Strategies that Work

1
Strategies that Work

• Improving access to mainstream health and human
  services that are coordinated with housing for
  persons who are chronically homeless
• Ann OHara
• Technical Assistance Collaborative, Inc.

2
What Works

• Know your target population and what they need
• Use systematic strategies
• Use permanent housing as a leveraging tool
• Include mainstream housing resources as well as
  HUD McKinney/Vento programs
• Target Medicaid for services
• Leverage State/local planning or system change
  efforts
• Be successful with initial efforts

3
People Who Are Chronically Homeless

• 10-15 percent of homeless people
• Majority are single adults
• Chronic disabilities
• Mental illness/co-occurring
• Chronic substance abuse
• Chronic health conditions
• More likely to be eligible for SSI, Medicaid,
  Food Stamps, VA services, etc.
• SSI income or below

4
SSI Income and Need for Subsidized Housing

• Priced Out in 2002 study
• SSI housing affordability standard 30 of
  income
• Nationally, 105 of SSI needed to rent a one
  bedroom unit
• Nationally, SSI equal to 18 of median income
• State SSI supplements dont close housing
  affordability gap

5
State by State SSI as Percent of Median Income
in 2002

• State by State housing affordability gap
• Connecticut 17.7
• District of Columbia 10.7
• Idaho 22.0
• Nebraska 17.2
• Nevada 16.2
• Oklahoma 25.1
• Oregon 19.2
• Virginia 14.6
• Wyoming 20.2

6
State by State 30 of SSI Income

• State by State housing affordability gap
• Connecticut - 224
• District of Columbia - 163
• Idaho - 179
• Nebraska - 166
• Nevada - 163
• Oklahoma - 179
• Oregon - 164
• Virginia - 164
• Wyoming - 166

7
Subsidized Housing Resources

• HUD McKinney/Vento
• Shelter Plus Care
• Supportive Housing Program
• Section 8 SRO
• Permanent housing bonus Up to 750,000
• Mainstream housing resources
• Section 8
• HOME
• State/local bridge subsidies
• Analysis of resources controlled/influenced at
  State level

8
Two Housing Approaches

• Housing development/rehabilitation
• Complex activity that takes time, expertise, and
  multiple sources of funding
• Creates supply of permanent supportive housing
• New mixed-income approaches
• Rental assistance
• Can be done more quickly with rent subsidies and
  services funding
• Not as permanent
• Master leasing, scattered-site models, links to
  mental health bridge subsidies
• Both approaches are important in a long-term plan

9
Medicaid

• Must be core component in long-term plan for
  services
• State Medicaid approaches
• Rehabilitation option
• Medicaid waivers
• Targeting Medicaid for substance abuse services
• Work within budgetary constraints Lead with
  your strengths
• Use other services funding (i.e., PATH, SAMHSA
  block grants) to fill in gaps

10
Housing First

• Pathways model
• Capitalize on value of housing as an
  outreach/engagement tool
• Give people what they need first
• Permanent housing, not transitional or congregate
  programs
• SSI, Food Stamps
• Have sufficient and flexible services available
  to support the model

11
Final Thoughts

• Target State housing resources whenever possible
• Strategize with local continuums doing a good job
• Planning
• Linking with PHAs
• Linking with VA programs
• Examine Medicaid opportunities
• Make your strategies as specific as possible and
  outcome focused

12
Examples of Successful Efforts

• District of Columbia Homeless people with
  mental illness/co-occurring
• Policy priority for new DMH administration
• New Medicaid Rehab Option approved
• Emphasis on consumer choice/permanent housing
• Rental assistance and housing development
  strategies
• Maximizing McKinney/Vento permanent housing
• Use of bridge subsidies linked to Section 8
• Involvement of PHA
• Providers with housing first expertise

13
Vancouver, Washington

• 5 Year Plan to address homelessness developed in
  2001
• Initial focus on rental assistance strategies
  while building capacity for developing permanent
  supportive housing
• One mental health provider willing to work with
  homeless people with mental illness McKinney
  SHP linked with PATH, Medicaid and State-funded
  mental health services
• Housing first approach for chronic substance
  abuse population living on the streets SHP
• Partnership with Veterans Administration - 124
  unit SRO on VA land
• Partnership with PHA Section 8 preference for
  homeless people graduating from McKinney/Vento
  transitional housing
• Section 8 strategy for people with disabilities
  at risk of homelessness
• Over 400 new permanent housing resources in 3
  years

14
Hawaii

• Target population Homeless people with mental
  illness/co-occurring
• Mental health system housing planning process
  Housing strategy through 2004
• Bridge subsidies and State-funded Housing
  Support Teams linked to Section 8 vouchers
  State and local PHAs involved
• Medicaid Rehabilitation Option being implemented
  in 2003 Providers will be able to bill for most
  wrap-around services
• Military base closure providing housing for
  veterans and people with mental illness
• Targeting HUD/HHS/VA Chronic Homeless Initiative

15
Maryland

• Target population Homeless people with mental
  illness/dual diagnosis
• Baltimore mental health system Medicaid waiver
  for wrap-around services
• Non-profit developing permanent supportive
  housing 100 units
• PHA partnership for Section 8
• Shelter Plus Care project-based subsidies
  combined with State mental health capital funding