The Role of Health Care in the Effort to Prevent and End Homelessness

The Affordable Care Act is a game-changing opportunity for our shared efforts to end homelessness, which Opening Doors does address. Since the launch of the plan, the U.S. Supreme Court issued its decision that gives States the option of whether to expand Medicaid or not. In addition, innovative and effective approaches for bringing Medicaid to bear on ending homelessness have also emerged, creating significant opportunities for states that have expanded Medicaid coverage and to a lesser extent, for states that are not expanding Medicaid coverage; the opportunities for health care reform to drive integration of housing and healthcare may be more significant that we could have anticipated when Opening Doors was drafted.

Since the launch of Opening Doors, our understanding of what works has further solidified, and we’ve seen tremendous progress. Your input is essential to the ongoing success of Opening Doors. Please share and vote for the ideas you think would have the greatest impact in an amendment to Opening Doors.

Please consider these questions when crafting your feedback and voting for the feedback you think is most valuable. And please use the Opening Doors Amendment 2014 Participation Guide for more information on what strategies are currently included in Opening Doors. Find it here: http://bit.ly/USICH2014

1. Other than the strategies that are currently included, are there additional strategies for fully realizing the opportunities created through the Affordable Care Act that you think should be reflected in an amendment to Opening Doors?

2. What information around Medicaid’s role in ending homelessness would be most helpful to you in an amendment to Opening Doors? How would that information strengthen your community’s / organization’s efforts?

3. Are there other areas of the Plan you feel would benefit from updated information or the incorporation of additional strategies?

What information around health care’s role in ending homelessness would be most helpful to you in an amendment to Opening Doors?

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  1. Remove barriers to health care for youth

    • Determine how health care, especially under Medicaid as expanded under the Affordable Care Act, can be used to provide services and housing to homeless youth and youth at risk of homelessness (pay for case management, housing, mental and behavioral health services, etc.).

    • Develop protocols for enrolling homeless youth in Medicaid and other services as expanded under the Affordable Care Act that will remove existing barriers to enrolling and receiving services, including exceptions to parental signature requirements for minors.

    • Remove barriers that prohibit unaccompanied homeless minors from accessing the health care services they need without a parent or…

    99 votes
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      1 comment  ·  Flag idea as inappropriate…  ·  Admin →
    • Update & expand strategy related to Medicaid expansion

      Ensuring all states expand Medicaid should be a priority area as should ensuring sufficient community capacity in all states to deliver needed services to those with significant health care needs. Beyond that, how can Opening Doors strengthen its role to support/encourage states to go further with Medicaid flexibility to add needed services to the benchmark package (e.g., adult dental, case management, care coordination, etc.)? Some states have successfully implemented waivers, Health Homes, and other mechanisms (even connecting them with housing initiatives), but all states should be targeting comprehensive service packages to chronically ill/homeless populations that fill existing service gaps.

      63 votes
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      • share info about health care strategies aligned with housing solutions for people without serious mental illness

        Most of the ways Medicaid services are integrated with strategies to end homelessness have been designed for people with serious mental illness, but many homeless people have needs related to other health or behavioral health conditions, and many homeless people aren't eligible for benefits or services that are available through the mental health system. Opportunities to use Medicaid for services that help these people get and keep housing should be expanded and highlighted.

        35 votes
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        • Strengthen strategy related to medical respite care

          What sustainable funding can be created in all communities to support medical respite care to ensure successful care transitions between hospital and home? As PSH models increasingly focus on the most vulnerable, we need to ensure people are being discharged appropriately, do not lose housing while recuperating, and receive the intensive services they need.

          35 votes
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            0 comments  ·  Other  ·  Flag idea as inappropriate…  ·  Admin →
          • Establish training protocols for PSH service workforce

            Objective four focuses on providing PSH to prevent/end chronic homelessness. Could Opening Doors add a strategy that seeks to establish training protocols for the health care and other service workers who support vulnerable people in housing? Examples include standardized case loads, training curricula to establish core competencies (appropriate to clinical/support role), bundled service packages based on levels of need/intensity, case rates/reimbursements that are sufficient to cover costs, and other supports needed to ensure that the clinicians and other support team members are adequately trained and staffed to ensure client stability and meet established program outcomes.

            30 votes
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              0 comments  ·  Other  ·  Flag idea as inappropriate…  ·  Admin →
            • With Medicaid expansion well underway suggest the Opening Doors strategies for preparing for medicaid expansion be updated and refined.

              Develop strategies for assisting states to increase capacity for supportive housing providers to become part of the healthcare system either as providers or network partners especially in an integrated system. States can play a vital role in the design, policy making and access to housing and healthcare beyond current expectations. This also includes involving states more in what this capacity building strategy would need to entail for the systems they manage.

              30 votes
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              • Detailed how-to guidance

                Everyone, homeless or not, needs health care, and current plan provides many strategies to secure it. For homeless people with the most severe disabilities, however, the inability to access specific kinds of care remains a barrier to housing stability. Changes in Medicaid in the ACA, however, have the promise to provide that care to everyone who needs it. The plan should include making the know-how available in communities to take advantage of this opportunity.

                In order to end chronic homelessness, it would be extremely helpful to have detailed assistance available, listing the different kinds of health care and supportive services…

                18 votes
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                  1 comment  ·  Flag idea as inappropriate…  ·  Admin →
                • Role of Medicaid and services

                  Supportive services, particularly strong case management services, are critical to the success of transitional, rapid rehousing and permanent supportive housing programs. There has been much talk about the role that Medicaid expansion can play in addressing the services needs of supportive housing tenants. Yet much of this talk glosses over the fact that many states, including ours, are not using Medicaid in way that it can be easily utilized for supportive housing services. HUD, the USICH and other federal entities should provide more technical assistance and guidance to states and local communities so they can effectively advocate for the necessary…

                  7 votes
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                  • Olmstead -- Medicaid -- Housing -- Failure to Provide Amounts to Massive Olmstead Violations

                    From our perspective, with respect to many people who are homeless there should be a rebuttable presumption that they do qualify for Medicaid services, perhaps most importantly of the traditional services intensive case management. However, failure to provide housing leads to great risk of institutionalization in hospitals, prisons, & jails. Further, traditional Medicaid & Waivers pay for nursing home care and assisted living -- failure to provide for housing is a clear case of discrimination under the ADA and the Olmstead decision. ----- Orchid Mental Legal Advocacy of Colorado

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                    The Role of Health Care in the Effort to Prevent and End Homelessness

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