5.10 Using Medicaid for Housing (Hurwitz)
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5.10 Using Medicaid for Housing (Hurwitz)



Medicaid is a government health insurance program that can be used to offer services in supportive housing programs. Under the new Health Care Reform law, virtually all homeless people will be ...

Medicaid is a government health insurance program that can be used to offer services in supportive housing programs. Under the new Health Care Reform law, virtually all homeless people will be eligible, and can benefit from configuring supportive housing services to take advantage of Medicaid reimbursement. Consideration will be given to the administrative and data burdens inherited when a housing provider becomes eligible for reimbursement from Medicaid/medical assistance, as well as the benefits of delivering a flexible array of supports to maintain persons in their homes.



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5.10 Using Medicaid for Housing (Hurwitz) Presentation Transcript

  • 1. USING MEDICAID FOR HOUSING AND SERVICESNational Conference on Ending HomelessnessJuly 13, 2010Mark HurwitzDeputy DirectorProject Renewal
  • 2. Project Renewal: Background
    Project Renewal offers innovative solutions to the intertwined problems of homelessness, mental illness and addiction
    Founded in 1967 as a shelter-based detoxification program providing an alternative to incarceration for chronic alcoholics
    Now 35 distinct programs, primarily serving chronically homeless single adults
  • 3. Project Renewal: Key Services
    Residential programs: 1,487 beds
    4 emergency shelters: 600 beds
    4 congregate supportive
    housing programs: 596 beds
    Scattered site housing: 291 beds
    Integrated primary care, addiction treatment, and mental health
    Education, training, and job placement
  • 4. Today’s Presentation
    New York’s Medicaid Program
    How Project Renewal Uses Medicaid
    Policy Issues
  • 5. Health Insurance Coverage
    Source: CDC National Health Interview Survey
  • 6. New York State’s Medicaid Program
    New York has covered very low income childless adults on Medicaid since 1966
    1997 - Sec 1115 managed care waiver approved
    1999 - NYC began mandatory enrollment for families
    2001 - Expanded coverage to include childless adults at 100% of FPL and families at 150% of FPL
    2005 - NYC required mandatory enrollment for SSI recipients
    Those that do not choose a plan or claim an exemption within 60 days are automatically enrolled in a plan
  • 7. NY State Medicaid Managed Care: Exemptions From Mandatory Enrollment (partial list)
    Individuals who are HIV+ or who have AIDS
    Individuals with chronic medical conditions who have been under active treatment for at least six months with a sub-specialist who is not a network provider for any Medicaid managed care plan in the service area
    Individuals with End Stage Renal Disease (ESRD)
    Homeless Individuals
  • 8. Behavioral Health Carve Out
    NY’s waiver application originally called for the creation of Mental Health and HIV Special Needs Plans, but the legislature did not approve the enabling legislation for Mental Health SNPs
    SSI recipients who are enrolled in managed care receive mental health and addiction treatment (except for inpatient detox) on a fee-for service basis by using their Medicaid card
  • 9. How Does Project Renewal Use Medicaidto Deliver Services?
    Outpatient detoxification
    Mental health case management linked with scattered site housing
    Federally Qualified Health Center
  • 10. Project Renewal’s 30-bed Medically Supervised Detoxification Program is co-located with a 170-bed homeless shelter
    Program provides 652 detoxifications annually
    The daily cost of the program is $118 compared with $1,302 for inpatient detoxification
    53% of patients are linked with continuing addiction treatment, compared with 20% for inpatient detoxification
    Revolving door syndrome: one person spent 279 days a year in detox at a cost to Medicaid of $324,485
    Funding Model:Outpatient Detoxification
  • 11. Funding Model: Transitional Housing with Case Management
    Project Renewal’s Parole Support and Treatment Program is a 50-bed scattered site transitional housing program for parolees with serious mental illness
    Team of 4 Case Managers carries a caseload of 56 (50 in housing, 6 exiting prison)
    Non-housing portion of program budget is $360,000
    78% of this budget is funded by Medicaid
    Case managers must have a minimum of 4 (intensive) or 2 (supportive) encounters per month
  • 12. Funding Model:Federally Qualified Health Center
    Any Health Care for the Homeless program receiving 330(h) funding from HRSA is an FQHC
    State Medicaid programs pay an enhanced rate to FQHCs to subsidize uncompensated care
    Managed Care Plans are required to contract with FQHCs
  • 13. Project Renewal’s FQHC
    Three freestanding primary care clinics and dental clinic in shelters
    3 mobile vans, 2 for primary care: “MedVan”
    1 mobile specialty care clinic: “ScanVan”
    21,000 visits/year
    Budget: $5.5 million
    Medicaid covers 63% of primary care visits and 40% of budget
    Patient Navigators
    Electronic medical record
  • 14. Considerations in Forming an FQHC
    Developing in-house expertise
    Information Technology
    Recent HRSA grants mostly for expansion or underserved areas
    Billing and accounting requirements
    Fee-for service business carries financial risk
  • 15. Why Integrate Health Care & Housing?
    Practitioners partner with residential program staff to ensure follow-through:
    Keeping Appointments
    Medication compliance
    • Collaboration on disability applications
    • 16. Coordination of care with specialists and after hospitalization
  • Integration of Primary and Behavioral Care: Example
    Patient complained to primary care physician of chronic pain that was preventing him from sleeping. With patient’s permission, physician consulted with the patient’s psychiatrist, who determined that sleeplessness was related to anxiety and prescribed anti-anxiety medication.
  • 17. Project Renewal’s MedVan
    Launched in 1986
    Staffed by 2 providers and a driver/receptionist
    Provides full range of primary care, including:
    Blood draws
    Pregnancy Tests
    Wound care
    Specialty care relationships
    including teledermatology
    Suboxone Rx privileges
  • 18. Benefits of Mobile Primary Care vs. Traditional Clinic
  • 19. Policy Questions
    Should medical and behavioral services be provided in the community or on-site in shelter? In permanent housing?
    Financing: Who takes the risk / who gets the reward?
    How well does managed care work for chronically homeless individuals?
  • 20. Thank You
    Mark Hurwitz