PARTNERING TO END HOMELESSNESS IN A CHANGING HEALTH CARE

ENVIRONMENT

Pamela S. Hyde, J.D.

SAMHSA Administrator

National Alliance to End Homelessness

U.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

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RECOVERY REQUIRES HOUSING

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Individuals and

Families

HOME ↑ Permanent

Housing

COMMUNITY ↑ Peer/Family/

Recovery Network Supports

PURPOSE ↑ Employment/

Education

HEALTH ↓ Symptoms &

Distress ↑ Abstinence, Self-Care & Resilience

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

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PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP

CI = Confidence Interval

Sources: 2008 – 2010 National Survey of Drug Use and Health

2010 American Community Survey

7.0%

14.9% 14.2%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Percent with a SeriousMental Illness (1,283,000)

CI: 6.3%-7.7%

Percent with SeriousPsychological Distress

(2,731,742)CI: 14.0%-15.9%

Percent with a SubstanceUse Disorder (2,603,405)

CI: 13.2%-15.2%

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nt w

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Uninsured Adults Ages 18-64 with Incomes < 138% FPL (18 Million)

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PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS

Primary MH plus some SA: 85 percent

Primary SA: 56 percent

Other (homeless shelters and social services): 37 percent

Residential SA: 54 percent

Inpatient: 95 percent

Outpatient: 68 percent

Source: NSATSS

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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

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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

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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)

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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

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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

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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

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