Expanding Access to Housing-Related Services and Supports
On November 1, HHS and HUD solicited applications for the Housing and Services Partnership Accelerator, which will support states in developing or expanding innovative housing-related supports and services for Medicaid-eligible people with disabilities and older adults who are experiencing or at risk of homelessness. As the name suggests, the Accelerator will focus on helping states improve collaboration and coordination between organizations and systems that provide services and resources that help people find – and keep – stable housing in the community.
On February 9, 2024, HHS and HUD announced that the following eight states and the District of Columbia were selected to participate in the Accelerator.
- Arizona
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Arizona’s Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), developed the Health Opportunities (H2O) waiver to cover health-related social need interventions as Medicaid services for eligible populations. The H20 waiver complements the agency’s housing program, which provides rent subsidies to nearly 3,000 individuals with serious mental illness who also experience homelessness. By participating in the Accelerator, Arizona seeks to educate those who are experiencing homelessness and those at risk of becoming homeless about housing services and interventions. Arizona will also support housing and services providers to identify opportunities to use variety of funding sources to provide additional housing and supportive services to eligible populations. Arizona also seeks to maximize housing stability for Medicaid members by providing wraparound services using the H2O waiver, the Arizona Long Term Care System (ALTCS), and home and community-based services provided through the state’s Older Americans Act programs.
The team is led by Arizona’s Medicaid office and includes representatives from the state’s continuums of care, the state's housing finance agency, local public housing authorities, area agencies on aging, health entities, and housing and homelessness programs.
- California
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California has taken steps to support the “whole-person” needs of Medicaid beneficiaries, with a focus on the social drivers of health, including housing. The state is in the third year of a 5-year transformation of its Medicaid program called CalAIM: California Advancing and Innovating Medi-Cal. The CalAIM framework encompasses broad-based delivery system, program, and payment reform across the Medi-Cal program to shift to a statewide population health approach that prioritizes prevention and addresses social drivers of health, including housing.
To end homelessness and address the needs of its most vulnerable populations, California is working to leverage the state Medicaid program (Medi-Cal) to provide its Medicaid members with a range of housing services and supports. While California has made great strides, participating in the Accelerator will help state agencies better coordinate services across housing, health, and social care systems to prevent and end homelessness for older adults and people with disabilities.
The team is led by California’s Medicaid office and includes representatives from state and community housing and homelessness, health, aging and disability organizations.
- District of Columbia
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The District of Columbia (DC) has a goal of achieving a whole-person, population-based, integrated Medicaid health system that is comprehensive, coordinated, high quality, culturally competent, and equitable. DC plans to leverage coaching and peer learning through the Accelerator to enhance and expand housing supports and services to Medicaid-eligible older adults and people with disabilities, under their1915(i) State Plan Benefit. DC has substantially reduced homelessness after implementing several multiyear strategic plans focused on ending homelessness, addressing the opioid epidemic, and improving access to care and services for individuals with complex needs, older adults, and people with disabilities.
DC’s Medicaid agency, the Department of Health Care Finance, leads a diverse team that was formed and tested through years of partnership. The team includes representatives from the Department of Human Services, the Interagency Council on Homelessness, and other District of Columbia government health and human service agencies and will work in partnership with DC managed care, healthcare, and supportive housing providers.
- Hawai’i
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Hawai’i has taken a multi-faceted health and housing approach towards ending homelessness. This approach brings together public and private collaborations to meet the housing and health-related social needs of individuals experiencing homelessness. Through the Accelerator, the state's Medicaid agency and its partner organizations seeks to learn from the experience of other states that have implemented or expanded housing-related supports and services for similar populations, particularly those experiencing behavioral health challenges. The Accelerator will help Hawai’i formalize the existing collaboration among various state agencies and key stakeholders to expand the implementation of housing-related supports and services in Hawai‘i-- particularly in geographically isolated and rural areas. The state seeks to develop a coordinated system that connects and supports individuals through all housing, health, and social care programs and systems.
The team is led by Hawai’i’s state Medicaid agency and includes agencies representing developmental disability, aging, and behavioral health services, as well as the public housing authority, housing and homeless organizations, community service organizations, and healthcare providers.
- Maryland
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Through the Accelerator, Maryland plans to expand a statewide coalition of critical stakeholders that will work together to increase housing stability and improve health outcomes for Medicaid participants at risk of institutional placement or homelessness. This will complement the state’s work to expand its Assistance in Community Integration Services (ACIS) pilot statewide. Maryland seeks to increase integrated support for Medicaid-eligible people and to identify ways to streamline access to services through its Maryland Access Point (MAP), to ensure people at risk of or experiencing homelessness are prioritized for assistance through Medicaid. Maryland’s Medicaid agency aims to use this technical assistance opportunity to improve and sustain coordination and collaboration across agencies and organizations to address homelessness statewide. Maryland's goals for expansion are supported by the state's strategic plan to end homelessness, its “Olmstead” activities to support community living for people with disabilities, and the state’s disabilities plan.
Led by the state Medicaid agency, Maryland comes to the Accelerator with an integrated team that includes the state departments of housing and community development, aging, and disabilities, in close coordination with other statewide associations and organizations.
- Massachusetts
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Through the Accelerator, the state will examine ways that Medicaid resources and other supportive services funding can be aligned in preparation for the implementation of a new supportive housing pool fund. In alignment with the state plan on aging and its Olmstead Plan to support community living for people with disabilities, the Commonwealth plans to create a comprehensive map of housing related services available to homeless people. The state also plans to study the range of service costs required to build and operate permanent supportive housing programming required to keep people housed. The Massachusetts Medicaid waiver framework provides for housing-related services for people with complex health needs, including but not limited to pre-tenancy navigation and housing search assistance, one-time transition and moving costs, tenancy and sustaining services and individualized case management, and housing transition and navigation services
The Executive Office of Housing and Livable Communities (HLC), the state housing agency, is Massachusetts' lead agency in the Accelerator, with the support of the state Medicaid agency. Team members include state agencies for aging, rehabilitation, housing and stabilization, elder affairs, community services, substance addiction services and several community health and housing organizations.
- Minnesota
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Recognizing the health impacts of housing instability, the Minnesota state Medicaid agency has implemented its Housing Stabilization Services (HSS) Medicaid benefit, a home and community-based service that supports people with disabilities to live, work, and play in communities of their choice. , The purposes of HSS are to help support individual in transitioning into housing, increase long-term stability in housing in the community, and avoid additional periods of homelessness or institutionalization. Over the past several years, the service has experienced significant growth both in terms of people served and providers enrolled. Based on this growth, Minnesota seeks help to improve coordination between this Medicaid service and other health care and housing resources. The Accelerator aligns with efforts to use Minnesota’s Medicaid authority to drive improvements in health, to close disparities in access and health outcomes, and to address social determinants of health. Through the Accelerator, the state hopes to identify how HSS providers can use their services to help enrollees access appropriate health care in more consistent way, and to connect to other programs that support affordable and stable housing.
Led by the state Medicaid agency, the Minnesota team includes representation from housing, aging and disability services and behavioral health partners.
- North Carolina
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North Carolina seeks to build on current initiatives to improve housing supports and services by strengthening the collaboration between Medicaid and housing resources within the state, including the Healthy Opportunities Pilot (which has provided more than 13,000 services to 33 rural counties representing one third of the state) and Olmstead Transition to Community Living. The state will explore ways to align eligibility criteria across programs, maximize resources, and design a centralized, streamlined point of access for individuals to ensure that all people with disabilities and older adults who are at risk for homelessness, or experiencing homelessness, have access to eligible housing and support services.
Led by the North Carolina Medicaid agency, the state team includes representation across the North Carolina Department of Health and Human Services and the North Carolina Interagency Council for Coordinating Homeless Programs
- Washington
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In 2016, Washington was the first state approved to provide supportive housing and supported employment benefits via a Medicaid 1115 demonstration. The program, known as Foundational Community Supports, launched in January 2018 and has served more than 40,000 individuals by over 200 statewide contracted providers. Washington has administered 1115 waiver-funded housing-related services for over six years, a state-funded Transition Assistance Program (TAP) for nearly two years, and has taken steps to fold in CMS-funded short-term rental assistance through Money Follows the Person (MFP) within the state’s Aging and Long-Term Support Administration (ALTSA) subsidy and the newly approved Health Related Social Needs (HRSN) services framework under its renewed 1115 waiver. With a commitment to Housing First, Washington seeks to design a continuum of housing options to support the needs of people where they are, to facilitate movement within the housing continuum to effectively serve more people, and to increase funding to develop or expand all types of housing and services. As a part of the Accelerator and other initiatives, Washington seeks to expand partnerships with public housing agencies to develop programs that create pathways to community housing options and promote social inclusion, community integration, and housing choice. Through the 12-month Accelerator, Washington hopes to develop a pilot that can be scaled over the two-year period. The team is led by the state's Medicaid agency and includes partners from ALTSA's office of housing and employment and the state Department of Commerce's Office of Apple Health & Homes, with support from key stakeholders in the aging and disability networks and housing and homelessness services providers.
The Accelerator will help the participating teams unlock critical resources to reduce homelessness by addressing health-related social needs, such as housing-related services.
“Nobody in America should experience homelessness. Today we are taking important steps to help communities better access HHS’ programs to address homelessness and connect people with housing-related services and supports – which could be life changing,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration has worked tirelessly to help people experiencing homelessness to provide needed services and supports that help them maintain that housing. We will continue to work on strengthening partnerships across housing, disability, aging, and health sectors and do everything we can to prevent and address homelessness.
Complete details about the Accelerator are available in the program overview.
Helping States Improve Collaboration and Leverage New Flexibilities and Funding
A growing number of states are leveraging new opportunities and flexibilities available under Medicaid, new federal housing resources, and expanded opportunities under the Older Americans Act to cover a range of services and supports that help people find, obtain, and maintain their housing. The Housing and Services Partnership Accelerator will bring interdisciplinary teams together in a 12-month learning collaborative to tackle common issues, such as navigating payment models and rates, data integration and sharing, and more. The Accelerator also will offer participants an opportunity to share lessons learned and promising practices for improving collaboration and coordination to optimize resources, cover resource gaps, align state and local policies, and to deliver more integrated and seamless services. Finally, participants will also receive one-on-one coaching support from housing and services subject matter experts.