This document summarizes a presentation about California's Whole Person Care Pilots, which aim to integrate housing and health services. The 5-year, $3 billion pilot program provides funding for housing services and infrastructure to help reduce health costs for vulnerable populations. Initial results show cost savings from providing housing and wraparound services to those experiencing homelessness or housing instability. The pilot program could serve as a model for other states looking to address social determinants of health through Medicaid.

1. A System-Level
Approach to Housing
and Health
Integration:
California’s Whole
Person Care Pilots
APHA
Atlanta, GA
November 7th, 2017
Jeremy Cantor, MPH
Senior Consultant, JSI
@jeremy_cantor

2. Whole Person Care Pilots
 5-year (2016-2020) pilot
authorized under Medi-
Cal 1115 waiver
 $3 billion total statewide
(up to $1.5 billion in
federal match)
 Significant infrastructure
investment
 Revenue neutral:
hypothesis is spend
money up front to avoid
later costs
Source: Harbage Consulting

8. “Thousands of extremely low-
income and vulnerable people are
cycling through the system, and we
can’t do anything for them with all of
our other medical and behavioral
health tools while they are still
homeless. We are just throwing good
money after bad, treating them
repeatedly in the emergency room
and acute hospital beds.”
– Marc Trotz, Director of Housing for
Health, Los Angeles County
Department of Health Services

9. Project 25 San Diego:
Extremely low client-staff
ratio, 24-hour “Whatever
it takes” support
Net savings of over
$33,000 per
participant per year

11. Whole Person Care Pilots
 5-year (2016-2020) pilot
authorized under Medi-
Cal 1115 waiver
 $3 billion total statewide
(up to $1.5 billion in
federal match)
 Significant infrastructure
investment
 Revenue neutral:
hypothesis is spend
money up front to avoid
later costs
Source: Harbage Consulting

13.  Individual housing transition services help
individuals transition from institutions to
community-based housing. These services include,
among others, tenant screening and housing
assessments that identify enrollees’ preferences
and barriers to successful tenancy; development of
a housing support plan; assistance with the
housing application and search process; assistance
with one-time move-in expenses, such as security
deposit; arranging for details of the move; and
development of a crisis plan that includes
prevention and early intervention services when
housing is jeopardized.
 Individual housing and tenancy sustaining
services help individuals maintain tenancy after
housing is secured. Tenancy support services
include education and training on tenants’ and
landlords’ role, rights, and responsibilities;
assistance in resolving disputes with landlords and
neighbors to reduce the risk of eviction; assistance
with housing recertification; and others.
 State-level housing services are “ strategic,
collaborative” activities to assist in identifying and
securing housing resources. Among the activities
for which Medicaid financing is available are
development of agreements with local housing and
community development agencies to facilitate
access to housing resources, and participation in
these agencies’ planning processes.
“CMS does not provide Federal
Financial Participation (FFP) for
room and board in home and
community based services, but
can assist states with coverage of
certain housing-related activities
and services.”

14. b. County Housing Pools. WPC
Pilot entities may include
contributions to a county-wide
housing pool (Housing Pool)
that will directly provide
needed support for medically
necessary housing
services…The Housing Pool
may also incorporate a
financing component to
reallocate or reinvest a portion
of the savings from the
reduced utilization of health
care services into the Housing
Pool.
 a. Tenancy-based care management services.
Tenancy-based care management supports to
assist the target population in locating and
maintaining medically necessary housing.
These services may include individual
housing transition services, such as
individual outreach and assessments;
individual housing and tenancy sustaining
services, such as tenant and landlord
education and tenant coaching; and housing-
related collaborative activities, such as
services across public agencies and the
private sector that assist WPC entities in
identifying and securing housing for the
target population.

16. Data
Sharing:
San
Francisco’s
MACCS/
Navigation
System

17. Braided
Funding:
Alameda’s
funding flow

18. Staffing and
Coordination: San
Joaquin’s specialized
service teams
Source: Harbage Consulting

19. Key Takeaways
 There is a genuine shift in health policy
and payment toward SDOH, in particular
housing
 CMS has provided guidance on use of
Medicaid funds to support stable
housing
 CA is in the midst of a pilot project that
could have significant implications for
other states

20. Thank you!
@jeremy_cantor
jeremy_cantor@jsi.com
“We provide very expensive medications to AIDS patients
without considering the cost. We have a similar treatment for
people with mental illness and substance use. We know what
will keep people alive. But we are hesitant to spend the money
[on housing]. The kicker is that investing in housing reduces
health costs.”
– Dr. Josh Bamberger, Medical Director for Housing and Urban Health,
San Francisco Department of Public Health