Housing and Services Partnership Accelerator

Program Overview

Advancing Housing Stability and Community Living through 

State and Community Partnerships for People with Disabilities and Older Adults 

Who Are at Risk of or Are Experiencing Homelessness

Background

A growing number of states are leveraging new opportunities and flexibilities under 

Medicaid, new federal housing resources, and expanded opportunities under the Older 

Americans Act (OAA) to cover a range of services and supports that help people find, 

obtain, and maintain their housing. The Housing and Services Partnership Accelerator 

(HSPA) is an opportunity for states with an approved section 1115 demonstration or an 

approved section 1915(i) state plan benefit covering housing-related supports and 

services for individuals experiencing or at risk of experiencing homelessness to 

strengthen their state Medicaid agency collaboration with agencies providing housing, 

aging and disability resources and programs. HSPA seeks to help states accelerate and 

improve their service delivery and effectiveness at reducing potentially avoidable, highcost services such as emergency room visits and institutional care and to improve 

physical and mental health outcomes for Medicaid beneficiaries. The coordination of 

housing assistance and wrap-around supportive services—such as in the form of 

supportive housing—is a proven, cost-effective approach to assisting people with 

disabilities and chronic/complex health conditions to transition from homelessness, exit 

or avoid institutional settings, and live in the community.
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Implementation of these new Medicaid-covered housing-related services and supports 

remain in the early stages, and many states have expressed interest in receiving 

greater support with implementation including through knowledge exchange with other 

states. The HSPA responds to states’ requests for assistance to tackle a common set of 

issues, including payment models and rates; alignment with federal and local housing 

assistance programs; provider capacity; partnerships with health organizations, 

community-based organizations and housing agencies; and data integration/sharing. 

States have a unique opportunity to take a whole-of-government approach to address 

housing stability by emphasizing greater collaboration and coordination across state 

and local health and housing agencies and community-based organizations to optimize 

resources, cover resource gaps, align state and local policies, and deliver more 

integrated and seamless services.

The HSPA is an activity being carried out by the Housing and Services Resource 

Center (HSRC), which is a partnership among the U.S. Department of Health and 

Human Services (HHS), the U.S. Department of Housing and Urban Development 

(HUD), and the U.S. Department of Agriculture (USDA) to improve access to affordable, 

accessible housing and the critical services that make community living possible. Within 

HHS, this partnership is led by the Administration for Community Living (ACL) and 

includes the Administration for Children and Families (ACF), the Centers for Disease 

Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), 

the Substance Abuse and Mental Health Services Administration (SAMHSA), and the 

Office of the Assistant Secretary for Planning and Evaluation (ASPE). The Health 

Resources and Services Administration (HRSA) is also supporting complementary 

efforts to fund technical assistance to states to support the development and 

implementation of sustainable financing of health and housing programs.

Overview of Accelerator Opportunity

The goal of the HSPA is to provide technical assistance and support to states to 

accelerate the development and implementation of innovative state strategies to provide 

housing-related activities and supports to persons with disabilities and/or older adults 

who are experiencing or are at risk of experiencing homelessness. The HSPA will bring 

together states with an approved section 1115 demonstration or section 1915(i) state 

plan benefit covering housing-related supports and services for people experiencing or 

at risk of experiencing homelessness who are interested in effectively implementing, 

expanding, or improving the delivery of these services and strengthening the necessary 

housing and community-based organization partnerships needed to achieve state goals. 
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HSPA is a 12-month technical assistance program that will leverage federal 

collaboration to support selected states by providing them with individualized technical 

assistance and the opportunity to learn from peer states through facilitated sharing of 

information, resources, best practices, and lessons learned. HSPA will select up to 4 

states to participate in the technical assistance program. 

CMS identifies the following categories of housing-related activities and supports as 

described in the January 2022 State Health Official letter on Social Determinants of 

Health:

1) Home Accessibility Modifications – Temporary or permanent changes to a 

home’s interior or exterior structure to improve individuals’ ability to remain in 

their homes and communities.

2) One-Time Community Transition Costs – Non-recurring set-up expenses for 

individuals transitioning from an institutional or another provider-operated 

congregate living arrangement (such as a group home or homeless shelter) to a 

community-based living arrangement in a private residence where the person is 

directly responsible for his or her own living expenses.

3) Housing and Tenancy Supports – Includes both pre-tenancy services, which 

assist individuals to prepare for and transition to housing, and tenancy sustaining 

supports, which are provided once an individual is housed to help the person 

achieve and maintain housing stability.

What Is the Benefit to Selected States?

Participating state Medicaid agencies in collaboration with their state and local housing 

partners and relevant disability and aging networks, health, and behavioral health 

system partners -- will have the opportunity to expand their knowledgebase around 

delivering effective housing-related supports and services, increasing collaboration and 

coordination across state and local health and housing agencies, covering resource 

gaps, and advancing ways to deliver seamless services to individuals experiencing or at 

risk of experiencing homelessness. 

Accelerator topics may include the following areas based on identified state technical 

assistance needs: 

• Strategies for creating new partnerships/strengthening existing partnerships 

between Continuums of Care (CoC) and other housing entities, aging and 

disability network organizations, and state Medicaid agency/operating agency(s) 
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• Braiding funding from CoCs, public housing authorities, Medicaid, and other 

funding for health and community living to link/connect people to housing 

resources and supportive services and/or to create supportive housing models 

• Services and benefits design (e.g., Assertive Community Treatment, community 

support programs, peer support services, etc.)

• Developing medical appropriateness or needs-based criteria based on health 

and social risk factors for Medicaid housing-related services

• Best practices in contracting with managed care organizations and community 

care hubs with aging, disability, health, behavioral health and housing 

organizations

• Strategies for service delivery and billing in fee-for-service environments

• Payment models and rate-setting, including bundled payment models (e.g., per 

member per month rates, case rates) and other value-based purchasing 

strategies 

• Creating flexible funding pools to cover housing and supportive services/activities 

not covered under the Medicaid program 

• Aligning/coordinating housing assistance matching (e.g., via Coordinated Entry 

Systems, PHA waitlists, and other housing waitlists) and eligibility/approval for 

Medicaid housing-related services and supports with consideration to disability, 

aging and health organizations that support individuals 

• Building disability, aging, health, behavioral health, and supportive housing 

provider network capacity to deliver, track, and receive payment for Medicaid 

housing-related services 

• Data strategies to identify and prioritize individuals for housing and services, 

including establishing data use agreements and cross-system data matching and 

other infrastructure at multiple levels: system, network, and service provider

• Strategies to implement a partnership with a PHA to administer short-term rental 

assistance covered under Medicaid and to seamlessly transition an individual 

from short-term rental assistance to a federal rental assistance program 

• Strategies to support persons with disabilities and older adults to transition from 

hospitals, nursing homes or institutions to stable housing in the 

community through aging, disability, health, behavioral health, and housing 

partnerships

• Evaluation methods to assess the performance and impact, including on 

measures of equity, of housing-related activities/supports 

• Approaches in rural areas 

• Scaling up existing pilot or geographically-based programs 

• Other topics as identified by states
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Accelerator Components 

This Accelerator begins in January 2024 and runs for 12 months through December 

2024. Each state will participate in the following activities: 

• One virtual kick-off meeting;

• State needs assessment;

• One in-person meeting (up to 3-day) in the Washington, DC, area with ACL, 

CMS, SAMHSA, ASPE, HRSA, HUD, and subject matter experts (travel 

expenses will be covered for HSPA state team members);

• 2 Peer-to-Peer Learning Tracks with up to 4 (90-minute) sessions each;

• One-on-one state coaching support from housing and services subject matter 

experts;

• Final close out webinar on lessons learned and next steps.

States teams are expected to dedicate at least one key staff from each of the Core 

Team member entities to participate in each of the above-listed activities and at least 

one key staff from every participating agency or organization listed on the application. 

Additionally, states may want to dedicate some time in between sessions to debrief on 

their learnings and share with others within their state. 

Participant Eligibility & Team Requirements

Only states with approved section 1115 demonstrations or section 1915(i) state plan 

benefits that include the coverage of housing-related supports and services for 

individuals experiencing or at risk of experiencing homelessness are eligible to apply 

and only one application per state will be accepted.

Participating states will be required to form a core team of representatives from their 

state Medicaid agency, a state housing agency, and state service agencies relevant to 

the intended target populations for housing-related services (e.g., state unit on aging, 

state agency that administers programs or advocates for people with disabilities, state 

behavioral health agency), as well as representative/s from housing/homeless and 

aging and disability networks organizations.

States may engage with a wide range of partners during the HSPA but only require a 

few core partners for the initial application. Each state’s application will identify a team 

comprised of representatives from each of the sectors below with a designated lead 
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state agency or organization and must explain their current progress, need for technical 

assistance, and intended areas of focus. States are highly encouraged to have their 

state Medicaid agency apply as the lead applicant, but it is not required. If the lead 

applicant is not the state Medicaid agency, the lead applicant must obtain a letter of 

commitment from their state Medicaid director. 

Required core team members: 

1) state Medicaid Agency; 

2) state and/or local aging agency/organizations; 

3) state and/or local disability agency/organizations; and 

4) state and/or local housing and homeless agency/organizations. 

These may include, but are not limited to: 

Aging and Disability Network Organizations:

• Aging and Disability Resource Centers – These centers provide information and 

counseling to help individuals make informed decisions about long-term services 

and supports.

• Area Agencies on Aging – These agencies address the needs of older adults at 

the regional and local level through services and supports (like home-delivered 

meals and homemaker assistance) to support independent living.

• Assistive Technology – These programs support making assistive technology 

devices and services more available and accessible to individuals with disabilities 

and their families.

• Centers for Independent Living – These centers provide tools, resources, and 

supports for integrating people with disabilities fully into their communities to 

promote equal opportunities, self-determination, and respect.

• Protection and Advocacy Systems – These state systems work to protect 

individuals with disabilities by empowering them and advocating on their behalf to 

defend their personal and civil rights.

• Senior Centers and Supportive Services for Older Adults – This program 

provides grants to states and territories that fund multi-purpose senior centers 

that coordinate services for older adults, such as congregate meals, community 

education, health screening, exercise and health promotion programs, and 

transportation. 

• State Councils on Developmental Disabilities – These self-governing 

organizations identify and address the most pressing needs of people with 
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developmental disabilities in their state or territory through conducting advocacy, 

facilitating systems change, and capacity building efforts to promote selfdetermination, integration, and inclusion.

• State Units on Aging – These state-level agencies develop and administer plans

to provide assistance for older adults, families, and in many states, adults of any

age with physical disabilities.

• University Centers for Excellence in Developmental Disabilities – These grants

are affiliated with universities to serve as liaisons between academia and the

community for advancing research, information sharing, and community

services.

Housing & Homeless Services Network Organizations:

• State Housing Finance Agencies – State-chartered authorities that help finance

the development of affordable housing, including administering state allocations

of the federal Low Income Housing Tax Credit Program and housing bonds.

They also administer HUD’s HOME Investment Partnerships and Section 811

Supportive Housing Program for people with disabilities.

• Continuum of Care (CoC) Programs – The Continuum of Care (CoC) Program is

designed to promote community-wide commitment to the goal of ending

homelessness; provide funding for efforts by nonprofit providers, and State and

local governments to quickly rehouse homeless individuals and families while

minimizing the trauma and dislocation caused to homeless individuals, families,

and communities by homelessness; promote access to and effect utilization of

mainstream programs by homeless individuals and families; and optimize selfsufficiency among individuals and families experiencing homelessness.

• Homelessness Assistance Programs – Homelessness assistance programs

provide funding to States and local governments and nonprofit providers to serve

individuals and families across the United States who are affected by

homelessness.

• Public Housing Agencies – Public housing was established to provide decent and

safe rental housing for eligible low-income families, the elderly, and persons with

disabilities. Public housing comes in all sizes and types, from scattered singlefamily houses to high rise apartments for elderly families. There are

approximately 1.2 million households living in public housing units, managed by

some 3300 PHAs.
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• Municipal and county government housing agencies – Municipal and county 

government agencies help finance the development of housing. They also 

administer federal housing capital programs like HOME, CDBG, as well as local 

housing resources.

• Multifamily Affordable Housing Owner, Operators, & Developers – Housing 

owners, operators and developers create and manage affordable housing units 

that can be a resource for individuals and families experiencing homelessness. 

National intermediaries such as LISC, CSH, Enterprise Community Partners, and 

local departments of planning and housing and community development can help 

connect communities to affordable housing providers.

In addition to required Core Team members, states may also include and are highly 

encouraged to invite eligible partners such as their Single State Agency (SSA) for 

Substance Abuse Services and State Mental Health Agency (SMHA), community care 

hubs (CCH),managed care organizations (MCOs), state or local public health agencies,

federally qualified health centers (FQHCs), certified community behavioral health clinics 

(CCBHCs), hospitals and health systems, behavioral health providers, communitybased organizations, (CBOs) and other service providers to be a part of their teams. 

Priority will be given to states with the most robust partnerships across state and local 

agencies in the housing, disability, aging, and health sectors. 

Selection Criteria and Timeline

The goal of the HSPA is to provide technical assistance and support to states to 

accelerate the development and implementation of innovative state strategies to provide 

housing-related activities and supports to persons with disabilities and/or older adults 

who are experiencing or are at risk of experiencing homelessness, and who are 

receiving services under Centers for Medicare & Medicaid Services (CMS) an approved 

section 1115 demonstration or section 1915(i) state plan benefit. Each state will submit 

a simple letter of Intent (LOI) to apply, a full application, and the top-rated states will be 

invited to participate in an individual state interview with an interagency panel of federal 

partners as part of the application process. Using information gathered through these 

application processes, the following criteria will be used to select participating states: 

• Evidence of well-established and currently active Medicaid, community living, 

and housing partnerships that provide a foundation for implementing housingrelated services and supports;
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• Approved section 1115 demonstration or 1915 (i) covering housing-related 

services and supports for individuals experiencing or at risk of experiencing 

homelessness

• Clearly identified goals and detailed strategies to improve or expand housing and 

services for the state’s target population(s) of persons with disabilities, older 

adults, and persons at risk for or experiencing homelessness 

• Clear articulation of technical support needs and the specific outcomes the state 

wants to achieve with the HSPA technical support;

• Designation of a staff member from the Medicaid agency who will serve will have 

the time and resources necessary to be responsible for the day-to-day activities;

• Identification of a core team that includes: a state Medicaid agency 

representative, a state/local housing representative, an aging network 

representative, and a disability network representative;

• Degree to which the team includes cross-sector representation from state and 

local agencies in housing, disability, aging, and health;

• Alignment of goals with other relevant housing and service activities in the state 

(e.g., state plan for addressing developmental disabilities, state aging plan, state 

plan for independent living, relevant SAMHSA grant activities, State Opioid 

Response Task Forces, plans to end homelessness, etc.); 

• Alignment of technical support goals with other housing and service activities in 

the state;

• Capacity and readiness to begin work immediately upon selection for HSPA;

• Acknowledgement from the State Medicaid Director or letter of support if lead 

agency/organization is not the state Medicaid agency;

• Assurance that team members will have sufficient time and resources for the 

duration of the track necessary to achieve success with this effort.

Important Dates

Date Activity

October 30 Application released

November 13 HSPA Information Session 

November 15 Initial LOI (while LOIs are not required they are helpful for 

planning application receipt and review process)

November 15 – 21 Scheduling interviews

December 1 Application deadline
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Date Activity

December 1-4 Applications vetted for minimum requirements

December 4-5 Selection committee scores vetted applications

December 6-14 Interviews of highest rated state applicants

December 15 Selection committee meets to discuss interview and 

composite scoring and recommendations

December 18 Full HSPA team meets to discuss composite scores and 

make final selections

December 19 States notified

December 20 State deadline to accept

December 21 Selections announced

How Do Interested States Apply for Technical Assistance?

Interested states are asked to submit a simple letter of intent to assist with application 

receipt and review planning. For best consideration, states are asked to submit the

simple letter of intent to ACL by midnight (EDT) on November 15, 2023, online on 

the HSPA web page at: ACL.gov/HousingAndServices/Accelerator.

Please also direct any questions to HSRC@acl.hhs.gov.

Applications are due to ACL by midnight (EDT) on December 1, 2023. The full

application can be found online on the HSPA web page here.