Housing & Health Care Policy

1. Housing & Health Care Policy October 2014

2. Burning Questions

3. Home & Community Based Standards (HCBS) and Settings that Isolate DOJ HEARTH Act – Homeless Programs HUD

4. Housing has… HUD or IRS or USDA SNAPS, Multifamily, Public Housing, etc Con Plan Annual Action Plan, QAP Eligible Activities Grantees/Contractors Services has….. Health & Human Services (HHS) Centers for Medicaid Services (CMS) State Plan State Plan Amendment (SPA) Service Definition Providers Translation Chart for this Conversation

5. Home & Community Based Standards (HCBS) 1915 (b) Mental Illness 1915 (c) 1915 (i) Developmental Elderly Disabilities

6. Last Year When We Met • Proposed Rules • Disability specific complex • “designed”

7. Final Rules • Disability specific complex – that phrase was replaced with “any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS …”

8. Definitely not HCBS • Nursing facility • Institution for mental diseases (IMD) • Intermediate care facility for individuals with intellectual disabilities (ICF/IID) • Hospital

9. Probably not HCBS • Settings in a publicly or privately-owned facility providing inpatient treatment • Settings on grounds of, or adjacent to, a public institution • Settings with the effect of isolating individuals from the broader community of individuals not receiving Medicaid HCBS

10. Next Steps • NC DHHS currently working on a State Plan Amendment with numerous stakeholders. That plan says how we will bring HCBS Waivers into compliance. • NC will operationalize your regulations by and come into compliance with these new regulations by doing these things …. • NC will operationalize the definitions in your regulations by …… • NC DHHS is required to submit that plan to CMS by March 15, 2015 CMS provides feedback • A back and forth can go on for quite a while • The steps outlined in the plan are required to be completed by 2019. • A draft of the NC plan will be posted for public comment later this year or early next year.

11. Any Ideas What One Might Look Like? • First state plan was approved by CMS – Indiana’s Community Integration and Habilitation Waiver renewal- effective 10/1/14

12. Beds vs. Units “any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS …” It’s easier to understand how HCBS applies to facilities with beds CMS says they will provide additional guidance related to housing units

13. Heightened Scrutiny • Review of HCBS to determine if a residence meets Standards – • Yes, it meets standards • No, it doesn’t meet standards • Presumptively non HCBS, State must provide evidence for or against • Heightened Scrutiny Process, CMS reviews evidence provided by state and Stakeholders • If Determined not to be Home and Community Based Setting or Service there are 3 options – • Individuals move to a setting that meets home and community based setting or • Services are funded using non waiver services (i.e. State $) • Individuals receive no services

14. HUD – HEARTH Act • A few policy U-turns • Fortunately, the turns are based on research and data

15. Most relevant for this conversation….. SHELTER TRANSITIONAL HOUSING TREATMENT PROGRAM

16. Delineating the Track ? If Dave enrolls in the program today, and next week you find an apartment that would work for Dave, do you help him to move into that apartment, or do you tell Dave you’d prefer he stay in your program until X intervention has been completed? Shelter Treatment Program

17. Department of Justice • Olmstead Decision of the Supreme Court • Americans with Disabilities Act (ADA) • Settlement Agreement • August 23, 2012

18. Housing Components of Settlement Agreement • 3,000 people over 8 years • Preference for single occupancy • 1 bedroom units • Maximum 20% required saturation in a community • NO licensed housing options • Roommate with informed choice • Tenancy Supports • Diversion from Adult Care Homes (ACH)

19. Diversion • 1000 of the 3000 Housing Slots are for persons who are being diverted • Additional persons being diverted are still expected to be given community housing options

20. Are licensed facilities bad? • NO • They are appropriate for some people • DOJ determined that the state lacked community based housing options and wants the state to invest in creating more of those options • Some are viable options for non-housing slot Diversion

21. NC Supportive Housing Program • Guaranteed rental assistance • Administered by Quadel • Guaranteed Tenancy Supports • Through Assertive Community Treatment (ACT) Teams Or • Coordinated by Quadel

22. Rental Assistance • State voucher for up to $360 • If additional rent assistance is needed, it comes from the tenant’s Supplemental Assistance-In Home payment, or a Community Living Assistance Payment • Those funds will come to the landlord from the tenant as part of the tenant’s portion of the rent

23. Tenancy Supports • Relationship with landlord and neighbors • Tenant must give consent for worker to talk directly with landlord • Cleaning • Maintenance • Healthy social relationships • Unexpected time away

24. Quality Control • SocialServe.com (nchousingsearch) will contact landlords on a regular basis unless asked not to by the landlord

25. Interested in Participating? • NC Quadel • John Rowland – Managing Director • (919) 319-1838 • jrowland@ncquadel.com

26. Martha Are Housing & Homeless Unit Manager 919-855-4994 (c) 919-559-6193 martha.are@dhhs.nc.gov