Project Renewal offers a range of services aimed at addressing homelessness, mental illness, and addiction, including various residential and supportive programs. The presentation outlines how New York's Medicaid program supports these services, including outpatient detoxification and transitional housing funded significantly by Medicaid. The integration of health care and housing is emphasized, highlighting the importance of collaboration between health care providers and housing staff.

1. USING MEDICAID FOR HOUSING AND SERVICESNational Conference on Ending HomelessnessJuly 13, 2010Mark HurwitzDeputy DirectorProject Renewalh1

2. Project Renewal: Background2Project Renewal offers innovative solutions to the intertwined problems of homelessness, mental illness and addictionFounded in 1967 as a shelter-based detoxification program providing an alternative to incarceration for chronic alcoholicsNow 35 distinct programs, primarily serving chronically homeless single adults

3. Project Renewal: Key Services3Residential programs: 1,487 beds4 emergency shelters: 600 beds4 congregate supportive housing programs: 596 bedsScattered site housing: 291 bedsIntegrated primary care, addiction treatment, and mental healthEducation, training, and job placement

4. Today’s Presentation 4New York’s Medicaid ProgramHow Project Renewal Uses MedicaidPolicy Issues

5. Health Insurance CoverageSource: CDC National Health Interview Survey 5

6. New York State’s Medicaid Program6New York has covered very low income childless adults on Medicaid since 19661997 - Sec 1115 managed care waiver approved 1999 - NYC began mandatory enrollment for families2001 - Expanded coverage to include childless adults at 100% of FPL and families at 150% of FPL2005 - 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)7Individuals who are HIV+ or who have AIDSIndividuals 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 areaIndividuals with End Stage Renal Disease (ESRD)Homeless Individuals

8. Behavioral Health Carve Out8NY’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 SNPsSSI 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?9Outpatient 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 shelterProgram provides 652 detoxifications annuallyThe daily cost of the program is $118 compared with $1,302 for inpatient detoxification53% 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 $324,485Funding Model:Outpatient Detoxification10

11. Funding Model: Transitional Housing with Case Management11Project Renewal’s Parole Support and Treatment Program is a 50-bed scattered site transitional housing program for parolees with serious mental illnessTeam of 4 Case Managers carries a caseload of 56 (50 in housing, 6 exiting prison)Non-housing portion of program budget is $360,00078% 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 Center12Any Health Care for the Homeless program receiving 330(h) funding from HRSA is an FQHCState Medicaid programs pay an enhanced rate to FQHCs to subsidize uncompensated careManaged Care Plans are required to contract with FQHCs

13. Project Renewal’s FQHCThree freestanding primary care clinics and dental clinic in shelters3 mobile vans, 2 for primary care: “MedVan”1 mobile specialty care clinic: “ScanVan”21,000 visits/yearBudget: $5.5 millionMedicaid covers 63% of primary care visits and 40% of budgetPatient NavigatorsElectronic medical record13

14. Considerations in Forming an FQHC14Developing in-house expertiseClinicalAdministrativeInformation TechnologyRecent HRSA grants mostly for expansion or underserved areasBilling and accounting requirementsFee-for service business carries financial risk

15. Why Integrate Health Care & Housing?15Practitioners partner with residential program staff to ensure follow-through:DietKeeping AppointmentsMedication complianceCollaboration on disability applications

16. Coordination of care with specialists and after hospitalizationIntegration 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.16

17. Project Renewal’s MedVan17Launched in 1986Staffed by 2 providers and a driver/receptionistProvides full range of primary care, including:VaccinationsCaridiographyBlood drawsPregnancy TestsWound careSpecialty care relationships including teledermatology consulting Suboxone Rx privileges

18. Benefits of Mobile Primary Care vs. Traditional Clinic18

19. Policy QuestionsShould 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?19

20. Thank YouContact:Mark Hurwitzmark.hurwitz@projectrenewal.org212.620.0340www.projectrenewal.org20