Services in PSH: Medicaid Makes a Difference Leah Bradley Community Healthlink, Inc.
Community Support for Persons Experiencing Chronic Homelessness (CSPECH) <ul><li>Pilot project started in 2004 by the Medi...
Home Again <ul><li>Funded by The Health Foundation of Central Massachusetts (THFCM) </li></ul><ul><li>5 year project with ...
Home Again Project <ul><li>THFCM funded services for 5 years  </li></ul><ul><li>CoC funded housing </li></ul><ul><li>Evalu...
Advocacy Strategy  <ul><li>Case management as a covered benefit in all Medicaid products </li></ul><ul><li>Case management...
Data <ul><li>Massachusetts Housing and Shelter Alliance (MHSA) lead organization </li></ul><ul><li>Data showed a savings o...
Data (Con’t) <ul><li>THFCM Evaluation </li></ul><ul><ul><li>Randomized control trial for 1st 21 months </li></ul></ul><ul>...
Cultivate Champions <ul><li>MHSA </li></ul><ul><ul><li>Leader in state on homeless individuals </li></ul></ul><ul><ul><li>...
Cultivate Champions (Con’t) <ul><li>THFCM President and CEO </li></ul><ul><ul><li>Outside interest in the issue </li></ul>...
Messaging <ul><li>Demonstrate cost effectiveness  </li></ul><ul><li>Present as behavioral health intervention </li></ul><u...
Steps taken <ul><li>Presentation of data at multiple levels </li></ul><ul><li>Meetings with senior administration official...
Progress to date <ul><li>CSPECH expanded to eliminate CAP </li></ul><ul><ul><li>Currently 36 additional enrolled – all of ...
Recommendations <ul><li>Start collecting data </li></ul><ul><li>Educate yourself about Health Care Reform  </li></ul><ul><...
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2.9 Leah Bradley

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2.9 Leah Bradley

  1. 1. Services in PSH: Medicaid Makes a Difference Leah Bradley Community Healthlink, Inc.
  2. 2. Community Support for Persons Experiencing Chronic Homelessness (CSPECH) <ul><li>Pilot project started in 2004 by the Medicaid behavioral health carve out </li></ul><ul><li>Cap on the number in the project </li></ul><ul><li>Providers provide permanent housing </li></ul><ul><li>Collected data on members before and after being housed </li></ul><ul><li>Billed as a day rate </li></ul>
  3. 3. Home Again <ul><li>Funded by The Health Foundation of Central Massachusetts (THFCM) </li></ul><ul><li>5 year project with sustainability through systems change as end goal </li></ul><ul><li>Goal to end chronic homelessness in the city of Worcester </li></ul><ul><li>Included evaluation of model to assist with sustainability </li></ul>
  4. 4. Home Again Project <ul><li>THFCM funded services for 5 years </li></ul><ul><li>CoC funded housing </li></ul><ul><li>Evaluation included tracking: </li></ul><ul><ul><li>housing stability </li></ul></ul><ul><ul><li>health outcomes, </li></ul></ul><ul><ul><li>social connectedness and </li></ul></ul><ul><ul><li>amount of case management </li></ul></ul>
  5. 5. Advocacy Strategy <ul><li>Case management as a covered benefit in all Medicaid products </li></ul><ul><li>Case management covered for those dually eligible for Medicare and Medicaid </li></ul><ul><ul><li>Combined data from MHSA and THFCM to “make the case” </li></ul></ul><ul><ul><li>Identified champions to take the lead </li></ul></ul><ul><ul><li>Administrative (vs. legislative) strategy </li></ul></ul>
  6. 6. Data <ul><li>Massachusetts Housing and Shelter Alliance (MHSA) lead organization </li></ul><ul><li>Data showed a savings of $9,610 per client </li></ul><ul><li>Savings calculation includes the cost of case management and housing </li></ul><ul><li>http://www.mhsa.net/matriarch/documents/HHG_June2011_Report.pdf </li></ul>
  7. 7. Data (Con’t) <ul><li>THFCM Evaluation </li></ul><ul><ul><li>Randomized control trial for 1st 21 months </li></ul></ul><ul><ul><ul><li>97% housing retention rate </li></ul></ul></ul><ul><ul><ul><li>Decrease in self-reported emergency services use for those housed </li></ul></ul></ul><ul><ul><ul><li>Mental health improved more for those in housing </li></ul></ul></ul><ul><ul><li>Case management “dosage” analysis </li></ul></ul><ul><ul><ul><li>In general case management is reduced over time </li></ul></ul></ul><ul><ul><ul><li>More case management resulted in reduction in mental health symptoms </li></ul></ul></ul><ul><ul><li>www.homeagaincentralma.org </li></ul></ul>
  8. 8. Cultivate Champions <ul><li>MHSA </li></ul><ul><ul><li>Leader in state on homeless individuals </li></ul></ul><ul><ul><li>Outside interest </li></ul></ul><ul><li>Former Deputy Undersecretary of Health and Human Services </li></ul><ul><ul><li>Personal connections </li></ul></ul><ul><ul><li>Understanding of state government and how decisions are made </li></ul></ul><ul><ul><li>Understanding of Medicaid system and its complexities </li></ul></ul>
  9. 9. Cultivate Champions (Con’t) <ul><li>THFCM President and CEO </li></ul><ul><ul><li>Outside interest in the issue </li></ul></ul><ul><ul><li>Politically connected </li></ul></ul><ul><ul><li>Contributed substantial resources to solving chronic homelessness </li></ul></ul>
  10. 10. Messaging <ul><li>Demonstrate cost effectiveness </li></ul><ul><li>Present as behavioral health intervention </li></ul><ul><ul><li>Show direct connection to behavioral and/or medical services </li></ul></ul><ul><li>Call it care coordination – not case management </li></ul>
  11. 11. Steps taken <ul><li>Presentation of data at multiple levels </li></ul><ul><li>Meetings with senior administration officials </li></ul><ul><li>Meetings and communication with top elected officials </li></ul><ul><li>Follow-up, follow-up, follow-up </li></ul>
  12. 12. Progress to date <ul><li>CSPECH expanded to eliminate CAP </li></ul><ul><ul><li>Currently 36 additional enrolled – all of those eligible in Home Again </li></ul></ul><ul><li>Negotiating with other MCOs to cover remaining participants on Medicaid </li></ul><ul><li>Following state innovations grant for dually eligible </li></ul>
  13. 13. Recommendations <ul><li>Start collecting data </li></ul><ul><li>Educate yourself about Health Care Reform </li></ul><ul><li>Create partnerships with mental health and/or substance use organizations </li></ul><ul><li>Plan to bill Medicaid directly or through a subcontract </li></ul>
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