PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE
ENVIRONMENT
Pamela S. Hyde, J.D.SAMHSA Administrator
National Alliance to End HomelessnessU.S. Interagency Council on Homelessness
Washington, DC • July 16, 2012
BEHAVIORAL HEALTH AND HOMELESSNESS
Among sheltered homeless adults (HUD, 2010 Point-in-Time):
34.7 percent (~552,000) with substance used disorders (SUD)
26.2 percent (~417,000) with serious mental illness (SMI)
46 percent (~732,000) with co-occurring disorders (COD)
Of those using homeless residential services in 2010: 6.4 percent (>100,000) reported a psychiatric facility, SA treatment facility, or hospital as their living arrangement the night before entry
TEDS, 2010: Of the ~1.8 million treatment admissions aged 12 or ↑, 12.7 percent were homeless at time of admission
3
RECOVERY REQUIRES HOUSING
4
4
2014 – MORE AMERICANS WILL HAVE HEALTH COVERAGE OPPORTUNITIES
Currently, 37.9 million are uninsured <400% FPL*
• 18.0 M – Medicaid expansion eligible • 19.9 M – ACA exchange eligible**• 11.019 M (29%) – Have BH condition(s)
* Source: 2010 NSDUH**Eligible for premium tax credits and not eligible for Medicaid
5
PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP
CI = Confidence IntervalSources: 2008 – 2010 National Survey of Drug Use and Health 2010 American Community Survey
6
PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS
Primary MH plus some SA: 85 percentPrimary SA: 56 percentOther (homeless shelters and social services):
37 percentResidential SA: 54 percentInpatient: 95 percentOutpatient: 68 percent
Source: NSATSS
7
SAMHSA ENROLLMENT ACTIVITIES
Consumer Enrollment Assistance (thru BRSS TACS)• Outreach/public education• Enrollment/re-determination assistance• Plan comparison and selection• Grievance procedures• Eligibility/enrollment communication materials
Enrollment Assistance Best Practices TA – Toolkits
Communication Strategy – Message Testing, Outreach to Stakeholder Groups, Webinars/Training Opportunities
SOAR Changes to Address New Environment
Data Work with ASPE and CMS
8
SAMHSA PROVIDER CAPACITY EFFORTS
Provider Business Operations Contract• Billing• Electronic Health Records• Compliance• Business Planning• Being in a Provider Network
Technical Assistance and Training
Workforce Issues
SAMHSA FUNDING TO ADDRESS HOMELESSNESS
SAMHSA’s 2012 homeless programs budget (PATH, GBHI & SSH) is ~$139 million
Support for 220 direct grantees and > 600 PATH provider agencies in 50 states
93 active grantees: GBHI, including CABHI and CSAT’s Services in Supportive Housing (SSH) and general grantees
71 active grantees: SSH programs, supported by CMHS
10
SAMHSA’S CABHI PROGRAM
Subprogram of GBHI• A 3-year program that began in September 2011• 31 active CABHI grants
CABHI Grantees: • Development/implementation of programs integrating services
and treatment for individuals who are chronically homeless• ↑ number of individuals who are placed in permanent housing
with supportive services• ↑ provider capabilities to enroll individuals in mainstream
benefit programs (e.g., Medicaid, SSI/SSDI, SNAP)
11
CABHI COLLABORATION WITH HOUSING PARTNERS
First 6 months, CABHI grantees placed > 300 individuals into housing
Funding sources
• U.S. Department of Housing and Urban Development:
Supportive Housing Program
Project-based vouchers
Shelter Plus Care vouchers
Section 8 vouchers
• U.S. Department of Veterans Affairs Supportive Housing Vouchers
• Public and private program partnerships
• Local housing authorities
12
COMMUNITY LIVING INITIATIVE (CLI)
HHS’s CLI promotes federal partnerships in support of the 1999 Olmstead decision
As part of the CLI, HUD and HHS cooperated in the Housing Capacity Building Initiative for Community Living
Combines efforts among HUD, CMS and SAMHSA
Encourages public housing agencies to establish persons transitioning from institutions as a priority population for public housing and Housing Choice vouchers
Awarded ~ 1,000 of the 5,400 new Non-Elderly Disabled (NED) vouchers to individuals leaving institutions, including many in the CMS Money Follows the Person program
13
2013: SAMHSA POLICY ACADEMY
Focus on states or cities with high rates of chronic homelessness
Federal partners include HRSA, HUD, VA, CMS and ASPE
Process will rely heavily on web technology in providing TA and communicating with teams
Teams will include policymakers in housing, BH, Medicaid, criminal justice, labor, and veterans affairs
Consumer leaders and members of State Interagency Councils, Continuums of Care, and Coalitions for the Homeless will participate
14
Top Related