SHPA Healthcare Committee

1. SHPAHealthcare Committee Quarterly Meeting Report August 13, 2013

2. A Quick Review - Healthcare and Supportive Housing • Implementation of the Patient Protection and Affordable Care Act (ACA) is scheduled to begin enrollment on October 1st and healthcare coverage to begin January 1, 2014 • The ACA is focused on: • involving people to get connected to healthcare; • working with people in a way to provide care efficiently and: • proactively, focusing on preventative healthcare.

3. A Quick Review - Healthcare and Supportive Housing The State of Illinois has set the following requirements: • implement Medicaid reform law (Public Act 96-1501). • specifically, 50% Medicaid recipients in Illinois must be enrolled in “risk-based Care Coordination” by 2015. • implement Medicaid expansion (SB 26 – soon to be signed into law).

4. A Quick Review - Healthcare and Supportive Housing Illinois has established four models of care coordination: • Coordinated Care Entities (CCEs), • Managed Care Community Networks (MCCNs), • Managed Care Organizations (MCOs) and • Accountable Care Entities (ACEs) It is important that we seek to relate with one or more of the above, in addition to our public partnerships.

5. “One Voice” for Supportive Housing Our Goals for today: • Refine our statements about Supportive Housing. • Make our collective voice stronger. • Continue in developing our positive messages about supportive housing • Continue looking for opportunities for involvement with healthcare reform.

6. “One Voice” for Supportive Housing Our process today: 1. We will review four documents with you, one at a time. 2. We will then ask you to discuss them, one by one, in small groups. 3. And, we’ll ask you to report back to the larger group. Please find these documents in your folder: • “Supportive Housing and Healthcare Reform Goals” • “Supportive Services in Healthcare Reform” • Supportive Housing and Healthcare Reform Action Plan • “The Strengths of Supportive Housing Providers”.

7. “One Voice” for Supportive Housing When you talk in your small group, please: a. Pick a Discussion Leader and Recorder b. Decide what you like about each one. c. Identify what else needs to be said in each one. d Report back to the larger group with your comments.

8. First Up: Supportive Housing and Healthcare Reform Goals Proposed Healthcare Reform Goals Healthcare Reform Must Include the Following Key Ingredients: • Medicaid Expansion to include all Residents and Clients • An End to Homelessness through Permanent Supportive Housing • Coordination of Care for Those in Supportive Housing • Improved Health Outcomes for Those in Supportive Housing • Cost Savings Resulting from Improved Health Outcomes

9. Supportive Housing and Healthcare Reform Goals Healthcare Reform Must Include the Following Key Ingredients: • Medicaid Expansion Medicaid expansion and implementation of the Affordable Care Act in Illinois will improve access to primary and behavioral health care. Expanded eligibility will require Resident/Client engagement and enrollment. An expanded set of services may also be required. • An End to Homelessness through Permanent Supportive Housing Without permanent supportive housing and supportive services, the sickest and poorest of our citizens will not be in a position to effectively benefit from improved access to primary and behavioral health care. Permanent supportive housing is the necessary first step for effective healthcare reform. True healthcare reform must include an end to homelessness • Coordination  of Care Improved health outcomes for the formerly homeless and/or mentally ill person through permanent supportive housing, primary and behavioral healthcare and supportive services will require coordination of care , a focus on preventative care and development of an effective medical information exchange system. • Improved Health Outcomes Permanent supportive housing, provision of basic supports and supportive services and coordination of care for the population of formerly homeless and/or mentally ill persons will result in improved health outcomes for the individual and for the population of formerly homeless and/or mentally ill persons. • Cost Savings as a Result of Improved Health Outcomes Provision of permanent supportive housing, basic supports, and supportive services coupled with coordination of care through the enrollee’s medical or behavioral health “home” and a focus on preventative measures and wellness education for enrollees will result in more appropriate use of medical services, improved health outcomes and a reduction in the cost of medical care for the individual and for the population of formerly homeless and/or mentally ill persons.

10. Supportive Housing and Healthcare Reform Goals: Discussion OK. Let’s stop here, break up into groups and spend a few minutes talking about this first set of information. • Ask yourselves: • Why is this important to supportive housing discussions? • Is there something else that needs to be said? • How might we use this information? • Please be ready to report back to the group.

11. Next Up: Supportive Services in Healthcare Reform • Supportive Services’ financial support comes from a variety of sources: state funding, federal funding, local funding, donations and other sources. • Services provided to Residents/Clients varies, depending on location, programming and funding source. • Are Residents/Clients receiving the right mix of services? • Let’s look at the varied listings of services currently funded and provided.

12. Supportive Services in Healthcare Reform • Support Services Offered to Individuals in Supportive Housing • Case management - 98% of all individuals served. • Mental health services - 89% of all individuals served. • Money management - 84% of all individuals served. • Medication monitoring - 71% of all individuals served. • Transportation services - 62% of all individuals served. • Employment assistance - 60% of all individuals served. • Alcohol and drug abuse services - 59% of all individuals served. • Clothing assistance - 42% of all individuals served. • Other health services - 38% of all individuals served. • HIV/AIDS services - 31% of all individuals served. • Education classes - 28% of all individuals served. • Legal services - 17% of all individuals served. • Childcare - 16% of all individuals served . Homeless Services • Advocacy • Alcohol Abuse Services • Case management • Counseling • Child care • Children’s Services • Education • Employment Services • English as a Second Language • Follow up Services • GED Services • Health/Dental Services • Housing/Location Inspection • Mental Health Services • New Participant Services • Outreach • Permanent Housing • Substance Abuse Services • Supportive Housing • Transitional Shelter • Transportation • Support for attending healthcare appointments • Support for primary care and avoidance of ER use Mental Health Medicaid Services • Assertive Community Treatment • Cases Management: Mental Health, Transition, Linkage and Aftercare • Client-Centered Consultation • Community Support • Comprehensive Mental Health Services • Crisis Services • For the Blind and hard of Hearing DMHhas established "The Standards of Care for Deaf, Hard of Hearing, Late-Deafened, and Deaf blind People." • Forensic Services inpatient units- DMH operates six secure adult and one secure juvenile inpatient facility for persons who have been referred through the courts for mental health reasons. • Inpatient Services – regionally-based State-operated hospitals and one forensic hospital. • Intensive Family-Based Services • Job Finding, Retention and Termination Supports – • Mental Health Assessment – • Mental Health Intensive Outpatient Services Group • Outpatient -includes counseling, individual and group therapy, medication, and medication monitoring, psychiatric evaluation and treatment, including prescription medications, case management. • Psychological Evaluation • Psychosocial Rehabilitation and Support (PSR) • Psychotropic Medication - Administration, Monitoring and Training • Short-Term Diagnostic and Mental Health Services – • Therapy/Counseling, Treatment Plan Development, Review and Modification • Vocational Assessment and Engagement - Testing Source: Source: IDHS- Homeless Services Program Source: Illinois DHS/DMH, Rule 132: Medicaid Mental Health Services • Source: Supportive Housing in Illinois: A Wise Investment - Supportive Housing Providers’ Association, Social IMPACT Research Center, (April,2009)

13. Supportive Services in Healthcare Reform: Discussion OK. Let’s stop here, break up into groups and spend a few minutes talking about this second set of information. • Ask yourselves: • Which of these lists is the most inclusive of services? The least inclusive of services? • What other services should be included to construct a “full set” of supportive services? • How can we best advocate for the “right” services for our Residents/Clients? • Please be ready to report back to the group.

14. Next Up: Supportive Housing and Healthcare Reform Action Plan The Supportive Housing Healthcare Reform Action Plan will focus on all Residents and Clients of Supportive Housing and will include: • Outreach and engagement for Medicaid expansion; • Advocacy for and facilitation of enrollment in expanded Medicaid; • A focus on the Resident/Client’s improved health outcomes, enhanced access, safety and overall wellness; • Active relationship development and involvement as a Partner with other service providers, in the provision of the Resident/Client’s care;

15. Supportive Housing and Healthcare Reform Action Plan • Relationship development and interaction with the Resident/Client’s medical home, medical specialists, mental health and substance abuse providers, community service agencies, and hospital and emergency facilities; • Providing Resident/Client’s housing and supportive services, service planning, resource coordination, problem solving, referral and linkage, evaluation and record keeping; • Building relationships and agreements among providers that lead to shared expectations for communication and care; • Participating in service plan evaluation and transition from one level of care to another.

16. Supportive Housing and Healthcare Reform Action Plan • Participating in connectivity via electronic and other information pathways that will encourage timely and effective information flow between and among providers. • Participating in the evaluation of a reformed healthcare system. • Partnering creatively with other service providers and care coordination entities, for increased service capacity . • Enhancing organizational expertise through training of staff, credentialing of staff, certification or accreditation of the organization.

17. Supportive Housing and Healthcare Reform Action Plan: Discussion OK. Let’s stop here, break up into groups and spend a few minutes talking about this third set of information. • Ask yourselves: • Do you think housing is part of effective healthcare services? • What else could this set of action steps include? • What is the best way to demonstrate the value of supportive housing? • How can we use this information? • Please be ready to report back to the group.

18. Next Up: The Strengths of Supportive Housing This information identifies the strengths of supportive housing: • Experience and Expertise • Relationships  • Creativity and Flexibility  • Evidence of Value and Effectiveness

19. The Strengths of Supportive Housing Providers Supportive Housing Service Providers are in the unique position to help with Medicaid expansion, ending homelessness, coordination of care, improved health outcomes for participants and achieving cost savings for the State. Supportive Housing Providers’ strengths can be seen in our: • Experience and Expertise Supportive housing providers have experience and expertise in engaging, working with and wrapping services around those who are most vulnerable, most at-risk for poor health outcomes and who may incur the most expense in the Illinois publicly financed healthcare system. • Relationships Supportive housing providers have built relationships with these “high risk/high cost” individuals over time, relationships that may not be duplicated by “navigators” or “in-person assistors” new to the world of the homeless and/or mentally ill person. • Creativity and Flexibility Supportive housing providers have demonstrated great creativity and flexibility in providing services to these high risk/high cost persons. • Evidence of Value and Effectiveness Multiple studies of Illinois’ supportive housing services provide evidence that supportive housing is a valuable, effective and efficient service that contributes to positive health outcomes and taxpayer cost-savings for those involved in supportive housing services.

20. Strengths of Supportive Housing Providers: Discussion OK. Let’s stop here, break up into groups and spend a few minutes talking about this last set of information. • Ask yourselves: • Are there other strengths of supportive housing that should be highlighted? • How can we use this information? • Please be ready to report back to the group. • Next Steps?

21. Join Healthcare Committee We can learn from each other! • 2nd Tuesday of each Month • Time: 10.00 am • Place: Conference Call • Call in # - 888-296-6500 • Access Code 292814#