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
- State by state housing affordability “gap”
- Indiana
- Massachusetts
- Pennsylvania
- Rhode Island
- South Dakota
- Utah
- Kansas
- Texas
- New Jersey
Slide 6:
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 7:
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 8:
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 9:
“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 10:
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 11:
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 12:
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 13:
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 14:
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
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