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Ending Chronic Homelessness State by State: Strategies for Medicaid to Make a Difference
May 14, 2012
- Homeless Advocates at the Table. One facet is effective engagement at the right time in state health policymaking. How do homeless advocates get the ear of state health care officials before they make decisions that have implications for addressing chronic homelessness in a person-centered way? New York has an inspiring story of supportive housing stakeholders at the table of statewide Medicaid reform -- with results that bolster community-based strategies to end homelessness. In Louisiana, supportive housing is now viewed as a core element in Medicaid’s plans for managing care of behavioral health enrollees. In short, policy gaps have been successfully bridged with stakeholder input at high levels.
- Benefits and Payment Policy. Another facet is how a state defines Medicaid benefits and payment policies. Do these policies promote housing solutions in a plan of care for homeless people with significant behavioral and other health needs? As federal authorities roll out approved benefits and demonstrations, we are seeing how states embrace new community-based services allowed by the Affordable Care Act (ACA). States like Oregon and New York are doing this with a clear view of supportive housing in the domain of health care, at least for those as vulnerable as chronically homeless people. It may be too soon to know how these approaches succeed, but the state policy pieces are evident and intentional.
- Federal Policy Implementation. A third facet is coordination at the federal level, such as initiatives led by the Department of Housing and Urban Development (HUD) and various subdivisions of the Department of Health and Human Services (HHS). Which new federal policies and regulatory decisions will have the most impact on ending chronic homelessness by 2015, as the federal strategic plan envisions? Federal Medicaid rules are more favorable to the concept of permanent supportive housing, and HUD is looking for ways to promote access to Medicaid in housing for people with disabilities. Federal policy will continue to drive state and local responses.