# Presentation: 683179

## Strategies that Work

- “Improving access to mainstream health and human services that are coordinated with housing for persons who are chronically homeless”
- Ann O’Hara
- Technical Assistance Collaborative, Inc.

## 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

## 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

## 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 don’t close housing affordability gap

## State by State – SSI as Percent of Median Income in 2002

- State by State housing affordability “gap”
- Delaware – 14.0%
- Iowa – 17.4%
- Louisiana – 23.6%
- Maryland – 12.8%
- North Dakota – 20.0%
- Ohio – 16.6%
- Vermont – 21.1%
- West Virginia – 25.1%
- Wisconsin – 18.2%

## State by State – 30% of SSI Income

- State by State housing affordability “gap”
- Delaware - $165
- Iowa – $164
- Louisiana – $164
- Maryland – $164
- North Dakota – $164
- Ohio – $164
- Vermont – $181
- West Virginia – $164
- Wisconsin – $189

## 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

## 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

## 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

## “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

## 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

## 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

## 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

## 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

## 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