HRC is pleased to share the following article, originally published by the United States Interagency Council on Homelessness (USICH) and used with permission from the USICH.
John Parvensky has served as President and CEO of the Colorado Coalition for the Homeless since 1986. In this capacity, he has spearheaded development of over 1,400 affordable housing units throughout the Denver area and has directed the day-to-day activities of an organization providing housing, health care, mental health care, substance abuse treatment, counseling, and other supportive services to more than 16,000 people experiencing homelessness each year. He was instrumental in the creation and passage of the McKinney-Vento Act, and he serves on the board of directors for both the National Coalition for the Homeless and the National Health Care for the Homeless.
USICH: There’s a lot of talk around the country about tapping into Medicaid for supportive housing services. What role does Medicaid play in your programs?
Medicaid is critical to our funding for integrated primary health care, mental health care, and substance abuse treatment services for homeless individuals and families through our Health Care for the Homeless program. The ability to receive cost-based reimbursement through the Federally Qualified Health Center (FQHC) designation is vital.
We have been able to expand services outside of our Stout Street Clinic into supportive housing in a number of ways. First, FQHC Medicaid reimbursement allows us to pay for clinical services (primary health care, mental health counseling, etc.) within supportive housing developments and at scattered site housing.
One problem has been paying for case management and non-clinical supportive services (employment services, connection to community resources, etc.) for residents of supportive housing. These services are not reimbursable under Medicaid in most states (unless the state has included it in their state Medicaid plan). Also, many supportive housing service providers do not (and are not able to) bill Medicaid. This requires a partnership with a Medicaid provider and a sharing of the reimbursements with the housing service providers.
In addition, currently, only a fraction of residents of supportive housing qualify for Medicaid. Thus, dedicated staff cannot be funded solely with Medicaid. After 2014, this will hopefully change as the majority of those living below the poverty standard will become eligible.
For more intensive services for chronically homeless individuals, Assertive Community Treatment (ACT) services are the best practice approach, but whether they are viable or not depends on how states pay for ACT services. “Bundled payments” that are based on the average cost of providing a package of services seem to work best.
USICH: What has been your biggest lesson learned in using Medicaid to pay for supportive services?
Our greatest success has been creating teams of clinical case managers (LCSW’s) who are eligible to bill for Medicaid services provided to residents in supportive housing and non-clinical case managers who work together. With FQHC billings for the clinical services, the reimbursement is sufficient to pay the cost of both the clinical staff and the non-clinical staff (assuming a high enough percentage of Medicaid eligible persons).
We have done this for chronically homeless individuals, and are replicating this with teams to serve homeless families through the Section 8 Family Unification Program.
USICH: What next step would you suggest agencies take if they’re looking to broaden their funding sources for supportive housing to include Medicaid?
Agencies need be become FQHC qualified, or team up with FQHC providers to develop a service plan and reimbursement plan to sustain it.
Changes need to be made to state Medicaid plans to allow and encourage home-based services to include case management and on-site clinical services.
Aggressive Medicaid enrollment efforts are required to ensure the highest penetration of Medicaid eligibility for residents of supportive housing.
Check out the "Related Items" to the right of the screen.