Services in PSH: Medicaid Services in PSH: Medicaid Makes a DifferenceMakes a Difference

Leah BradleyLeah Bradley

Community Healthlink, Inc.Community Healthlink, Inc.

Community Support for Persons Experiencing Community Support for Persons Experiencing Chronic Homelessness (CSPECH)Chronic Homelessness (CSPECH)

Pilot project started in 2004 by the Pilot project started in 2004 by the Medicaid behavioral health carve outMedicaid behavioral health carve out

Cap on the number in the projectCap on the number in the project

Providers provide permanent housingProviders provide permanent housing

Collected data on members before and Collected data on members before and after being housedafter being housed

Billed as a day rateBilled as a day rate

Home AgainHome Again

Funded by The Health Foundation of Funded by The Health Foundation of Central Massachusetts (THFCM)Central Massachusetts (THFCM)

5 year project with sustainability through 5 year project with sustainability through systems change as end goalsystems change as end goal

Goal to end chronic homelessness in the Goal to end chronic homelessness in the city of Worcestercity of Worcester

Included evaluation of model to assist with Included evaluation of model to assist with sustainabilitysustainability

Home Again ProjectHome Again Project

THFCM funded services for 5 years THFCM funded services for 5 years

CoC funded housingCoC funded housing

Evaluation included tracking:Evaluation included tracking:– housing stabilityhousing stability– health outcomes,health outcomes,– social connectedness and social connectedness and

– amount of case managementamount of case management

Advocacy Strategy Advocacy Strategy

Case management as a covered benefit in Case management as a covered benefit in all Medicaid productsall Medicaid products

Case management covered for those Case management covered for those dually eligible for Medicare and Medicaiddually eligible for Medicare and Medicaid– Combined data from MHSA and THFCM to Combined data from MHSA and THFCM to

“make the case”“make the case”– Identified champions to take the leadIdentified champions to take the lead– Administrative (vs. legislative) strategyAdministrative (vs. legislative) strategy

DataData

Massachusetts Housing and Shelter Massachusetts Housing and Shelter Alliance (MHSA) lead organizationAlliance (MHSA) lead organizationData showed a savings of $9,610 per Data showed a savings of $9,610 per clientclientSavings calculation includes the cost of Savings calculation includes the cost of case management and housing case management and housing

http://www.mhsa.net/matriarch/documents/HHG_June2011_Report.pdfhttp://www.mhsa.net/matriarch/documents/HHG_June2011_Report.pdf

Data (Con’t)Data (Con’t)

THFCM EvaluationTHFCM Evaluation– Randomized control trial for 1st 21 monthsRandomized control trial for 1st 21 months

97% housing retention rate97% housing retention rate

Decrease in self-reported emergency services use for those Decrease in self-reported emergency services use for those housedhoused

Mental health improved more for those in housingMental health improved more for those in housing

– Case management “dosage” analysis Case management “dosage” analysis In general case management is reduced over timeIn general case management is reduced over time

More case management resulted in reduction in mental More case management resulted in reduction in mental health symptomshealth symptoms

www.homeagaincentralma.orgwww.homeagaincentralma.org

Cultivate ChampionsCultivate Champions

MHSAMHSA– Leader in state on homeless individualsLeader in state on homeless individuals– Outside interestOutside interest

Former Deputy Undersecretary of Health and Former Deputy Undersecretary of Health and Human Services Human Services – Personal connectionsPersonal connections– Understanding of state government and how Understanding of state government and how

decisions are madedecisions are made– Understanding of Medicaid system and its Understanding of Medicaid system and its

complexitiescomplexities

Cultivate Champions (Con’t)Cultivate Champions (Con’t)

THFCM President and CEOTHFCM President and CEO– Outside interest in the issueOutside interest in the issue– Politically connectedPolitically connected

– Contributed substantial resources to solving Contributed substantial resources to solving chronic homelessnesschronic homelessness

MessagingMessaging

Demonstrate cost effectiveness Demonstrate cost effectiveness

Present as behavioral health interventionPresent as behavioral health intervention– Show direct connection to behavioral and/or Show direct connection to behavioral and/or

medical servicesmedical services

Call it care coordination – not case Call it care coordination – not case managementmanagement

Steps takenSteps taken

Presentation of data at multiple levelsPresentation of data at multiple levels

Meetings with senior administration Meetings with senior administration officialsofficials

Meetings and communication with top Meetings and communication with top elected officialselected officials

Follow-up, follow-up, follow-upFollow-up, follow-up, follow-up

Progress to dateProgress to date

CSPECH expanded to eliminate CAPCSPECH expanded to eliminate CAP– Currently 36 additional enrolled – all of those Currently 36 additional enrolled – all of those

eligible in Home Againeligible in Home Again

Negotiating with other MCOs to cover Negotiating with other MCOs to cover remaining participants on Medicaid remaining participants on Medicaid

Following state innovations grant for dually Following state innovations grant for dually eligibleeligible

RecommendationsRecommendations

Start collecting dataStart collecting data

Educate yourself about Health Care Educate yourself about Health Care Reform Reform

Create partnerships with mental health Create partnerships with mental health and/or substance use organizationsand/or substance use organizations

Plan to bill Medicaid directly or through a Plan to bill Medicaid directly or through a subcontractsubcontract