08/13/2012 - A Unique Permanent Supportive Housing Plan and Using Medicaid to Make it Happen: My time in Louisiana

I spent August 8, 9, and 10 in Louisiana with Don Moulds, the Acting Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services. Don is also Secretary Sebelius’ point person for USICH. We went to talk with people operating and overseeing the Louisiana Permanent Supportive Housing project. For those who aren’t familiar with this incredible project, you can find more information from the Corporation for Supportive Housing, which highlighted this state-wide project as part of their Focus on Health Care Series in February 2012. If you don’t have time to listen to the webinar now, here’s the short version:  after the hurricanes in 2005 and 2006, the state, advocates, and community providers worked together to figure out how to help people with one-time federal recovery investments. What has emerged is a unique model to use these new resources for housing and supportive services to provide permanent supportive housing across the region. Federal investments included Community Development Block Grant funds, Shelter Plus Care and Section 8 Housing Choice Vouchers. 

One of the design components that makes the Louisiana model unique is that multiple vulnerable populations were deemed eligible for supportive housing: people displaced by the hurricanes; people who were homeless before and/or after the disaster; people with developmental disabilities, and people transitioning out of institutions or nursing homes. A prioritization process was developed to assess need. As new housing units come on line, people at the top of that priority list are given options in housing, supported by a combination of new Assertive Community Treatment Teams and Housing Support Teams.

Medicaid Financing for Supportive Housing 

As Louisiana anticipates using up the one-time recovery funds, they have been building a sustainable financing model for the services through their Medicaid program. Don and I were able to talk with frontline staff from one of the Assertive Community Treatment Teams to learn not only how their program works in New Orleans, but also the changes they are making to begin billing Medicaid for what they do. 

I don’t want to pretend that this is easy for anyone. Moving to Medicaid systems and language in the administration of permanent supportive housing programs has been a very heavy lift by many State stakeholders. They are asking Magellan, a behavioral health managed care organization, to create a high functioning community behavioral health system where before the hurricanes one barely existed, and what was there was stressed by the damage. Community providers are being asked to transition from the tremendous work they have done housing over two thousand people in the last few years using very flexible service dollars to translate what they do with people to Medicaid language, benefits, and billing structures. (For those who are fluent in Medicaid, this is actually a combination of home and community-based behavioral health benefits and waiver programs for people who would otherwise be in institutions.) Don and I went to talk to people who are making this happen because we wanted to know what’s working, what’s not, what they’re afraid of, and what they hope for as this project continues. As you can imagine, we got a range of answers from different people with whom we spoke. 

Walking through new housing units that sparkle with new paint where once there was only destruction, it is hard not to feel a little bit of hope. Hearing some stories about people who have opted to come inside after long and stressful periods living outside, it is hard not to believe that something pretty amazing is happening. And talking with policymakers and the managed care executives to hear their vision of how they want this to turn out, I left hoping that this vision will come to life. A vision where everyone who needs the level of care available in permanent supportive housing will someday have it because of the courageous and dedicated work of many, many people in the state. One thing’s for sure: you can’t do any of this without housing; and you can’t do supportive housing—especially in a scattered model like this—without services that can meet the intensity of the need and be mobile to meet people where they live.

Driving from Baton Rouge back to the airport with Marti Knisley (our “tour guide” from Technical Assistance Collaborative who has been helping design and implement this model), the three of us were talking about what is applicable to the rest of the country from this unique situation in Louisiana. A couple of things stood out.

First, states are increasingly turning to managed care because the cost of health care is unsustainable. We need managed care allies who can help figure out how to manage costs and care while improving outcomes for people who have not done well in the status quo. 

Second, state policymakers can learn a lot from this model that breaks down siloes between disability groups or other subgroups. We can focus on working together to create one program that can meet the housing needs of people regardless of where they are coming from or what their diagnosis.  

Third, this is not easy, but it’s possible. Those who figure out how to use Medicaid successfully in this way will have a more consistent and adequate source of services and therefore will be able to help a larger number of people who need this support. That sounds to me like a good formula for ending homelessness for people where their health is a major factor.

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