Housing as a Platform for Services: Section 202 and Section 811 Supportive Housing

Transcription

1 Housing as a Platform for Services: Section 202 and Section 811 Supportive Housing Benjamin Metcalf Office of Multifamily Housing Programs U.S. Department of Housing and Urban Development

2 AGENDA I. Long History of Serving Vulnerable Populations II. III. IV. Key Principle: Housing as a Platform for Services Legislative and Regulatory Changes Section 202 Supportive Housing V. Section 811 Supportive Housing VI. Questions and Answers

3 LONG HISTORY OF SERVING POPULATIONS VULNERABLE The Section 811 Program Provides capital advances to nonprofit organizations to develop rental housing with available of supportive services for very low income adults with disabilities, and provides rent subsidies to make projects affordable for the long term. Now provides Project Rental Assistance to be administered by State houising agencies and applied to other affordable housing developments funded at the federal, state, or local level Approximately 30,000 units assisted over 20 years Median household income is $9,204; includes people with developmental and physical disabilities, and people with serious mental illness

4 LONG HISTORY OF SERVING POPULATIONS VULNERABLE The Section 202 Program Provides capital advances to develop supportive housing for very low income elderly persons, including the frail elderly, and provides rent subsidies to help make projects affordable over the long term. More than 380,000 units assisted over 50 years Median household income is $11,220; median age is 75 years old.

5 HOUSING AS A PLATFORM FOR SERVICES Key Guiding Principle for 202/811 Reform Ensure that these housing programs serve as platforms to access critical services required for low income elderly to live independently and age in place and for persons with disabilities to live independently.

6 LEGISLATIVE AND REGULATORY CHANGES Section 202 Increased emphasis on service coordination Owners encouraged to facilitate delivery of long terms supports and services to frail elderly through service enriched housing without requiring licensure Section 811 increase emphasis on integration Owners encouraged to facilitate delivery of long terms supports and services to frail elderly through service enriched housing without requiring licensure

7 SECTION 202 SUPPORTIVE HOUSING Service Coordinators Service Coordinator: hired individually or contracted through a community agency by the property owner Responsible for connecting residents to health care and other long term supports and services to facilitate independent living Integrated with community based care, such as that provided by Area Associations on Aging

8 SECTION 202 SUPPORTIVE HOUSING Service Enriched Housing New statutory authority to use existing Assisted Living Conversion Program to support retrofits to support not only conversion of existing 202 funded properties into licensed facilities but also to support delivery of licensed services, in order to assist residents in carrying out activities of daily living Also being encouraged in new construction of new Section 202 housing

9 SECTION 811 SUPPORTIVE HOUSING Project Rental Assistance Demonstration Projects (PRAD) Through PRAD, Section 811 program will better integrate supportive housing for people with disabilities into larger affordable rental housing complexes Program will provide a more cost effective delivery system while also putting federal housing funds into service of state health care priorities to better align and leverage state efforts to serve most vulnerable populations in the community through service enriched housing.

10 HOW DOES PRAD WORK? State housing finance (or other appropriate) agencies must create formal partnership with the state health and human services or Medicaid agency who will be providing appropriate services/supports to residents. State or local housing agency awards Section 811 operating assistance only to projects No more than 25% of units in any building funded may be set aside as supportive housing for persons with disabilities Households served must include one person with a disability and be extremely low income at 30% of Area Median Income (AMI) or less State agency responsible for HHS which administers the State Plan for medical assistance under the Social Security Act must develop policy for referrals, tenant selection, and service delivery.

11 QUESTIONS AND ANSWERS Please watch our website for news and updates: With further questions and inquiries on Section 202 and Section 811 reform efforts, please contact Ben Metcalf at the Office of Multifamily Housing Programs at

12 NASUAD September 14, 2011 Improving the Availability of Affordable & Accessible Housing for Individuals with Disabilities & Chronic Conditions: Purpose & Overview of Initiatives Kate King, Housing Team Lead CMS, CMCS, Disabled & Elderly Health Care Programs Division of Community Systems Transformation 1

13 Presentation Outline Why is Medicaid interested in the Availability of Affordable & Accessible Housing for Individuals with Disabilities & Chronic Conditions? Money Follows the Person (MFP) Demonstration Framework for promoting this mission. Examples of initiatives Capacity Building Initiative New Real Choice System Change Grants

14 Medicaid s Interest in Housing Why? Federal, State and local governments have increasingly begun to take actions to renew and reaffirm a commitment to improving the systems that will support people of any age with a disability or long-term illness that wish to live in their communities Passage of the Americans with Disabilities Act (ADA) in 1990: Recognized society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem (42 U.S.C (a) (2)). In 1999, the Supreme Court issued landmark decision in Olmstead v. L.C. recognizing that unjustified institutional isolation of persons with disabilities is a form of discrimination under the Americans with Disabilities Act. CMS reimburses persons in many of those institutions.

15 Why? States faced formidable challenges in their efforts to fulfill their legal responsibilities under the ADA. Congress has appropriated funds substantial funds to CMS since 2001 to strengthen the capacity of states to provide services in HCB setting. $158 million in Real Choice Systems Change Grants to States: Create enduring improvements in their home and community based systems of care and related infrastructures. Included 8 grants to link housing with long term services and supports $4 billion under the Money Follows the Person (MFP) Demonstration in 2005: Assist States in their efforts to reduce their reliance on institutional care, while developing community-based long-term care opportunities, enabling the elderly and people with disabilities to fully participate in their communities.

16 Overview of MFP Demonstration Includes 44 states & $4 billion budget thru 2016 Transition Component 12,000 MFP participants transitioned to date & new grantees expected to transition 13,000 Medicaid eligible with institutional stay of 90 consecutive days (originally 180 days) Provide rich service benefit continuity of services to participants AFTER the demo Qualified community residences statutorily defined System Rebalancing Component 5

17 Transitioning to the Community Number One Problem LACK OF AFFORDABLE AND ACCESSIBLE HOUSING! People with disabilities and chronic conditions transitioning to the community are poor. Lost housing and supports while in the institution

18 Framework for Action In commemoration of the 10th Anniversary of the Supreme Court s landmark decision, President Obama launched the Year of Community Living Initiative (CLI) on June 22, Develop and implement innovative strategies that increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living. 7

19 Framework for Action Secretary Sebelius announces the Community Living Initiative Created 5 Work Groups to address barriers that prevent Americans with disabilities and older adults from enjoying meaningful lives as part of their community. The Housing Work Group identifies ways to create more affordable and accessible housing opportunities for people with disabilities and older people. Build strong working partnership between HUD and HHS Work Group includes representation from major agencies from both departments

20 CLI HUD-HHS Work Group Purpose To meet the needs of vulnerable populations by better connecting housing, healthcare, and social services. To make working together toward common outcomes business as usual rather than a random act. To create a forum for ideas and input

21 Barriers to Collaboration Don t understand the other s system or programs Don t know who to talk to Different Language (ex. Frail elderly vs functional disability) Eligibility criteria Different time frames System issues (ex. Need to work with Social Security Administration)

22 Capacity Building to Link Services with Affordable Housing Contract awarded by CMS in June 2010 HUD will co-lead with CMS CLI Housing Work Group will act as the Interagency Advisory Committee. Goal: Build sustainable housing and services collaboration infrastructure Across housing, Medicaid and human service agencies at all government levels Linking housing options with long-term community-based support service for people with disabilities & chronic conditions. 11

23 Capacity Building: Major Tasks Increasing capacity (knowledge & tools) through training on how to link services and affordable housing options. Provide technical assistance For Federal activities In 5 MFP states Fund pilot projects within those states Conduct on-site team building activities between Medicaid, human service agencies and housing staff Disseminate lessons learned from pilot sites 12

24 Federal Activities: Phase I Conduct interviews of key Federal agency personnel in HUD and HHS at Central Offices, HUD Field Offices and CMS Regional Offices. Interviewed over 34 key senior officials in HUD and HHS Central Offices in Fall Conducted interview with five HUD Field Offices in March. Conducted CMS Regional Office interviews in April & May. Interview results guided the design (agenda, format, content and materials) of the Federal level cross-agency training

25 Federal Activities: Phase I First Federal level cross-training was June 23rd 50+ Participants from HUD & HHS Housing 101 and Medicaid 101 presentations by TA/consultants and key HUD, HHS, CMS staff Networking Now identifying follow-up activities to sustain the momentum 14

26 Regional Meetings Project includes 4 regional meetings: Location TBD Possibly Atlanta, Boston, Dallas & Chicago Determine goals, agenda, participation 1 st meeting by end of calendar year, if possible

27 Five Sites for Intensive TA Selection criteria Diversity in geographic location/population served Availability of or application for HUD s new NED Category II vouchers (948 vouchers, $7.5 million, awarded to 28 PHAs in 15 states) Prior performance in transitions & housing for community living Status as a MFP grantee Expert assessment of current needs Input from CMS, HUD and Interagency Advisory Work Group CA, NJ, WA, VA & TN Will conduct on-site interview with state Housing and Human Services personnel and local public housing agencies to determine options for specific TA training program

28 New Real Choice System Change Grants 6 grantees - each will be awarded $330,000 Assist States in developing sustainable partnerships with State Housing Agencies resulting in effective and long term strategies to provide permanent and affordable rental housing for people with disabilities receiving Medicaid services and supports in the community. Housing must be affordable to extremely low income persons with disabilities or chronic conditions with incomes equivalent to Supplemental Security Income (SSI) payments. Target housing for persons in MFP Demo, homeless, using Medicaid HCBS waivers, or receiving Medicaid State Plan services for the treatment & rehabilitation of behavioral health problems.

29 New RCSC Grant Three Strategies Strategy 1: Capitalizing on New Opportunities in HUD's Section 811 Supportive Housing for Persons with Disabilities Program (Project Rental Assistance (PRA) funds) Strategy #2: The Development of a State Housing Agency HOMEfunded Tenant-Based Rental Assistance Program for People with Disabilities with SSI-level incomes receiving Medicaid services and supports in the community Strategy #3: The development of a partnership with a State Housing Agency that is also a State Public Housing Agency (State PHA) that administers a state-wide HUD Housing Choice Voucher (HCV) program that includes the creation of a new Housing Choice Voucher Waiting List preference for people with disabilities with SSI-level incomes receiving Medicaid services and supports in the community

30 HUD s Category I & II NED Vouchers Notice of Funding Availability (NOFA) was developed in partnership with staff from CMS Final NOFA took into consideration public comments as well as input from CMS staff. Technical Assistance was available to applicants through CMS TA provider.

31 Category I Vouchers Awards announced on October 1, ,321 vouchers (approx. $33 million) awarded These vouchers enable non-elderly individuals with disabilities and their families, including those at risk of institutionalization, to access affordable housing in a community that adequately meets their needs.

32 Category II Vouchers Awards announced on January 6, vouchers ($7.5 million) awarded 28 PHAs in 15 states These vouchers enable non-elderly persons with disabilities to transition out of nursing homes and other institutions into the community. Partnering service agencies will refer persons to the PHA and provide care/case management, as well as link these individuals to the necessary health and social services.

33 MFP/Partnering Agency For Category 2 vouchers, PHAs will partner with the MFP program or a state human service or Medicaid agency that carries out an institutional transitional program. 25 PHAs are in states that have MFP demonstration grants (12 states). Persons referred to the PHA by the MFP program are guaranteed to receive the needed health and social services to transition; however, the PHA was not required to partner with the MFP program. CMS TA contractor is providing technical assistance to MFP grantees and other Category II awardees.

34 Kate King Contact Information Housing Team Lead Centers for Medicare and Medicaid Services

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36 Section 202 Background Older Section 202 projects Loan/No rental assistance Service coordination: unlikely Section 202/8 projects Loan/Project based Section 8 contracts Service coordination: possibly Section 202 PRAC projects 1990 present Grant with operational assistance Service coordination: possibly, but rare

37 Section 202 Reform (S.118/PL ) Title I: New Section 202 PRAC Added service coordination as a criteria for evaluating applications Title II: Refinancing Old Section 202 & 202/8 Permits refinancing and creates project-based assistance for earliest projects Increased flexibility of refinancing proceeds to provide services Title III: Assisted Living Conversion Program and Service Enriched Housing Creation of Service Enriched Housing designation and eligibility for ALCP funding

38 Service Enriched Housing definition (A) makes available through licensed or certified third party service providers supportive services to assist the residents in carrying out activities of daily living, such as bathing, dressing, eating, getting in and out of bed or chairs, walking, going outdoors, using the toilet, laundry, home management, preparing meals, shopping for personal items, obtaining and taking medication, managing money, using the telephone, or performing light or heavy housework, and which may make available to residents home health care services, such as nursing and therapy; (B) includes the position of service coordinator, which may be funded as an operating expense of the property (C) provides separate dwelling units for residents, each of which contains a full kitchen and bathroom and which includes common rooms and other facilities appropriate for the provision of supportive services to the residents of the housing; and (D) provides residents with control over health care and supportive services decisions, including the right to accept, decline, or choose such services, and to have the choice of provider

39 Case Study of What is Possible: Support and Services at Home (SASH) Cathedral Square Corporation (Vermont), partnering with public housing authorities and other non profit housing providers In 2009 funding to develop model of housing and supportive services Using (MAPCP)demonstration, $10.2 million over a 3 year period 112 sites throughout the state

40 Multi payer Advanced Primary Care Practice (MAPCP) Demonstration Demonstration announced in September 2009 Goal to allow Medicare to join Medicaid and private insurers in Statebased health reform initiatives aimed at improving the delivery of primary care Includes a care management fee is intended to cover care coordination, improved access, patient education and other services to support chronically ill patients CMS selected eight states to participate in this demonstration: Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. Will operate for 3 years

41 CSC SAHS Resident Profile (Heineberg) 85% over 70; 40% over 85 49% used ER in past year 54% take 6 or more prescription meds 61% fallen in past year 32% self reported mental health concerns 59% use a cane or walker 49% failed 2 3 components of a cognitive screen

42 SASH Model Includes: Person centered care Transitions support Self management education and coaching Care coordination Team based care management Community care providers (AAA, VNA, PACE) Regular care meeting and information sharing Prevention and wellness programs Information sharing through technology Maximum volunteer engagement

43 SASH Impact After One Year (Heineberg): Hospital admissions decrease by 19% Individuals reporting one to two falls decline from 45.6% to 23.6% Residents who reported just 30 minutes od physical activity decreased from 13.8% to 4% Moderate nutritional risk declined from 71% to 52%

44 Additional Opportunities to Promote HUD NOFA revisions Housing & Services: Housing & services proposal for the Older Americans Act reauthorization Affordable Care Act demonstrations Replication of successful partnerships Interagency collaboration

45 Contact information: Alayna Waldrum Housing Legislative Representative (202)