Case Management

Case Management includes assessing, arranging, and coordinating the delivery of individualized services to meet the needs of program participants. Such services may include counseling, developing, securing, and coordinating services; accessing resources through the centralized or coordinated assessment system; obtaining Federal, State, and local benefits; monitoring and evaluating program participant progress; providing information and referrals to other providers; providing ongoing risk assessment and safety planning with victims of domestic violence, dating violence, sexual assault, and stalking; and developing an individualized housing and service plan, including planning a path to permanent housing stability.

Which HHS programs might be used to provide these services?

Temporary Assistance for Needy Families (TANF)

TANF funds are used to provide a range of benefits and services to low-income families with at least one child or to pregnant women.  In addition to cash assistance, which can help low-income families cover basic needs like food, clothing, and shelter, TANF can also pay for supportive services which can include case management and housing search and placement services. 

Who is eligible to receive services?

Each jurisdiction determines its eligibility criteria for TANF benefits and services.  Many families experiencing homelessness are likely to meet income eligibility requirements for TANF benefits and services. There may be additional requirements, including participation in work activities, associated with eligibility for TANF cash assistance or other TANF benefits. 

How is it financed?

Funding is provided as a block grant to each state, the District of Columbia and the territories of Guam, Puerto Rico, and the U.S. Virgin Islands.  These jurisdictions have broad discretion to offer a range of relevant benefits and services. State TANF agencies run a large variety of programs to address and prevent family homelessness, and, at times, form partnerships between the TANF program and other government or private stakeholders.  States have great flexibility in serving low-income families, including those who are homeless or at risk of becoming homeless. 

How can services be coordinated with homeless service providers?

TANF agencies, or community-based organizations they contract with, can offer comprehensive approaches that include multiple programs and supports, such as combining a housing benefit with transportation, childcare, and/or job placement services.  TANF agencies can also partner with local homeless providers to coordinate and streamline services delivered across the two service systems.  At the caseworker level, coordination can facilitate the integration of both housing and employment interventions, improving the performance of both service systems and enhancing the outcomes of families.  Co-location of staff can be used to help ensure vulnerable families are connected to the full array of assistance they need to achieve self-sufficiency.  Developing mechanisms to share client-level data can help both systems evaluate their performance in minimizing homelessness, increasing self-sufficiency, refining interventions, and improving the targeting of scarce resources. For more information on the TANF-ACF-IM-2013-01 (Use of TANF Funds to Serve Homeless Families and Families at Risk of Experiencing Homelessness), visit http://www.acf.hhs.gov/programs/ofa/resource/tanf-acf-im-2013-01.

How can it be used to address housing needs?

Federal TANF and Maintenance of Effort (MOE) funds may be used to address the housing-related needs of families who are homeless or precariously housed, consistent with TANF rules on providing benefits and services to needy or eligible families.  Families do not have to be receiving TANF cash assistance in order to qualify for housing services, although those receiving a cash grant may use TANF assistance to pay for housing.  States may adjust cash benefit levels in relation to housing costs and/or provide a housing supplement to cash assistance grants.  Along with providing ongoing basic assistance, a TANF program can provide an array of non-recurrent, short-term benefits and services.  In order to fall under this category, these must be designed to extend no longer than four months and must address a specific crisis situation rather than meet ongoing needs. Also, TANF funds can be used in coordination with HUD’s targeted homeless assistance grants programs – the Continuum of Care (CoC) program and the Emergency Solutions Grants (ESG) program – to maximize the impact of both resources.  For example, TANF could be used to pay for rental assistance while ESG is used to pay for supportive services to help a family remain housed. For more information on the TANF-ACF-IM-2013-01 (Use of TANF Funds to Serve Homeless Families and Families at Risk of Experiencing Homelessness), visit

http://www.acf.hhs.gov/programs/ofa/resource/tanf-acf-im-2013-01.

Partnerships

In addition to offering a range of benefits and services, TANF agencies can serve as active partners in statewide, regional, and local homeless efforts, such as the Continuum of Care.  The expertise of TANF agency leaders can be helpful in ensuring state and local efforts are deploying the full array of available supports to prevent and end family homelessness.  Partnerships can also lead to the identification of strategies that TANF agencies can adopt to minimize homelessness among families receiving assistance.  For more information on the TANF-ACF-IM-2013-01 (Use of TANF Funds to Serve Homeless Families and Families at Risk of Experiencing Homelessness), visit

http://www.acf.hhs.gov/programs/ofa/resource/tanf-acf-im-2013-01.

Medicaid

Under Medicaid regulations, case management services are defined as services available that assist individuals “in gaining access to needed medical, social, educational, and other services.”  There are several ways Medicaid can cover case management services, which can be defined as a rehabilitative service, targeted case management (TCM) services for specific beneficiary groups, a home and community-based service (HCBS) for a person with a disability as part of the services provided by a health home, or as an administrative function of the Medicaid program or a Medicaid managed care plan.  For each of these approaches, a state Medicaid program establishes “medical necessity” criteria, which takes into consideration a person’s diagnosis and functional impairments to determine eligibility for specific services. 

Who is eligible?

Medicaid is an “entitlement” program, meaning that eligible individuals are entitled to receive covered health, behavioral health, and long-term care services. The Affordable Care Act gives states the choice to expand Medicaid eligibility to persons with incomes under 133% of the Federal Poverty Level (FPL), and allows States to determine eligibility under their Medicaid plans.

How is it financed?

The Medicaid program operates under broad state discretion, and is funded by a combination of state and federal matching funds.  Each state must develop a State Medicaid Plan that describes the benefits that will be provided.  Many Medicaid benefits, including those most likely to cover case management, are “optional” benefits, meaning that states can decide if and how to cover these services.  Federal spending on Medicaid is considered a “mandatory” program, meaning that the federal government matches state spending for all covered services provided to eligible individuals.  This makes Medicaid distinct from other HHS health and supportive services programs, which operate as “discretionary” programs with funding levels that can change from year to year based on actions taken by Congress and the President.

How can it be used to address housing needs?

Medicaid is the primary mainstream healthcare benefit that many people experiencing homelessness can access to obtain medical care, and it is a key benefit to help these individuals exit homelessness. There are several existing ways in which Medicaid is used to help people with disabilities exit homelessness and support them in housing, including Federally Qualified Health Centers, Targeted Case Management, the Medicaid Rehabilitation Option—which includes Assertive Community Treatment, and Home and Community-Based Services Waivers.

Where can I learn more about using Medicaid to pay for case management?

Where can I find which States have expanded Medicaid?

Medicaid.gov

Health Care for the Homeless Programs and Community Health Centers

In addition to primary care and some behavioral health services, Health Care for the Homeless Programs and Community Health Centers provide case management services and assistance with accessing public benefits and housing to patients and recipients of health care services.  The focus of case management services is usually helping to ensure that people have access to primary care. Partnership at the State and local level with both Health Care for the Homeless Programs and Community Health Centers play a crucial role in ensuring that people experiencing homelessness receive necessary case management services associated with maintaining healthcare. Health Care for the Homeless programs are targeted to persons who are homeless and local programs are encouraged to participate in the local CoC planning process.  The first step for any Continuum should be to reach out to any HCH program in its jurisdiction and connect to current services

Who is eligible?

Individuals and families who are literally homeless as well as those living in hotels or motels, transitional housing, or permanent supportive housing.

How are they financed?

These programs receive grant funding from the Health Resources and Services Administration (HRSA) as well as a grant under Section 330 of the Public Health Service Act, qualifying them as Federally Qualified Health Centers (FQHCs). FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. In addition, they receive Medicaid reimbursement for some of the services they provide to people who are enrolled in Medicaid.

Where can I find a local HCH provider with which to partner?

Health Care for the Homeless Grantees

Where can I find a local Community Health Center with which to partner?

Find a Health Center

PATH (Projects for Assistance in Transition from Homelessness)

PATH programs provide services to people with mental illness who are experiencing homelessness or at risk of homelessness.  PATH eligible services include habilitation and rehabilitation, case management, referrals, and housing support, as well as outreach and a range of other behavioral health services.  Case management and other services funded by PATH are typically provided to people who are currently or at-risk of homelessness as opposed to people who are formerly homeless and living in permanent housing. PATH programs are administered by the state.  State mental health authorities select providers, usually through a competitive process.  PATH providers are encouraged to participate in the local CoC process and all PATH providers are in the process of transitioning data and reporting practices to participate in HMIS.

Who is eligible?

Individuals determined to be experiencing serious mental illness or co-occurring serious mental illness and substance abuse disorder; and (2) experiencing homelessness or is at imminent risk of homelessness.

How is it financed?

PATH is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). PATH is a formula grant provided to all 50 states, the District of Columbia, and US Territories, and awarded to more than 480 local organizations

Where can I find a local PATH provider with which to partner?

SAMHSA’s PATH Providers

Community Services Block Grant (CSBG)

Community Services Block Grant (CSBG) funds may be used to provide a broad range of services and activities to reduce poverty, revitalize low-income communities, and empower low-income families and individuals in rural and urban areas to become fully self-sufficient.  Grantees are required to conduct community needs assessments and develop community action plans to address local needs, including services and activities related to employment, education, better use of available income, housing, nutrition, emergency services and/or health. In most cases, CSBG funds are allocated to Community Action Agencies (CAAs). 

Who is eligible? 

The Federal Poverty Guidelines must be used as the primary criterion in determining income eligibility. In order to receive assistance under any CSBG project involving direct services, an applicant's total household income must not exceed 125% of the poverty level. Household is defined by the Bureau of Census as consisting of all persons who occupy a housing unit (i.e., house or apartment), whether they are related to each other or not. Total household income is based on income at the time of application.

How is it financed?

CSBG funding is provided as a block grant to States, Tribes and Territories.  States pass through no less than 90 percent of block grant funds to a network of local entities, primarily Community Action Agencies (CAAs), and some local governments, migrant and seasonal farm worker organizations, that delivery the services in the communities.  CAAs are non-profit agencies created as a network of entities by the Economic Opportunity Act of 1964.  States contract with CAAs to plan, develop, implement, evaluate and provide local services. 

How can I apply for CSBG funding?

2014 Application for CSBG Funds

Where can I find local CSBG grantees with which to partner?

Social Services Block Grant (SSBG)

Social Services Block Grant (SSBG) funding supports social services directed towards achieving economic self-sufficiency; preventing or remedying neglect, abuse, or the exploitation of children and adults; preventing or reducing inappropriate institutionalization; and securing referral for institutional care, where appropriate. 

Who is eligible? 

Each State or Territory has the flexibility to determine what services (within the broad service categories) will be provided; set the eligibility limits (to low-income households) to receive services; and determine how funds are distributed among various services within the State.

How is it financed?

SSBG funding is allocated to each State or Territory to meet the needs of its residents through locally relevant social services, through programs that help people to achieve or maintain economic self-sufficiency to prevent, reduce or eliminate dependency on social services.

How can I apply for SSBG funding?

SSBG Grantees – Who Can Apply?

Where can I find local SSBG grantees with which to partner?

SSBG Grantees by State

Cooperative Agreements to Benefit Homeless Individuals (CABHI)

This SAMHSA services program supports infrastructure development at the community and state levels. The major goal of the Cooperative Agreements to Benefit Homeless Individuals program is to ensure that the most vulnerable individuals who are chronically homeless receive access to sustainable permanent housing, treatment, and recovery supports through mainstream funding sources. CABHI funds support three primary types of activities: 1) behavioral health, housing support, and other recovery-oriented services not covered under a State's Medicaid plan; 2) coordination of housing and services for chronically homeless individuals and families at the State and local level which support the implementation and/or enhance the long-term sustainability of integrated community systems that provide permanent housing and supportive services; and 3) efforts to engage and enroll eligible persons who are chronically homeless in Medicaid and other mainstream benefit programs (e.g., SSI/SSDI, TANF, SNAP). 

Who is eligible?

Persons who experience chronic homelessness with substance use disorders or co-occurring substance use and mental disorders.

How is it financed?

The Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS) provided grant funding to states.

Where can I find CABHI grantees with which to partner?

CABHI Grantees

Which states received CABHI-States funding?

The Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse Treatment (CSAT), and the Center for Mental Health Services (CMHS) recently modified its Cooperative Agreement to Benefit Homeless Individuals (CABHI), which provided grants directly to entities that provide services, into the ‘CABHI-States’ program focused on building state infrastructure and improving the capacity of state treatment service systems to provide services essential to ending chronic homelessness among people with substance abuse, mental health, and/or co-occurring disorders.

For FY 2013, eligible applicants for CABHI-States are the single state agencies for substance abuse in the District of Columbia (D.C.) and the following states: Arizona, California, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Nevada, New York, Oregon, Pennsylvania, Texas, and Washington. Services to be created through CABHI-States should include recovery-oriented services not covered under the state’s Medicaid plan including: treatment services; permanent supportive housing; peer supports; CMHS-funded peer navigator(s); assistance with streamlining application processes for mainstream benefits; and more. 

SAMHSA awarded eleven grants for up to $711,818 per year for up to 3 years.   The states that were funded are: Arizona, Georgia, Hawaii, Washington, Louisiana, Illinois, Pennsylvania, Massachusetts, Michigan, Colorado and Nevada. Each CABHI-State grantee will implement its own approach to issuing funding for services. Organizations seeking funding for services should contact the single state agencies who received an award for more information. 

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