5.10 Using Medicaid for Housing (Hurwitz)

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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)

  1. 1. USING MEDICAID FOR HOUSING AND SERVICESNational Conference on Ending HomelessnessJuly 13, 2010Mark HurwitzDeputy DirectorProject Renewal<br />h<br />1<br />
  2. 2. Project Renewal: Background<br />2<br />Project Renewal offers innovative solutions to the intertwined problems of homelessness, mental illness and addiction<br />Founded in 1967 as a shelter-based detoxification program providing an alternative to incarceration for chronic alcoholics<br />Now 35 distinct programs, primarily serving chronically homeless single adults<br />
  3. 3. Project Renewal: Key Services<br />3<br />Residential programs: 1,487 beds<br />4 emergency shelters: 600 beds<br />4 congregate supportive<br /> housing programs: 596 beds<br />Scattered site housing: 291 beds<br />Integrated primary care, addiction treatment, and mental health<br />Education, training, and job placement<br />
  4. 4. Today’s Presentation <br />4<br />New York’s Medicaid Program<br />How Project Renewal Uses Medicaid<br />Policy Issues<br />
  5. 5. Health Insurance Coverage<br />Source: CDC National Health Interview Survey <br />5<br />
  6. 6. New York State’s Medicaid Program<br />6<br />New York has covered very low income childless adults on Medicaid since 1966<br />1997 - Sec 1115 managed care waiver approved <br />1999 - NYC began mandatory enrollment for families<br />2001 - Expanded coverage to include childless adults at 100% of FPL and families at 150% of FPL<br />2005 - NYC required mandatory enrollment for SSI recipients <br />Those that do not choose a plan or claim an exemption within 60 days are automatically enrolled in a plan<br />
  7. 7. NY State Medicaid Managed Care: Exemptions From Mandatory Enrollment (partial list)<br />7<br />Individuals who are HIV+ or who have AIDS<br />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<br />Individuals with End Stage Renal Disease (ESRD)<br />Homeless Individuals<br />
  8. 8. Behavioral Health Carve Out<br />8<br />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<br />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<br />
  9. 9. How Does Project Renewal Use Medicaidto Deliver Services?<br />9<br />Outpatient detoxification<br /> Mental health case management linked with scattered site housing <br />Federally Qualified Health Center<br />
  10. 10. Project Renewal’s 30-bed Medically Supervised Detoxification Program is co-located with a 170-bed homeless shelter<br />Program provides 652 detoxifications annually<br />The daily cost of the program is $118 compared with $1,302 for inpatient detoxification<br />53% of patients are linked with continuing addiction treatment, compared with 20% for inpatient detoxification<br /> Revolving door syndrome: one person spent 279 days a year in detox at a cost to Medicaid of $324,485<br />Funding Model:Outpatient Detoxification<br />10<br />
  11. 11. Funding Model: Transitional Housing with Case Management<br />11<br />Project Renewal’s Parole Support and Treatment Program is a 50-bed scattered site transitional housing program for parolees with serious mental illness<br />Team of 4 Case Managers carries a caseload of 56 (50 in housing, 6 exiting prison)<br />Non-housing portion of program budget is $360,000<br />78% of this budget is funded by Medicaid <br />Case managers must have a minimum of 4 (intensive) or 2 (supportive) encounters per month<br />
  12. 12. Funding Model:Federally Qualified Health Center<br />12<br />Any Health Care for the Homeless program receiving 330(h) funding from HRSA is an FQHC<br />State Medicaid programs pay an enhanced rate to FQHCs to subsidize uncompensated care<br />Managed Care Plans are required to contract with FQHCs<br />
  13. 13. Project Renewal’s FQHC<br />Three freestanding primary care clinics and dental clinic in shelters<br />3 mobile vans, 2 for primary care: “MedVan”<br />1 mobile specialty care clinic: “ScanVan”<br />21,000 visits/year<br />Budget: $5.5 million<br />Medicaid covers 63% of primary care visits and 40% of budget<br />Patient Navigators<br />Electronic medical record<br />13<br />
  14. 14. Considerations in Forming an FQHC<br />14<br />Developing in-house expertise<br />Clinical<br />Administrative<br />Information Technology<br />Recent HRSA grants mostly for expansion or underserved areas<br />Billing and accounting requirements<br />Fee-for service business carries financial risk<br />
  15. 15. Why Integrate Health Care & Housing?<br />15<br />Practitioners partner with residential program staff to ensure follow-through:<br />Diet<br />Keeping Appointments<br />Medication compliance<br /><ul><li>Collaboration on disability applications
  16. 16. Coordination of care with specialists and after hospitalization</li></li></ul><li>Integration of Primary and Behavioral Care: Example<br /> 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.<br />16<br />
  17. 17. Project Renewal’s MedVan<br />17<br />Launched in 1986<br />Staffed by 2 providers and a driver/receptionist<br />Provides full range of primary care, including:<br />Vaccinations<br />Caridiography<br />Blood draws<br />Pregnancy Tests<br />Wound care<br />Specialty care relationships <br /> including teledermatology<br /> consulting <br />Suboxone Rx privileges<br />
  18. 18. Benefits of Mobile Primary Care vs. Traditional Clinic<br />18<br />
  19. 19. Policy Questions<br />Should medical and behavioral services be provided in the community or on-site in shelter? In permanent housing?<br />Financing: Who takes the risk / who gets the reward?<br />How well does managed care work for chronically homeless individuals?<br />19<br />
  20. 20. Thank You<br />Contact:<br />Mark Hurwitz<br />mark.hurwitz@projectrenewal.org<br />212.620.0340<br />www.projectrenewal.org<br />20<br />

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