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PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE ENVIRONMENT

PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE ENVIRONMENT. Pamela S. Hyde, J.D. SAMHSA Administrator. National Alliance to End Homelessness U.S. Interagency Council on Homelessness Washington, DC • July 16, 2012. BEHAVIORAL HEALTH AND HOMELESSNESS.

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PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE ENVIRONMENT

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  1. PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE ENVIRONMENT Pamela S. Hyde, J.D. SAMHSA Administrator National Alliance to End Homelessness U.S. Interagency Council on Homelessness Washington, DC • July 16, 2012

  2. BEHAVIORAL HEALTH AND HOMELESSNESS Among sheltered homeless adults (HUD, 2010 Point-in-Time): 34.7 percent (~552,000) with substance used disorders (SUD) 26.2 percent (~417,000) with serious mental illness (SMI) 46 percent (~732,000) with co-occurring disorders (COD) Of those using homeless residential services in 2010: 6.4 percent (>100,000) reported a psychiatric facility, SA treatment facility, or hospital as their living arrangement the night before entry TEDS, 2010: Of the ~1.8 million treatment admissions aged 12 or ↑, 12.7 percent were homeless at time of admission 3

  3. RECOVERY REQUIRES HOUSING 4

  4. 2014 – more AMERICANS WILL have HEALTH coverage OPPORTUNITIES 5 • Currently, 37.9 million are uninsured <400% FPL* • 18.0 M – Medicaid expansion eligible • 19.9 M – ACA exchange eligible** • 11.019 M (29%) – Have BH condition(s) • * Source: 2010 NSDUH • **Eligible for premium tax credits and not eligible for Medicaid

  5. PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP 6 CI = Confidence Interval Sources: 2008 – 2010 National Survey of Drug Use and Health 2010 American Community Survey

  6. PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS 7 • Primary MH plus some SA: 85 percent • Primary SA: 56 percent • Other (homeless shelters and social services): 37 percent • Residential SA: 54 percent • Inpatient: 95 percent • Outpatient: 68 percent Source: NSATSS

  7. SAMHSA ENROLLMENT ACTIVITIES 8 • Consumer Enrollment Assistance (thru BRSS TACS) • Outreach/public education • Enrollment/re-determination assistance • Plan comparison and selection • Grievance procedures • Eligibility/enrollment communication materials • Enrollment Assistance Best Practices TA – Toolkits • Communication Strategy – Message Testing, Outreach to Stakeholder Groups, Webinars/Training Opportunities • SOAR Changes to Address New Environment • Data Work with ASPE and CMS

  8. SAMHSA PROVIDER CAPACITY EFFORTS • Provider Business Operations Contract • Billing • Electronic Health Records • Compliance • Business Planning • Being in a Provider Network • Technical Assistance and Training • Workforce Issues

  9. SAMHSA FUNDING TO ADDRESS HOMELESSNESS 10 • SAMHSA’s 2012 homeless programs budget (PATH, GBHI & SSH) is ~$139 million • Support for 220 direct grantees and > 600 PATH provider agencies in 50 states • 93 active grantees: GBHI, including CABHI and CSAT’s Services in Supportive Housing (SSH) and general grantees • 71 active grantees: SSH programs, supported by CMHS

  10. SAMHSA’S CABHI PROGRAM 11 • Subprogram of GBHI • A 3-year program that began in September 2011 • 31 active CABHI grants • CABHI Grantees: • Development/implementation of programs integrating services and treatment for individuals who are chronically homeless • ↑ number of individuals who are placed in permanent housing with supportive services • ↑ provider capabilities to enroll individuals in mainstream benefit programs (e.g., Medicaid, SSI/SSDI, SNAP)

  11. CABHI COLLABORATION WITH HOUSING PARTNERS 12 • First 6 months, CABHI grantees placed > 300 individuals into housing • Funding sources • U.S. Department of Housing and Urban Development: • Supportive Housing Program • Project-based vouchers • Shelter Plus Care vouchers • Section 8 vouchers • U.S. Department of Veterans Affairs Supportive Housing Vouchers • Public and private program partnerships • Local housing authorities

  12. COMMUNITY LIVING INITIATIVE (CLI) 13 • HHS’s CLI promotes federal partnerships in support of the 1999 Olmstead decision • As part of the CLI, HUD and HHS cooperated in theHousing Capacity Building Initiative for Community Living • Combines efforts among HUD, CMS and SAMHSA • Encourages public housing agencies to establish persons transitioning from institutions as a priority population for public housing and Housing Choice vouchers • Awarded ~ 1,000 of the 5,400 new Non-Elderly Disabled (NED) vouchers to individuals leaving institutions, including many in the CMS Money Follows the Person program

  13. 2013: SAMHSA POLICY ACADEMY 14 • Focus on states or cities with high rates of chronic homelessness • Federal partners include HRSA, HUD, VA, CMS and ASPE • Process will rely heavily on web technology in providing TA and communicating with teams • Teams will include policymakers in housing, BH, Medicaid, criminal justice, labor, and veterans affairs • Consumer leaders and members of State Interagency Councils, Continuums of Care, and Coalitions for the Homeless will participate

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