Administration for Community Living

Administration on Disabilities (AoD)

Turning Resources into Action: Increasing 

Integrated Housing Options for People 

with I/DD

May 11, 2023

4:00 PM – 5:30 PM
WELCOME
3
4

HSRC@acl.hhs.gov
OPENING REMARKS
INTRODUCTION OF THE 

SPEAKERS
Opportunities to Strengthen Health and Housing under 

Medicaid Home and Community-Based Services Programs

This communication was printed, published, or produced and disseminated at U.S. taxpayer expense. The information provided in this document is intended only to be a 

general informal summary of technical legal standards. It is not intended to take the place of the statutes, regulations, or formal policy guidance that it is based upon. This 

document summarizes current policy and operations as of the date it was presented. We encourage readers to refer to the applicable statutes, regulations, and other 

interpretive materials for complete and current information.

Martha Egan, Technical Director

Division of Community Systems Transformation 

Disabled and Elderly Health Programs Group 

Center for Medicaid and CHIP Services

Centers for Medicare & Medicaid Services
Home & Community-Based Services (HCBS)

• Examples of Medicaid HCBS

—Personal care services

—Home health services

—Rehabilitative services, which may include HCBS

—HCBS waiver programs (section 1915(c))

—State plan HCBS (section 1915(i))

—Self-directed personal assistance services (section 1915(j))

—Community First Choice (section 1915(k))
Opportunities for States to 

Enhance, Expand, or Strengthen HCBS

Section 9817 of the American Rescue Plan Act of 2021 (ARP)

• Provides qualifying states with a temporary 10 percentage point increase to the federal medical 

assistance percentage (FMAP) for HCBS

• State Medicaid Director Letter (SMDL) released on 5/13/2021 provides guidance on implementation of 

ARP section 9817, including the requirements that: 

– funds from the increased FMAP must supplement, not supplant, existing state funds expended 

for Medicaid HCBS; and

– states must use the increased funds to implement or supplement activities to enhance, expand, 

or strengthen HCBS.

• SMDL is available at https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf

10
Opportunities for States to 

Enhance, Expand, or Strengthen HCBS (Con’t)

Money Follows the Person Demonstration (MFP)

• Provides eligible Medicaid beneficiaries who live in institutions the opportunity to transition to the 

community

• Consolidated Appropriations Act, 2021 made several changes to the MFP demonstration to advance 

MFP program progress

• Consolidated Appropriations Act, 2023 extended MFP through federal fiscal year 2027

• MFP Supplemental Services

• MFP Capacity Building Funding Opportunity
Medicaid.gov Resources

• CMS State Health Officials Letter: Opportunities in Medicaid and CHIP to 

Address Social Determinants of Health (SDOH)

• Long-Term Services and Supports Rebalancing Toolkit

• State Medicaid Director Letter (#21-003): Implementation of American Rescue 

Plan Act of 2021 Section 9817: Additional Support for Medicaid Home and 

Community-Based Services during the COVID-19 Emergency

• Money Follows the Person

• SUPPORT Act Innovative State Initiatives and Strategies for Providing HousingRelated Services and Supports: Sections 1017 and 1018

• Medicaid Innovation Accelerator Program State Medicaid-Housing Agency 

Partnerships Toolkit
Turning Resources into Action

Lisa Coffman – HUD

May 11, 2023

12
HUD’s Homeless Assistance Programs

• Continuum of Care (CoC) Program—(FY22 $2.8 billion) awarded through annual competition. 

Projects are ranked and awarded as part of a community entity also called a CoC. Program components 

include Permanent Supportive Housing (PSH), Rapid-Rehousing (RRH), Supportive Services (SS).

• Emergency Solutions Grants (ESG)—(FY21 $290 million) Distributed by formula to states and 

localities. Program components include street outreach, emergency shelter, homelessness prevention 

(HP), RRH, and HMIS; as well as administrative activities.

• ESG-CV—($3.96 billion CARES Act funding in 2020) 100% of funds must be expended by September 30, 

2023. Same program components as ESG.

• Youth Homelessness Demonstration Program (YHDP) – Since 2016 HUD has awarded $368 

million to 94 communities developing and implementing a coordinated community approach to 

preventing youth homelessness
HUD’s Homeless Assistance Programs (Con’t)

• Housing Opportunities for Persons with AIDS (HOPWA)—(FY22 $450 million) Distributed by 

formula to eligible cities, states, and nonprofit organizations to provide housing assistance and 

supportive services to low income people with HIV and their families

• HOPWA-CV—($65 million CARES Act funding in 2020) – Grantees have a three year period of 

performance. Same activities as HOPWA
A Continuum of Care (CoC) is a regional or local 

planning body that coordinates housing and services 

funding for homeless families and individuals.

The CoC is designed to promote community-wide 

planning and strategic use of resources to address 

homelessness and improve coordination and 

integration with mainstream resources and other 

programs targeted to people experiencing 

homelessness.

Continuum of Care Program
Continuum of Care Process

• CoCs run local competitions to select and rank 

projects for their consolidated application

• HUD awards projects based mostly on the order 

in which CoCs rank them and HUD has grant 

agreements with individual recipients for each 

project

• The amount of funding a CoC receives depends 

on:

• A formula for the geographic area covered by 

the CoC

• The amount of funding needed to renew all 

projects in the CoC for one year

• How well the CoC scores in the competition

16
Continuum of Care Program

Operations and Eligible Activities

17

Each year, HUD competitively awards over 

$2 billion to about 400 CoCs across the country

CoCs allocate funding to nonprofit organizations, 

State and local governments, and Public Housing 

Agencies (PHAs) within their jurisdiction to fund 

specific projects

Permanent Housing

Community-based 

housing without a limit 

on length of stay

• Permanent Supportive 

Housing

• Rapid Re-Housing

Transitional Housing

Time-limited housing 

with supportive services, 

with a goal of moving 

household to permanent 

housing within 24 

months

Other Eligible 

Activities

• Supportive services 

only

• Homeless Management 

Information System 

(HMIS)

• Homelessness 

prevention (high 

performing 

communities only)
Eligible Emergency Solutions Grants Activities

➢ Street Outreach

➢ Emergency Shelter

➢ Renovation

➢ Essential Services

➢ Shelter Operations

➢ Relocation Assistance

➢ Homelessness Prevention

➢ Housing 

Relocation/Stabilization

➢ Short/Medium Term Rental 

Assistance

➢ Rapid Re-Housing

➢ HMIS

➢ Administration (7.5%)
Eligible Youth Homelessness Demonstration Program Activities

➢ Permanent Housing

➢ Transitional Housing

➢ HMIS

➢ Supportive Service Only

➢ Host Homes and Kinship Care

➢ Shared Housing

➢ Planning
Eligible HOPWA Activities

➢ Facility-based and scattered-site 

emergency, transitional, and 

permanent housing

➢ Short-term rent, mortgage, and 

utility assistance to prevent 

homelessness

➢ Permanent housing placement

➢ Housing information services

➢ Supportive services

➢ Resource identification

➢ Administration (by statute, 3% for 

grantees and 7% for project 

sponsors)
Find Out More in Your Area
Questions and Resources

• Search for local grant recipients and/or programs

https://www.hudexchange.info/grantees/

• Get future funding opportunities by joining CPD’s listserv, go to 

https://www.hudexchange.info/mailinglist/

• Submit Questions to the HUD Exchange Ask-A-Question at: 

https://www.hudexchange.info/get-assistance/my-question/

www.hudexchange.info
Mainstream & Other Housing 

Choice Voucher Programs
Who Uses Housing Vouchers?

About 5 million people in 2.4 million households

30%

25%

32%

13%

Non-Elderly 

people with 

disabilities

Other 

households

Families with 

children

Older adults, 

incl. those with 

disabilities 

(“elderly”)
Housing Choice Vouchers Are Flexible

• Eligible households use HCVs to rent private market units

• Portable

• May be “project-based,” i.e., tied to specific supportive 

housing or other developments

• Shared housing with other assisted or unassisted families

• Live-in aides allowed as reasonable accommodation 

25
Housing Choice Voucher Programs

26

HCV Program Authorized Leased

Mainstream 69,017 52,028

Non-Elderly Disabled (NED) 54,727 46,666

VA-HUD Supportive Housing 108,515 78,975

Emergency Housing Vouchers 70,000 51,843

All Other HCVs 2,502,949 2,147,735

Total 2,805,208 2,377,247
Mainstream Voucher Program

• Only non-elderly people with disabilities are eligible.

• Other than household eligibility requirement above, 

Mainstream vouchers follow the same program policies as 

the regular tenant-based voucher program. 

• Funding and financial reporting for Mainstream vouchers 

are separate.

27
Recent Mainstream Funding Allocations

• Congress appropriated ~$500 million in new funding for new 

Mainstream vouchers in 2017, 2018, and 2019. 

• Through NOFAs in 2018 and 2019 and non-competitive 

awards in 2020-22, HUD awarded 56,000 new vouchers

• For list of PHA awards and other data, see HCV Data 

Dashboard: 

https://www.hud.gov/program_offices/public_indian_housing

/programs/hcv/dashboard

28
Mainstream NOFA PHA Rating Factors

1. Experience assisting people with disabilities and established partnerships with state 

Medicaid agencies (e.g., MFP), homeless assistance providers, health and human 

services agencies

2. Admissions preference for one of following:

• Transitioning out of institutional or other segregated settings

• At risk of institutionalization

• Homeless

• Previously experienced homelessness and is a resident of permanent supportive housing 

or a rapid rehousing program

• At risk of homelessness

3. Ability to connect assisted households with housing and community-based services

4. Program evaluation and improvement

29
Resources

• HUD’s Mainstream Voucher page: Mainstream Vouchers | 

HUD.gov / U.S. Department of Housing and Urban 

Development (HUD) 

• PIH Notice 2020-01: Revised Policies and Procedures for the 

Mainstream Voucher Program

• Topic guides: 

https://www.hudexchange.info/resource/6548/mainstreamvoucher-topic-guides/

• Submit your questions to MainstreamVouchers@hud.gov.

30
Section 811 Supportive Housing for 

Persons with Disabilities Program

Office of Multifamily Housing Programs

U.S. Department of Housing and Urban Development
32 Office of Multifamily Housing Programs

Program Purpose

• Created to provide housing by 

developing affordable integrated 

housing options for these 

vulnerable populations.

• Provides integrated, permanent 

supportive housing for nonelderly persons with disabilities 

through a state level housing and 

services partnership.

• Target populations = people living 

on the streets or in shelters, people 

living in institutions, states with 

settlement agreements.
Goals of the 811 Programs

• Provide persons with disabilities with meaningful choice about housing, health 

care and long-term services and support.

• Fund innovative Section 811 permanent supportive housing models that will be at 

the forefront of design, service delivery and efficient use of federal resources

• Encourage formal partnerships with health and human service agencies or local 

service agencies to coordinate voluntary services and support to enable persons 

with disabilities to live independently.

33 Office of Multifamily Housing Programs
34

Section 811 Programs

Offers two distinct programs

Section 811 Capital 

Advance 

Section 811 

Project Rental 

Assistance

Office of Multifamily Housing Programs
811 Portfolio Snapshot

Assisted Properties by Program

Program Type Property Count Unit

All 811 3,516 35,588

Section 811 PRA 764 5,952

Section 811 Capital Advance 2,752 29,636

35

*Source (1/2023): MPRD/HEREMS

Office of Multifamily Housing Programs
Capital Advance Program

• Provides funding for the development of housing for very-low 

persons with disabilities to non-profit organizations.

• Provides funding for rental assistance to maintain ongoing 

affordability for forty years.

36 Office of Multifamily Housing Programs
Project Rental Assistance (PRA) Program

• Provides funding to state housing agencies for housing assistance for extremely lowincome persons with disabilities.

• Requires the collaboration between the State Housing Agency and the State Health 

and Human Service/Medicaid Agencies.

• Program aims to target homeless or at risk of homeless, people living in institutions, 

states with Olmstead settlement agreements.

37 Office of Multifamily Housing Programs
Who do we serve?

• “Person with disabilities” means a household composed of 

one or more persons who is 18 years of age or older and less 

than 62 years of age, and who has a disability. 

• A person shall be considered to have a disability if such 

person is determined, pursuant to regulations issued by the 

Secretary to have a physical, mental, or emotional impairment 

which is:

➢ expected to be of long-continued and indefinite duration, 

➢ substantially impedes his or her ability to live independently, and

➢ is of such a nature that such ability could be improved by more 

suitable housing conditions

38 Office of Multifamily Housing Programs
Accessing the 811 Programs

Meet the income requirements under the program

• Capital advance, 50% below Area Median Income

• PRA – 30% below Area Median Income

How to Apply

• For 811 Capital Advance – apply directly at the property 

• For 811 PRA – Contact your state housing agency that has received a PRA grant

39 Office of Multifamily Housing Programs
Connection to Services

Section 811 Capital Advance

Must provide a well-develop supportive service plan

• Must be tailored for the population the housing is expected to serve 

• Must use a person-centered approach

• Align with state/local’s approach to expanding community living opportunities for persons 

with disabilities

• Document the implementation and strategies for outreach, referrals, communication, 

transition services, and tenancy supports.

• Outlines partnerships and coordination of services with local service providers.

40 Office of Multifamily Housing Programs
Connection to Services (Con’t)

Section 811 PRA

Must provide an Inter-Agency Partnership Agreement outlining the partnership 

between the State Housing Agency and Health and Human Service/Medicaid Agency

• Description of the target population

• Methods for outreach and referral

• Commitment to make the appropriate services 

• Outlines the available state administered services and how the such services will be 

available to residents.

41 Office of Multifamily Housing Programs
Helpful Resources

• 811 Capital Advance properties

• HUD Resource Locator, https://resources.hud.gov/

• Multifamily Regional Centers and Satellite Offices

• 811 PRA properties

• PRA Program Grantees

42 Office of Multifamily Housing Programs
Arizona Division of Developmental Disabilities
Department of Economic Security - DES

Mission: The Arizona Department of Economic Security makes Arizona stronger by helping Arizonans reach 

their potential through temporary assistance for those in need, and care for the vulnerable.

True North: All Arizonans who qualify receive timely DES services and achieve their potential.

Divisions and Departments of DES:

● Developmental Disabilities (DDD) 

● Aging & Adult Services (DAAS)

● Child Support Services (DCSS)

● Child Care (DCC)

● Arizona Early Intervention Program (AzEIP) 

● Benefits & Medical Eligibility (DBME)

● Employment & Rehabilitation Services (DERS)

● Community Assistance & Development (DCAD)
DDD Mission Statement

The Division of Developmental Disabilities 

empowers individuals with developmental disabilities 

to lead self-directed, healthy, and meaningful lives.
Division of Developmental Disabilities - DDD

DDD provides supports and services to individuals diagnosed 

with developmental disabilities, such as

● Autism, 

● Cerebral Palsy, 

● Epilepsy, 

● Cognitive/Intellectual Disability, 

● Down Syndrome 

DDD currently serves more than 50,000 Arizonans
DDD Membership: Primary Disability

Total Individuals Currently Served: 51,130

as of: April 30, 2023
DDD Functional Limitations Criteria

The disability must result in substantial functional limitations in 

three (3) or more of these (7) major life areas:

1. Self-care: Requires significant assistance in performing eating, hygiene, grooming, or health care skills or the time 

required to perform impacts ability to retain employment or conduct other ADLs.

2. Receptive and Expressive Language: Unable to communicate with others successfully without assistance (AAC; 3rd 

party).

3. Learning: Obtaining & processing of new information (attention factors, acquisition, storage & recovery) and 

unable to participate in age-appropriate activities without using additional resources.
DDD Functional Limitations Criteria Cont’

The disability must result in substantial functional limitations in 

three (3) or more of these (7) major life areas:

4. Mobility: Mechanical device or another person is required for movement from one place to another.

5. Self-Direction: Managing personal finances, protecting self-interest, or making independent decisions.

6. Capacity for Independent Living*: Safety or well-being requires daily assistance or supervision for health & 

housekeeping.

7. Economic Self-Sufficiency*: Unable to maintain regular employment or ability to earn income falls below poverty 

level. 

* Applies to age 18 years and older
DDD Membership: DD Only, Targeted (AHCCCS), Long Term Care 

(ALTCS)

Developmental Disability

DD ONLY

Will receive as DDD Member:

● Support Coordination

(Case Management)

● Person Centered Service 

Plan (PCSP) 180 days

● Community Resources

● Not Medically Eligible for 

ALTCS and not financially 

eligible for AHCCCS

● Responsible for own health 

insurance coverage

Targeted Support 

Coordination (TSC) AHCCCS

Will receive as DDD Member:

● Support Coordination

● PCSP (90, 180 or 365 days)

● Physical Health Care and 

Behavioral Health Care from 1 

of 7 AHCCCS Complete Care 

Programs

● Community Resources

● Financially Eligible for AHCCCS, 

and determined Targeted 

Support Coordination eligible by 

AHCCCS

Long Term Care (LTC) 

ALTCS

Will receive as DDD Member:

● Support Coordination

● PCSP (90 days)

● Physical Health Care and 

Behavioral Health Care from 1 of 

2 DDD Contracted Health Plans 

(Mercy Care or United 

Healthcare Community Plan), or 

the Tribal Health Program (THP)

● Receives Long Term Services 

and Supports based on 

assessed need and medical 

necessity 
DDD Membership

as of: April 30, 2023
DDD Membership: Where They Live

Total Individuals Currently Served: 51,130

as of:April 30,2023
Advocating for our Members

DDD members don’t typically access housing in the same way a member of the 

public would. 

Their vulnerability and functional limitations create barriers to accessing the 

coordinated entry and shelter systems.

This makes creating innovative partnerships and connecting with Public Housing 

Authorities (PHAs), Continuums of Care (COC), and Housing Providers 

imperative.
Affordable Housing In Arizona
National Average of Affordable Housing

https://nlihc.org/oor
DDD Affordable Housing Opportunities

For each of these 

opportunities, members 

pay 30% of their total 

household income for rent. 

Each DDD opportunity 

provides preference to our 

DDD members, which 

means the Division refers 

the members directly to 

the opportunity instead of 

a public waitlist.

811 Project Rental Assistance (811 PRA)

Coffelt-Lamoreaux Apartment Homes 

Mainstream Vouchers Non-Elderly Disabled Vouchers
811 PRA Property
Some Ways Arizona is Accessing Affordable Housing

The 811 Project Rental Assistance Program is a Grant from HUD to the 

Arizona Department of Housing, with the Arizona Health Care Cost 

Containment System, the Arizona Department of Health Services, and 

The Division of Developmental Disabilities as partners

FY13 $2.94 Million

● 55 Units 

FY19 $3,000,499

● Approximately 50 units 
Coffelt-Lamoreaux Apartment Homes
Voucher Programs

Vouchers are set aside for DDD referrals. 

DDD Collects all documents and submits a complete referral packet 

to the housing authorities. 

The individual must be DDD Eligible.

Housing Authority of Maricopa County (HAMC) 

Mainstream Vouchers

City of Tucson Vouchers: Non-Elderly Disabled (NED)
Referral Process Eligibility Requirements

ALTCS Eligible

Member aged 

between 18-62

SC Referral

Current Person 

Centered 

Service Plan 

(PCSP)

CoffeltLamoreaux811 PRA 

Phoenix

811 PRA 

Tucson

811 PRA 

Camp Verde

Tucson 

Vouchers

Tucson 

Vouchers*

Yes Yes Yes Yes Not 

Require

d

Not 

Require

d

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes
Housed by Program
Affordable Housing 811/Coffelt Wait List

Number of People on DDD Waitlist by 

Bedroom Size

Total referrals 459 since the program began

1 Bedroom 72

2 Bedroom 43

3 Bedroom 14

4 Bedroom 4

Total Currently Waiting 133

Longest wait: 2.7 years

Shortest wait: 7 days 

Average wait: 7 months 

from referral to move in
Overall Cost Savings

• From 2017 to April 2023 the Division has saved in 

service costs by members making progressive moves 

into the community. 

• This includes 11 members that made progressive 

moves from group homes and developmental homes..

$2,537,662
Productive Partnerships

How can DDD partner with Housing Providers, Public Housing Authorities, and 

Community Housing Agencies?

• We maintain our own waitlists for our current programs divided by eligibility criteria 

and can refer members off our waitlist directly to vacant opportunities.

• DDD can write letters of support for funding or assist in meeting priority/specialty 

population needs.

• We can provide eligible DDD Members with in-home services and case 

management to support their tenancy 

• Announce public waitlist openings to our case managers to assist members in 

accessing housing opportunities available to the public while by reaching a 

traditionally underserved population.
Advocating for Members

DDD members don’t typically access housing in the same way a member of the public would. 

Their vulnerability and functional limitations create barriers to accessing the coordinated entry and shelter 

systems.

This makes creating innovative partnerships and connecting with Public Housing Authorities (PHAs), 

Continuums of Care (COC), and Housing Providers imperative.
Member Success Stories by Lyn Riley

“The excitement of Blue’s new 

home is contagious. Zamora ticks 

off a list of attributes: “It’s 

huge. It’s really beautiful. It’s 

bright. The neighborhood is nice 

and very well maintained.” 

Another plus is having a clean 

slate on which to design your 

home to fit your personality.”

“Blue receives habilitation services from Leticia Salieda, a caregiver with 

DDD contracted provider Sonora Sky Community Services. The 

habilitation services help to improve Blue’s cooking, money and 

community safety skills. According to Zamora, “Leticia is a great help.”
Angie lives with her 

brother who helps her 

budget and pay bills. 
Interview with Anderson Moore
Office of Individual and Family Affairs

Megan Akens, MPA

Affordable Housing Program

DDDHousingGeneralInfo@azdes.gov

1-844-770-9500
Thank You!
QUESTIONS?

Please use the chat box to ask your question
CLOSING & CALL FOR 

IDEAS
THANK YOU