The document provides an overview of Medicaid as a federal and state funded medical insurance program tailored for persons experiencing homelessness. It highlights challenges such as limited coverage for housing supports and opportunities for states to innovate, including enrollment options and partnering with Medicaid providers. Additionally, it discusses common approaches implemented in various states to align Medicaid services with housing support and rehabilitation needs.

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

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

3. 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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

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

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

16. 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

17. 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