If you spend your day helping people who have experienced chronic homelessness, you know a lot about “person-centered” care. It means organizing services and supports around the specific needs of an individual – a place to live first and foremost, then recovery supports, medical treatment, supported employment, and so on. In a world of service silos and payment mazes, it also often means a headache of coordination – you braid together programs and accounts, keep an eye on staff resources, manage partner relationships, and try to catch whatever falls off the table before it lands on your client. (You’re welcome). Fortunately, the health care system just might be catching up to you.
There is one area of health care reform that doesn’t draw much partisan controversy. It’s the drive to make the system work smarter with the resources dedicated to people who use the most services. We are all aware of the problem. In health care, the highest share of spending is associated with a small percentage of people who have very complicated health and functional profiles. How much of the costs can be managed better by paying more attention to care management and service coordination? Medicaid policymakers think the answer is “a lot,” and they have gotten behind new strategies to prove it. This is welcome news for homeless advocates.
The medical home (or health home) is one of the most promising ways to integrate health care with supportive housing interventions. The concept came to the fore first as a health-care-quality initiative, and later as a possible cost-saver. A medical home is a single provider responsible for organizing a person’s care – especially needed if the care involves many disciplines and practitioners. A qualified medical home provider – like a health center or a doctor’s office — can be paid a certain monthly fee for this service.
Starting this year, Medicaid is paying extra federal funds to states that designate health homes for certain high-need, high-cost populations – including people with mental illness. The Centers for Medicaid and Medicare Services (CMS) has approved health homes in at least three states so far – Missouri, New York and Rhode Island. More health home approvals are in the pipeline. The federal guidelines are clear that Medicaid health homes can be broad in the scope of service – using interdisciplinary teams, emphasizing behavioral health, and providing links for covered enrollees to “community and social support services.”
New York state has clearly made the connection between Medicaid health homes and addressing chronic homelessness. Its application for federal approval explicitly mentions “lack of permanent housing” as an issue to be addressed in its health home population. Housing specialists are considered possible members of interdisciplinary teams in New York and in a number of other Medicaid health home models. All three of the early states have responded to the call for integrating behavioral health with Medicaid health homes. Missouri and Rhode Island are building on their existing infrastructures; community mental health centers will serve as health homes for their Medicaid enrollees with severe mental illness.
This could be good news, and something to watch, for advocates working to end chronic homelessness. However, better service coordination does not have to depend on a Medicaid health home designation. In many communities and service networks, leaders in housing and health care are taking stock and creating betters ways of working together to make supportive housing a sustainable solution. Often, the process begins by getting everyone on the same page about recent changes in policies and programs. Have you had a conversation with your community partners about what’s new in your state? There may be ways to leverage new resources together, to improve how vulnerable homeless people experience their systems of care.
The Alliance is on the lookout for best practices in integrating housing solutions with changes in the health care system. Let us know what’s happening in your community. We are also keeping track of new and improved policy approaches, as the Affordable Care Act is implemented. If you want more information on health homes and related Medicaid strategies, check out the Integrated Care Resource Center and the Safety Net Medical Home Initiative. Take another step: Advocate! Make sure your leaders in state health policy are using this important information as well.