ Bridge subsidies” and state-funded Housing Support Teams linked to Section 8 vouchers – State and local PHAs involved
• Medicaid Rehabilitation option being implemented in 2003 – Providers will be able to bill for most wrap-around services
• Military base closure providing housing for veterans and people with mental illness
• Targeting HUD/HHS/VA Chronic Homeless Initiative

Slide 15:

Maryland

• Target population: Homeless people with mental illness/dual diagnosis
• Baltimore Mental Health system Medicaid waiver for wrap-around services
• Non-profit developing permanent supportive housing – 100+ units
• PHA partnership for Section 8
• Shelter Plus Care project based subsidies combined with state mental health capital funding