Search results for "Medicaid"

5th December
2012
written by Lisa Stand

With elections nearly a month behind us, advocates are honing strategies to approach leaders and legislatures, new and old. With so much focus on federal budget and policy, it’s easy to overlook that all but half a dozen state legislatures will be in session by the time President Obama is inaugurated for a second term. At that time, state legislators will already be addressing budgetary issues and health care reform, two factors that will play huge roles in homelessness assistance next year.

A lot of the action on the issue of homelessness will be taking place in state capitals, and advocates can learn more about how to get involved on Tuesday, December 18, at 3 p.m. ET, when the Alliance hosts a live webinar, “Strategies to End Chronic Homelessness: Pursuing Innovative Policies at the State Level.” Field experts will show you and your community partners how to can make the most of new opportunities in your state. You can register for the webinar here.

The political landscape in the states has shifted a bit since the 2012 elections. So advocates in these 50 separate arenas must tailor their approaches in light of the election results in their states. Five new governors will assume office in 2013, but only in North Carolina did the gubernatorial seat change party hands. Party control shifted in just four states (Arkansas, Maine, Minnesota, and New Hampshire), and a handful of state legislatures are nearly evenly split between Democrats and Republicans.

Homelessness advocates are going to have to involve themselves in what’s happening in their state legislatures, and that means keeping track of the activities of leaders, lobbyists and grassroots organizations, and answering questions like, “Is the issue of homelessness on the state agenda? Are the leaders even interested in addressing homelessness? Do we as state advocates have the kind of access to leaders and influence that we need to affect state policies?

Every state is different, but here are a few points worth noting, from a national vantage. First the bad news:

  • As in the federal arena, programs require funding, so a lot of the big state policy decisions will be made during the budget debate. Unlike the federal government, however, many states are required by their constitutions to balance their annual budgets, which means more pressure to get the bottom line right year to year. Legislators may be tempted to skimp on state funding for housing and assistance in the expectation that federal programs and local coffers will make up the difference.
  • Though the economy is improving, states continue to feel the effects of the recession. Many states last year had to contend with shortfalls in state revenues, and they made up for the shortfalls with spending cuts. Again, the openings for advocates to propose and enact new policies – even cost-effective ones – are few and far between.

Now, the good news:

  • For people working to end chronic homelessness, the implementation of the Affordable Care Act (ACA) will present real opportunities as it moves to the states. In the next two years, a number of states (hard to know how many) will expand their Medicaid programs to cover many homeless adults who have gone without health insurance, for years or perhaps their entire lives.
  • A number of states will choose still other options under the ACA – such as Medicaid health homes – that will add capacity to the systems of care for chronically homeless people.

The Alliance’s policy team has been thinking about new ways to help our advocates affect state policymaking, particularly with regard to identifying and making the most of ACA opportunities. This fall, we reached out with an online survey to learn what issues are most pressing in the coming year when combatting chronic homelessness. Respondents from 32 states answered the call, and identified four relevant policy topics:

  • Funding for state mental health programs that offer supportive housing;
  • Expansion of Medicaid to cover all adults up to 133 percent of the federal poverty level;
  • Policy decisions to increase Medicaid coverage for behavioral health care; and
  • Funding for state programs to help people exiting jails and prisons.

We also learned that there is a nearly unanimous need for state-level strategies and tactics for addressing these challenges, with state advocates citing “data” as the primary tool that they lack

The Alliance has already begun to respond to these needs, with Alliance tools and materials and by connecting people with outside experts and resources. Now is the time for homeless advocates and their partners to define their role for 2013 in their states.

Here are some basic steps to get started:

    • Know your key statewide coalitions and make sure they know you.
    • Stay current on state legislative affairs – through your state representatives, local news sources and opinion-leaders, and state think tanks. Understand the big picture.
    • Prep your champions and spokespersons– are their messages up-to-date and relevant?
    • Have an “ask” for your state legislators that will engage them in your most important issues – whether it’s funding for behavioral health, public investment in supportive housing, or reporting of data needed to advance state solutions.
    • Build relationships for the long-term. Keep up with your contacts working in state policy settings, and inform them about your issues and your goals

The Alliance’s Economic Development Policy Fellow, Edward J. SanFilippo, contributed to this blog post.

21st November
2012
written by Emanuel Cavallaro

Tomorrow is Thanksgiving, and as we look forward to spending time with our families and loved ones, it is time for showing gratitude and giving thanks. It has been a busy year for the Alliance. Yesterday, I spent a little time speaking with some of our staff in an effort to get an idea of where the Alliance stands as we enter the holiday season. It turns out that the Alliance has a lot to be thankful for.

Lisa Stand, senior policy analyst, is thankful for the strong presence she saw at the Alliance’s Medicaid preconference in July, where attendees were energized by the recent Supreme Court Decision on the Affordable Care Act. As she works with advocates on state strategies to integrate supportive housing and health care, she’s continually heartened by how savvy and engaged they are.

André Wade, policy and program analyst, is thankful for the strong lead by the administration on youth homelessness, including USICH’s recent amendment to Opening Doors, which is focused on ending homelessness for youth by 2020. He is also thankful for new focus by HUD on the 18 to 25 transition age range for the January Point-In-Time Counts.

D’Arcy Klingle, director of meetings and events, is thankful for the 1,500 advocates, practitioners and officials who traveled from all over the country to Washington, DC, to trade best practices and learn about the most promising innovations going in the homeless assistance field today at the Alliance’s 2012 National Conference.

Ian Lisman, program and policy analyst, is thankful for the continued bipartisan support in congress for ending veteran homelessness. The VA has set the goal of ending veteran homelessness by 2015, and since 2010, we have reduced the number of veterans experiencing homelessness by 20 percent.

Kate Seif, policy outreach coordinator, is thankful for all the heard-working advocates we collaborate with year-round. These advocates are doing such a tremendous job educating congress on the issue of homelessness, and that’s having a noticeable impact on policymaking and federal funding levels.

Jennifer Olney, development and administrative associate, is thankful for our generous donors and sponsors who have shown continued support for the Alliance and its mission of ending homelessness.

Norm Suchar, director for the Alliance’s center for capacity building, is thankful for all the community leaders in the Alliance’s capacity-building network. They’re bringing their time and expertise to the field of homeless assistance and fighting homelessness at the local level.

We hope you all have the opportunity to spend time with your families this Thanksgiving, and we urge you to keep in your hearts and thoughts the plight of the most vulnerable of us, who may be spending their holidays, either alone or with their families, in a shelter or on the street. As we give thanks, it is important to remember that some of us may have more to be thankful for than others.

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13th November
2012
written by naehblog

Today’s federal post-election update was written by Kate Seif, the Alliance’s Policy Outreach Coordinator. The state post-election update was written by Lisa Stand, Senior Policy Analyst with the Alliance.

Eye on the Federal

President Obama won the election; the Republican Party maintained its majority in the House of Representatives; and the Democrats kept their majority in the Senate. It may look as though little has changed, but looks can be deceiving. Elections always mean change.

In Congress, both the House and Senate have a host of new members, while some long-term incumbents (and some new ones) have retired, resigned, or otherwise moved positions, paving the way for congressional committee reassignments and possible leadership changes. Many districts have been redrawn thanks to the decennial redistricting resulting from the Census, and that has left many constituents with new Representatives.

While the resident of the White House isn’t going anywhere, the 15 Executive Cabinet Members can (and often do) go elsewhere between terms. The same is true for a host of lower-level positions.  No announcements on that front, so far, though.

The question we in the Alliance are asking is how will these changes impact homelessness? The short answer is that right now, just days after the election, we don’t know. During the run-up to the election there was a lot of talk about the need for bipartisanship, and about crossing the aisle and working together. If that kind of talk translates into action, we could see progress.

Federal movement around preventing and ending homelessness has a long history of bipartisan support, with members of both parties working together to make an impact. We hope to see more of that in the weeks and months to come.

Post-election, there is a lot more certainty about the future of the Affordable Care Act (ACA) – and some clear direction for people working to end chronic homelessness in their communities. The health care reform law passed narrowly in 2010, with key provisions not intended to take effect in 2014. The lengthy lead time gave ACA opponents – among them candidate Mitt Romney – the opportunity to campaign to repeal it. With the ACA’s chief proponent Barack Obama now re-elected to a second term, the American public can expect the federal government to carry on with implementation.

Eye on the States

However, because of a Supreme Court ruling earlier this year,  debates about health care reform will continue in many states, and pick up pace as the 2014 implementation approaches. That is because the Supreme Court said that the decision to expand Medicaid as the ACA envisions is a state decision, not a matter of federal mandate. Though a number of states have fully embraced the ACA, not every state will immediately opt to expand its Medicaid program, even though the ACA offers generous subsidies to states to do so.

As homeless advocates well understand, the ACA on paper could extend Medicaid to virtually all chronically homeless people who do not already qualify for Medicaid disability. In fact, many people who are chronically homeless lack any health care coverage or a regular source of care for serious physical and behavioral health conditions. Local safety net programs are often burdened as a result – in the health care system as well as homeless assistance system. Clearly, by embracing the ACA and expanding Medicaid, states can boost the overall funding for those health care services in permanent supportive housing – the best approach to ending chronic homelessness.

At the same time that states consider their options for 2014, other ACA provisions are taking effect, as the law intended. One example is creation of person-centered health homes, which are already being implemented in some states. The health home benefit is a possible funding source for care coordination activities that help people stabilize in supportive housing. The Alliance recently published a policy brief about health homes, explaining how individual state decisions on this provision can best help drive solutions to chronic homelessness.

People working to end homelessness in their communities understand the importance of these and other relevant ACA provisions that fund services for vulnerable people and help safety net systems function more effectively. Now that so much of the ACA conversation is moving to states, it is critical, from a homeless services perspective, to engage and inform mainstream efforts to change Medicaid in states.

With state elected leadership now settled, policymakers are looking at 2013 state budget strategies, as well as actions needed to take advantage of health care reform. As states respond to ACA opportunities, community-based strategies to address chronic homelessness should be highlighted. Messages should convey the opportunities for supportive housing to help stretch the public dollars spent on vulnerable populations.

One first step is to educate new leaders and remind incumbents about the connections between homelessness and the high costs of providing health care to vulnerable people, and to suggest specifically what communities need from innovation in Medicaid and other state health care programs.

As Congress reconvenes to deal with the Fiscal Cliff and Washington gets back to work, the changes and issues that lie ahead will further emerge. The Alliance will, of course, continue to keep our readers posted on these issues and how they might impact the great work and progress being made on the ground.

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31st July
2012
written by Lisa Stand

Image Courtesy of Kate Mereand-SinhaIn his highlights of the themes of our 2012 National Conference, our Vice President Steve Berg touched on the implications of the U.S. Supreme Court’s interpretation of the Americans with Disabilities Act (ADA) in its 1999 Olmstead decision.

The Supreme Court ruled that the Act requires states to grant people with disabilities the choice of where to live, and that states must avoid placing them in living situations that segregate them from the rest of society. The Olmstead decision, and a number of cases that followed, spoke specifically about state Medicaid programs. However, the Olmstead decision is about “community integration” broadly, and has continues to shape the ways in which state programs and services promote the rights of  people with disabilities, particularly their right to live in the least restrictive settings of their choice.

The Department of Housing and Urban Development (HUD) has an interest in upholding Olmstead principles, as it does all federal fair housing provisions. While HUD’s purview may raise thorny questions about what kinds of housing are suitable for disabled people who are experiencing homelessness, an important, practical implication of the Olmstead decision is that it makes more resources available to house people who are experiencing chronic homelessness.

Recently, HUD published guidance about the role of public housing agencies (PHAs) in reducing inappropriate institutionalization of persons with disabilities. It is worth reading the entire document, for it gives needed context to local decision-making that can affect plans to end chronic homelessness.

For example, “persons at serious risk of institutionalization” can be included, along with those who are exiting institutions, in a local preference providing subsidies for people with disabilities. The guidance describes how such a preference can work, and offers other examples of actions a PHA can take to leverage resources and programs to realize Olmstead goals.

When states and localities make Olmstead decisions that affect mainstream housing and services programs, homeless service advocates should be involved. Participation in Delaware, for instance, resulted in people experiencing chronic homelessness being included among other groups of persons with disabilities as a target population.

Here are some ways advocates can connect with Olmstead efforts:

  • Learn more about the history of the ADA and Olmstead in your state. Most states have developed ADA compliance plans, with stakeholder consensus. The National Center for Personal Attendant Services tracks Olmstead matters, and updates state-specific plan information. To find these resources, search Olmstead on the main page. Also, the web-based resource, HCBS Clearinghouse, offers information and tools for state Medicaid reform.
  • Reach out to statewide disability groups, including state affiliates of the National Alliance on Mental Illness. Look for ways to collaborate on ADA and Olmstead enforcement.
  • Advocate for people who are chronically homeless within the diverse communities of people with disabilities people in your state and locality. Describe the systems of care and proven interventions for homeless people, the role of permanent supportive housing, and collaborative possibilities.

Additional Resources

U.S. Department of Justice website dedicated to Olmstead.

U.S. Department of Health and Human Services, Office for Civil Rights, Olmstead website.

Image Courtesy of Kate Mereand-Sinha

20th July
2012
written by Steve Berg

We’d like to thank the nearly 1,500 practitioners, public officials and other stakeholders who took time out of their busy schedules to attend our 2012 National Conference on Ending Homelessness. For us in the Alliance, the level of enthusiasm and positivity on display in the plenary sessions and workshops was immensely gratifying. The homeless assistance community has come far, in terms of its overall level of sophistication and focus on implementation in order to get results, and the conference was a great opportunity for people to share what they have learned, as well as for those of us in the community to engage in a discussion about what we still must do to achieve our goals.

In her remarks at the conference’s closing plenary, Alliance CEO Nan Roman touched on a few of the themes that emerged over the course of the three days. I’ll expand on some of those here.

Targeting – The message came through loud and clear: there are a range of interventions to draw upon, but for an intervention to be successful it must be targeted at the right people. Specifically, supportive housing is our most intensive intervention, and it is designed for the most vulnerable population with the most severe disabilities. If such people are screened out in favor of people with fewer challenges, they will live and probably die on the streets.

Olmstead – The Olmstead case reminded us that large programs devoted solely to housing people with severe mental illness are seldom the best way to serve people, and often are not what people in such programs would choose for themselves if they had more reasonable options. In some cases, such programs actually violate civil rights laws. This challenges people who run housing programs for people with disabilities to consider when it might be appropriate to develop mixed-use projects.

Rapid Re-housing – Somebody once said that the only people who believe in rapid re-housing are everyone who’s ever tried it. Now that virtually every sizeable community around the country has tried it, thanks to HPRP, there is a consensus that it’s the right model for moving most people who are experiencing homelessness into housing. With HPRP winding down soon, much of the talk at the conference was about how to maintain funding for rapid re-housing programs. Fortunately, new HUD regulations make it easy for communities to use Continuum of Care and ESG funds for this purpose, and many communities have also identified other funding sources for rapid re-housing.

Youth and youth counts – The homeless assistance community has begun developing a range of ideas about a more systemic approach to ending youth homelessness. A double track of workshops about youth homelessness, as well as increasing collaboration with the federal Administration for Children, Youth and Families and organizations like the National Network for Youth, focused on advancing these ideas. When the January 2013 point-in-time counts roll around, expect a stronger push for a more accurate count of youth experiencing homelessness.

Veterans’ money and leadership – During the conference, VA announced the awards for about $100 million in grants for the Supportive Services for Veteran Families program, which funds community-based organizations that run rapid re-housing and emergency homelessness prevention programs for veterans and their families. This announcement drew attention to the fact that VA now has a full array of programs to address homelessness, and that those programs are on their way to being funded at the scale necessary to end homelessness among veterans.

The struggle over other federal money – It’s clear that federal money for HUD programs has been harder to come by in the past two years, and that this will continue to be the case. Many communities are increasingly turning to the large antipoverty entitlement programs – TANF, SNAP, SSI, and Medicaid, for example – where federal funding has not been cut, while programs for veterans, which are less threatened by budget cuts, must serve as examples of what can be accomplished with the proper funding. Homeless assistance practitioners are also turning to more efficient models like rapid re-housing, which require less money per household. And they are making sure that their representatives in congress, who determine the funding levels, know about the good that their programs do.

Medicaid – The prospect of funding most services and treatment for chronically homeless people through Medicaid appears closer to reality that anyone would have thought possible only a few years ago. The Affordable Care Act will allow states to expand eligibility in 2014, and the majority of states will opt to do so. A lot of work behind the scenes has already gone into ensuring that the right kinds of services will be funded by Medicaid, but it will take new partnerships, particularly at the state level, to make the most of these new opportunities.

Progress – Perhaps the most rewarding part of the conference for us in the Alliance was seeing the resolve of advocates, in the face of enormous obstacles put up by the economy and the political system, to try new options, discard methods that are less effective, and work smarter and more efficiently to develop programs that, for thousands of people, mean the difference between housing and homelessness.

10th July
2012
written by Lisa Stand

What does the Supreme Court decision on the Affordable Care Act mean for communities poised to use new Medicaid funding to bolster their homeless assistance? First and foremost, communities have to engage more intensively with the state policymaking process – this, actually, was true before the ACA ruling came down. And it will be true no matter what the results of elections in November.

Since the decision, we now know that Medicaid will not expand nationally to cover virtually all uninsured people who earn less than $15,000. Therefore, the presumption no longer holds that virtually all people experiencing chronic homelessness will be able to enroll in Medicaid beginning in 2014. But states do have the option to expand in 2014, taking advantage of substantial federal Medicaid subsidies to do so. The ACA cannot require states to expand their programs, but still offers to pay them 90-100% of the cost of covering all uninsured adult citizens who earn around $15,000 or less annually.

Access to health care services – including behavioral health and recovery support – can be a key part of successful housing outcomes for the 107,000 people who experience chronic homelessness on any given night. Without funding for health care, many communities struggle for sustainable solutions – specifically, adequate permanent supportive housing (PSH), which is proven effective to address chronic homelessness. Since Congress passed the ACA in 2010, homeless assistance systems have anticipated the Medicaid expansion – to help individuals and to enhance safety net capacity.

Full Medicaid coverage will not be a “given” in every state. The Supreme Court ruling means additional challenges for the national agenda to end chronic homelessness by 2015. According to the U.S. Interagency Council on Homelessness, 60 percent of the nation’s chronically homeless population is concentrated in six states – California, Florida, Georgia, Louisiana, New York and Texas.  Four of these – California, Florida, Georgia and Texas – were projected to have the highest increases in Medicaid enrollment as a result of the ACA. Only two, New York and California, have indicated an intention to move forward with Medicaid expansion.

To see what might happen in your state, this map and this map from Think Progress are handy starting places.  A note of caution: There are many unknowns about how this part of ACA implementation will actually unfold. To name a few:

  • How many states will take up the expansion, despite what their governors said in the wake of the Supreme Court decision?
  • In the states that do expand, what services and supports will be covered?
  • Will ACA implementation really take place as soon as 2014?
  • Can a state opt in after 2014?

While these and other questions are sorted out, it is more important than ever for homeless advocates to inform state leaders and community partners in the full debate about health care priorities. The necessary policy choices to support communities will be steps that integrate housing, health care, and behavior health/recovery resources at the community level.

  • For chronically homeless populations, permanent housing is the first prescription, with person-centered services and supports to stabilize housing.
  • Opting into the ACA Medicaid expansion will bring federal resources directly to these vulnerable individuals – who otherwise are among the highest users of state and local safety net resources.
  • Failing to opt in means continued pressure on the capacity of state mental health programs and public safety operations.

Further, a number of promising Medicaid provisions remain in effect, including those meant to improve community supports for especially vulnerable enrollees, including those who are eligible because of a qualifying disability. These options were designed to be targeted to those most in need, and they tend to be less politicized. One example is the Medicaid health home. This optional benefit for people with severe mental illness (and other chronic conditions) pays for broadly-defined service coordination.

Several states, including New York, Missouri, Oregon and Rhode Island, have already opted to set up health homes. States can also offer home and community based services (HCBS) without applying for a federal waiver. In a recent proposed rule, Medicaid officials indicated that permanent support housing qualifies as a “community setting” for HCBS. Homeless advocates can join forces with advocates for older and disabled people, to press for their states to adopt these options in a way that adds to the capacity of homeless assistance.

Many states and communities have already embraced health care reform since the ACA passed in 2010. Often, homeless advocates have been at the table with Medicaid leaders, forging new strategies to integrate housing solutions with health care services to address chronic homelessness. The Alliance is paying close attention to successful new approaches and emerging best practices, especially in supportive housing. Speakers with hands-on experience and up-to-date policy knowledge will present on these topics at the July 16-18 National Conference on Ending Homelessness in Washington, DC.

11th June
2012
written by Lisa Stand

Leaders and innovators in supportive housing convened in Chicago last week for a multi-faceted look at integrating housing and health care. The Leadership Forum, sponsored by the Corporation for Supportive Housing, was also the occasion for the release of a “business case” for states to tap Medicaid to pay for key services in permanent supportive housing. The presenters at the day-long conference and the paper on the business case speak to recent innovations with health care and supportive housing — demonstrating what’s possible under the Affordable Care Act, and what’s actually happening in communities where state government and homeless providers are proactive.

Two stand-out ACA provisions enable homeless advocates to persuade state policymakers that supportive housing is a worthwhile Medicaid investment.

 

  • First, the “health home” benefit can be a good vehicle for funding care management and service coordination, services that make supportive housing viable as a strategy to end chronic homelessness. As the Forum audience heard, a Medicaid health home is a unique concept that has to be understood in a health policy context. But once that context is understood, it is easier to bring relevant data and analysis to Medicaid decision-makers. The business case illustrates that if Medicaid pays appropriately for care management via this new benefit, states can expand their service capacity in supportive housing. That’s because Medicaid allows the state to access federal funding to pay a portion of what the state would otherwise have to pay all by itself for a given number of supportive housing units.
  • Second, when Medicaid expands in 2014, states will have new responsibilities to care for very vulnerable people who currently lack coverage and tend to incur very high public costs, especially in hospital emergency rooms. They tend to have severe behavioral and physical health conditions, often co-occurring. And they tend to have unstable housing histories. This is not news to homeless advocates. However, the expanded Medicaid role creates an opportunity to talk to state decision-makers about the value of Housing First for clinical outcomes and managing health care costs.

This is all promising for systems of care addressing chronic homelessness. Safety net systems may always be somewhat fragmented financially, but in any case they need to be integrated and high-performing for the vulnerable people who rely on them. Of course, more needs to be done to finish the job of ending chronic homelessness, and Medicaid in supportive housing is not the answer by itself. As the business case also points out, new strategies should also consider “new processes and/or technologies to identify high-cost, chronically ill clients who could most benefit from supportive housing.” Those who are now experiencing chronic homelessness should be a priority.

The Medicaid proposition for ending chronic homelessness requires advocates to be active in statewide arenas – with Medicaid administrators, of course; but also with their partners – such as mental health directors, hospital systems, and even managed care organizations that deliver on Medicaid contracts. Advocating statewide is the theme of an Alliance pre-conference session on July 16, immediately preceding the start of the National Conference on Ending Homelessness. “Opening Medicaid Doors: State Strategies to Support Homeless Assistance for Vulnerable Populations” is co-sponsored by the U.S. Interagency Council on Homelessness. The half-day program will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless. Space is limited and pre-registration is highly recommended. RSVP at healthcare@naeh.org.

Image courtesy of donbuciak.

14th May
2012
written by Lisa Stand

“States vary” –  a top research finding in virtually every field studied inside the Beltway. When it comes to understanding how Medicaid is relevant to ending chronic homelessness, we would like to be more helpful. True, Medicaid’s relevance to ending chronic homelessness in your community depends greatly on the profile of your state. Still, success in another state is worth looking at, along with assessing what can be borrowed effectively. A pre-conference session for early arrivals at the Alliance’s summer conference will offer an opportunity to do just that.  The half-day mini-conference is co-sponsored by the U.S. Interagency Council on Homelessness. We will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless.

  • 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.

These topics will be covered by knowledgeable speakers convening for “Opening Medicaid Doors: State Strategies to Support Homeless Assistance,” on Monday, July 16, in Washington, DC. The half-day session immediately precedes the opening of the National Conference on Ending Homelessness, which takes places July 16-18. Both events are at the Renaissance Washington Hotel. For more information about Opening Medicaid Doors, contact healthcare@naeh.org. Space limited and pre-registration is highly recommended.

6th April
2012
written by Kate Seif

Starting with today’s post, the Alliance is beginning a new “Monthly Wrap” series. These series are intended to highlight and remind readers of the Alliance’s biggest accomplishments and takeaways from the previous month.  We start the series off with the month of March.

March was a very busy month at the Alliance! We had a full month of webinars, toolkits, and research releases. Let’s jump right in and start with the big stuff:

  • Youth Typology. In early March, the Alliance released An Emerging Framework for Ending Unaccompanied Youth Homelessness and broadcast an accompanying webinar. The framework lays out different categories of unaccompanied youth and estimates the numbers in each group.  The goal of the framework is to match those categories with the right interventions and improve the current response to youth homelessness.
  • Coordinated Assessment. The Emergency Solutions Grant regulations released by HUD in early December announced that the Continuum of Care regulations, to be released shortly, would include a requirement that communities implement a coordinated assessment (intake) system.  In response, the Alliance put together the Coordinated Assessment Toolkit which includes best practices, resources, sample checklists, and guide for communities either implementing or changing their coordinated entry system.  Coordinated Assessment can help communities use resources more efficiently and effectively by ensuring that people are diverted where possible and that people are connected with the right interventions as soon as they enter the system.  Does your community have a coordinated assessment process?  If so, we’d love to share your tools or training materials with other communities! Send them to Kim Walker!
  • Housing for Survivors of Domestic Violence. The Alliance placed an emphasis on rapid re-housing as a key solution for survivors of domestic violence in March.  In late February, we pulled together a variety of resources to create a Domestic Violence Toolkit. Throughout March, we populated the toolkit with videos, solutions briefs, two webinars (Housing for Survivors and Prevention), and much more! The toolkit aims to share the valuable lessons from communities successfully operating rapid re-housing programs for survivors.

But that’s not all! Lisa Stand, a senior policy analyst at the Alliance, has been keeping us up to date on the implementation of the Affordable Care Act, the corresponding Supreme Court decision, and the importance Medicaid plays in ending chronic homelessness.

We released our Media Counts Map and we need your help! If your local press has released any stories about your recent January Point-in-Time counts, please let Pete Witte know.  The map offers a great snapshot of trends in homelessness across the country before HUD is able to release the official data.

And you’ve been busy, too! In March, you sent over 615 letters (and much more!) to your Members of Congress about the importance of increasing funding for McKinney-Vento Homelessness Assistance Grants. It was one of our most impressive one-month advocacy pushes!

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5th April
2012
written by Steve Berg

Last week, the House of Representatives passed a budget resolution on a largely partisan vote.  Many people are asking what the impact of this “Ryan budget” (named after Rep. Paul Ryan (R-WI), the author) will be and what it means, so I’ll supply a brief explanation here.  As Amanda blogged about on March 22, a budget resolution sets the general outlines for Congress’s work on the budget for the year.

The House’s budget resolution, H.Con.Res. 112, would cut federal spending by about $5 trillion total over the next ten years, compared to the already-low spending levels in last year’s big debt deal – the Budget Control Act of 2011. (To put this in context, federal spending totaled just under $3.6 trillion in 2011.) Where would it get those savings?

For the 2013 fiscal year, discretionary spending – which is all of the spending decided annually by the Appropriations Committees – would be reduced even further than in the first round of cuts under the Budget Control Act, by about 2 additional percent to $1.028 trillion – and that entire additional cut could come from domestic programs, with no further cuts to military spending. If enacted, this would put further downward pressure on funding for discretionary spending programs, including all targeted homelessness programs and virtually all HUD programs.

Entitlement programs like Medicaid are not considered discretionary spending (it’s referred to as “mandatory” spending); they, however, would also be reduced under the House budget resolution through a separate process.  In the longer run, spending reductions would be even more extreme. These cuts in lifeline programs are coupled with large reductions in taxes for the wealthiest Americans.

So, that’s what the Ryan budget includes – but what will the impact be?

The first important thing to know about the House budget resolution is that, as a comprehensive plan for federal revenue and spending, it is going nowhere. At least, not this year.  The Senate leadership and the President have repeatedly said that they will agree to budget changes to address long-term federal deficits in a manner that is “balanced” between revenue increases and spending cuts from both domestic programs and the military. Although the budget resolution itself does not require the President’s signature, the changes it proposes would all require separate legislation to actually go into effect: appropriations bills, changes in the tax code, and overhauls of entitlement programs – none of which the Senate or President will agree to at this point.

The second important thing about the House budget resolution, however, is that one provision could have a real impact right away: its overall limit on discretionary spending will apparently be used by the House Appropriations Committee as it produces the House version of FY 2013 spending bills this spring. The Senate, on the other hand, will produce bills based on the higher limit agreed to in the Budget Control Act, setting up a conflict between the two chambers.  Conventional wisdom says that when the two chambers meet to work out final agreements, the totals will come out to the higher levels used by the Senate.  This, however, remains to be seen – the House could insist on the lower levels, bringing either additional cuts or a government shutdown when the fiscal year starts on October 1.

The third important thing to know is that the House budget resolution represents a school of thought calling for immense change in the role of the federal government.  Its long-term vision is of a federal government that does little other than run retirement and healthcare programs and the military.  In the long run, there is no room in this budget for HUD, or for any federal response to homelessness, inadequate housing, or poverty.  That a majority of the House of Representatives is willing to endorse such a vision is a new phenomenon in our lifetime.  It ignores, among other things, the effective, important work that is being done on homelessness by using federal funds to get excellent results for the most impoverished people in our country.

Image courtesy of 401K.

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