5.10 Using Medicaid for Housing (Knisley)

Medicaid Basics 2010 National Conference to End Homelessness Martha Knisley The Technical Assistance Collaborative www.tacinc.org

Overview
The Basics—Medicaid 101
Challenges and Opportunities
Case examples: Medicaid as a core service for persons who are homeless

The Basics
Medicaid is a federal and state funded medical insurance program
Federal government sets broad policy and rules
States administer the program
Medicaid operates as insurance:
Covered lives
Covered “individual” benefits
Providers apply to be part of a service network

The Basics
Federal Policy:
Statewideness
Comparability of Services
Freedom of Choice of Provider
Equal Access
Amount Scope and Duration
IMD

The Basics
Federal Financial Participation (FFP) matches “state” funding—based on formula—FFP goes as high as 72% down to 50% of payments
Federal rules and waivers administered by Centers for Medicare and Medicaid (CMS)
There are two broad categories of benefits: mandated and optional

The Basics
Each state has its own Medicaid State Plan that defines:
Access and “Medical Necessity”
Individual Benefits (both mandated and optional)
Eligibility
Provider Qualifications
Rate Structure and Basis

Challenges
Medicaid is an entitlement
Medicaid covers the person not the place, not the program
Not all housing supports can be covered by Medicaid

Challenges
There are incentives for states to expand coverage for people coming out of institutions
Less incentive for people who are homeless: cost savings are marginal in Medicaid budget
Waiver programs are capped

Opportunities
States can change their Medicaid state Plan
Persons who are homeless can be enrolled in Medicaid
Their health and behavioral health care can be covered by Medicaid

Opportunities
Opportunities to shift from grant funded services to Medicaid are desirable when:
There is an overlap between effective
interventions and “coverable” services
Providers can partner with Medicaid
providers or become qualified providers
Services are individualized

Opportunities and Challenges: PPACA
15 million single adults living at or below 133% of poverty will be eligible to enroll in Medicaid on January 1st 2014
States can innovate through Waivers and other opportunities that can directly benefit people who are homeless

Matching-Up Medicaid with Supportive Housing—Services
Targeted Case Management (MH/PH)
Rehabilitation Option (MH/SA)
Reinvesting MC Savings (MH/PH/DD/LTC)
Primary Health Care (FQHCs/HcH)
Home and Community Based Waivers (DD/PH)

Matching-Up Medicaid with Supportive Housing—Services
Section 6044 of the Deficit Reduction Act (DRA) (MH/PH/DD)
Clinic based Services (MH/PH)
EPSDT for transition age youth

Matching Up Medicaid with SH Medicaid Clinical treatment – MH and SA Primary health and chronic health care Rehabilitation Option Tenancy supports and community integration

Services Not Covered
Room and Board
Education
Watchful Oversight
Services provided in IMDs
Transportation

State Case Studies
Indiana
New Mexico
Louisiana
Common approaches:
All state-local initiatives
Housing support and Medicaid covered services were matched through a cross- walking exercise

Common Approaches (cont.)
Same crosswalk approach used for cost analysis
Single portal for housing and rehabilitation/ case mgmt. services;
most services are individualized; and
“ getting and keeping housing” included in service intervention and as outcome

5.10 Using Medicaid for Housing (Knisley)

by National Alliance to End Homelessness on Jul 28, 2010

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5.10 Using Medicaid for Housing (Knisley) Presentation Transcript