MRT Affordable Housing Work Group

1. Redesign Medicaid in New York State MRT Affordable Housing Work Group March 28, 2013 – 10:00 AM to 1:30 PMNew York State Department of Health Albany, New York

2. Goals for Today • Budget Recap • Jason Helgerson, Medicaid Director, Department of Health • Medicaid Tracking Overview: Salient • Rebecca Corso, Department of Health • Moving On Initiative • Connie Tempel, Corporation for Supportive Housing • Social Impact Bonds • Ryan Moser, Corporation for Supportive Housing Medicaid Redesign Affordable Housing Work Group 2

3. Enacted 2013-14 Budget Update Presented by Jason Helgerson

4. Enacted 2013-14 Budget Update • Supportive Housing • $86 million in 2013-14 ($5 million reduction from proposed budget) • $70 M base funding in 2013-14: $75 M in 2014-15 • $12.5 M in new funding: The budget allows for flexibility to restore as soon as resources are available. • $3.8 million from hospital and nursing home bed closures in 2013-14.

5. Enacted 2013-14 Budget Update: Supportive Housing Funding will support: • Capital funding to expand supportive housing units for high cost Medicaid Populations; • Continued rental subsidies and supports funded in 2012-13; and • The creation of seven new pilot projects to test new supportive housing models.

6. Salient Tracking Presented by Rebecca Corso

7. Salient Tracking • One goal of the MRT Supportive Housing initiative is to improve health outcomes for high Medicaid users. • Assumption that providing supportive housing will result in lower Medicaid costs. • Supportive Housing Data Collection Tool will track users of Supportive Housing programs supported by MRT. • Tool will allow for evaluating the program’s effectiveness in reducing Medicaid costs. Medicaid Redesign Affordable Housing Work Group 7

8. Salient Tracking The Tool is an Excel Spreadsheet. Data to be entered by providers includes: • Recipient ID (Medicaid Client Identification Number) • Social Security Number • Name (first, middle initial, last) • Date of Birth • Gender • Housing Program • Member Supportive Housing Begin Date • Member Supportive Housing End Date • State Agency Medicaid Redesign Affordable Housing Work Group 8

9. Salient Tracking • Agencies administering MRT supportive housing initiatives will be responsible for working with providers to complete the tool. • Providers will be required to submit data monthly to their administering agency. • Agencies will review submitted data and follow-up with providers on any incomplete or incorrect information. • Agencies will submit completed data into the Medicaid Data Warehouse. Medicaid Redesign Affordable Housing Work Group 9

10. Salient Tracking • NYSDOH will draw down the data from the data warehouse using Salient. • NYSDOH will gather historical Medicaid claiming for individuals included in the tracking tool and will track future Medicaid spending after entering the MRT supportive housing initiative. Medicaid Redesign Affordable Housing Work Group 10

11. Salient Tracking Providers are responsible for ensuring the security of data. • The Tool must be password protected • Only those that require access to the data should know the password. • When submitting the data to your administering agency, do not send the password in the same e-mail as the Tool. Send it in a separate e-mail. • Files should be encrypted • Download encryption software, such as WinZip • Administering agencies will provide instructions for password protecting and encrypting files when they send the tool to providers. Medicaid Redesign Affordable Housing Work Group 11

12. Salient Tracking Other security measures: • Create secure directories on network. • Maintain a clean desk – Remove paper records that includes confidential data and secure paper records in a locked area. • Clear the screen – Lock screens when leaving workstations and orient screens containing confidential information away from individuals passing by the workstation. • Only authorize access on a need-to-know basis. Medicaid Redesign Affordable Housing Work Group 12

13. Salient Tracking • Data tracking is a critical component of the MRT supportive housing initiative. • Tracking recipients will allow us to prove the cost effectiveness of the MRT supportive housing initiative. • Savings generated from the initiative can be reinvested in supportive housing programs. Medicaid Redesign Affordable Housing Work Group 13

14. What is Moving On? • Enabling stable tenants of single site supportive housing who no longer need on-site services to move to a private apartment with rental support and after care. • Backfilling vacated supportive housing units with targeted tenancy. Medicaid Redesign Affordable Housing Work Group 14

15. Moving On Initiative Presented by Connie Tempel

16. Why Moving On? • Goal of supportive housing is to promote highest level of independence and choice. • Providers can serve targeted individuals in need of supportive housing services, in alignment with MRT goals. • Targets scarce resources (supportive housing) to those who need it most when they need it most. • Increases supportive housing capacity without new construction. • Consistent with Recovery/Wellness model. Medicaid Redesign Affordable Housing Work Group 16

17. Moving On - NYC • Ten years ago few, if any, resources or incentives existed for moving people on. • 2003 with funding from RWJF, CSH-NY worked with DHS and HPD to provide more appropriate permanent housing opportunities resulting in CSH sponsored Moving On Initiative from 2004-2006. • 2006, The Network found that 40% of SH tenants capable of moving on. • 2007-2009, DHS created Moving On Initiative. • 2009-2012, CUCS ran pilot accessing 80/20 units. Medicaid Redesign Affordable Housing Work Group 17

18. Key CSH Program Components Moving Out • Voluntary, based on tenant interest • Single stable tenant with no arrears • Four providers were designated as “moving on” agencies to identify tenants and provide aftercare services • CUCS trained case managers to prepare tenants to move • CUCS provided tenants apartment locater services • Small moving on grants were provided to meet moving costs • HPD provided Section 8 vouchers and a liaison • OMH facilitated assigning tenants to mental health clinics • OMH, HPD, DHS, CUCS and CSH provided interagency coordination and troubleshooting Medicaid Redesign Affordable Housing Work Group 18

19. Key CSH Program Components Moving In • Long-term shelter stayers • Had to meet building program eligibility • Shelters matched with providers • Shelter operators oriented to SH with bus tours • Interagency coordination and troubleshooting Medicaid Redesign Affordable Housing Work Group 19

20. Participant Demographics - Move Outs (CSH) • 100 tenants moved out of 133 engaged • 766 days average length of homelessness prior to supportive housing • 67% living in Project-Based Section 8 units • 22.8% living in unsubsidized units • Mix of NY/NY, formerly homeless, low-income units Medicaid Redesign Affordable Housing Work Group 20

21. Moving Out from Where? Medicaid Redesign Affordable Housing Work Group 21

22. Where Did They Go? • More moved to Brooklyn • 25% moved to a different borough than their supportive housing unit. • 88.1% moved to a private market apartment. Medicaid Redesign Affordable Housing Work Group 22

23. DHS Moving On Initiative • DHS Initiative Program Components: • Section 8 • $2,000 bonus per placement to providers • Units backfilled with long-term shelter stayers Medicaid Redesign Affordable Housing Work Group 23

24. DHS MOI Outcomes The Network’s analysis found: High Demand • 1,118 tenants applied Acceptance Rate • 58% accepted • Main reasons for rejection were background check, exceeded income limits, and didn’t meet tenancy requirements (one year in housing) Low Moving On Rate • 19% (209 individuals) moved on Medicaid Redesign Affordable Housing Work Group 24

25. MOI DHS Challenges 909 Tenants Engaged • 189 rejected (20.8%) • 216 in process when initiative ended • 61 certified but never received voucher • 443 received voucher but never moved Issues • Lack of housing placement resources • Landlord reluctance • Lack of accessible apartments • Tenants opt to not move = other housing options not as attractive (location) concern over losing services and community DHS also stated that: • Providers reluctant to move out stable tenant and have unit filled with less stable tenant, according to DHS Medicaid Redesign Affordable Housing Work Group 25

26. CUCS 80/20 Pilot • 13 units set-aside by developers • 76 applicants received • 9 units filled • Finding applicants who felt they were ready to move and met all eligibility requirements was difficult • Loss of Section 8 vouchers hampered progress • All 9 housed at end of project • Optional aftercare helped applicants consider moving on • Many found financial counseling helpful and informative • Prescreening helped tenants prepare for formal screening Medicaid Redesign Affordable Housing Work Group 26

27. Moving On Pilots Beyond NYC • New and growing interest in replicating Moving On model: NAEH, USICH, Connecticut, Los Angeles • Chicago : In partnership with Chicago Housing Authority, CSH launched May 1, 2012 • Coordinated assessment to determine moving out • Moving in – referrals from Central Referral System and/or CHA Waitlist • 2nd Moving On Initiative in Chicago now in progress Medicaid Redesign Affordable Housing Work Group 27

28. Moving On Assessment Tool: Chicago Medicaid Redesign Affordable Housing Work Group 28

29. Recommendations for New York Moving On Initiative KEY COMPONENTS • Rental subsidy • Prepare case managers – training on assessment/transition • After care services need to be offered • Housing locater services to identify quality affordable units • Appropriate linkages to new community services • Need to establish and track outcomes and long-term stability Medicaid Redesign Affordable Housing Work Group 29

30. Recommendations for New York Moving On Initiative DISCUSSION • Is placement one-way? What if tenant fails in new location? • Flexible services that can ebb and flow/start and stop? • How could moving on work with Health Homes? Medicaid Redesign Affordable Housing Work Group 30

31. Social Innovation Financing Presented by Ryan Moser

32. What is Social Innovation Financing? “Social Impact Financing restructures the relationships – and the risks and rewards – in the funding, design and financing of social services.” – KPMG • Outcomes over outputs • Increase scale of innovation • Increase efficiency of systems • Alter risk structure • Utilize private capital to increase public capacity Medicaid Redesign Affordable Housing Work Group 32

33. A Note on Terminology Social Innovation Financing Social Impact Bonds Pay for Success Contracts Medicaid Redesign Affordable Housing Work Group 33

34. Bonding, Tax Credits, SIF time $ $ Private Sector Medicaid Redesign Affordable Housing Work Group 34

35. Social Impact Bond Structure Image: McKinsey & Company, 2012 Medicaid Redesign Affordable Housing Work Group 35

36. Pay For Success Construct Image: 3rd Sector Capital Partners, 2012 Medicaid Redesign Affordable Housing Work Group 36

37. Key Elements Medicaid Redesign Affordable Housing Work Group 37

38. FUSE Medicaid Redesign Affordable Housing Work Group 38

39. Child Welfare Involved Families and Youth Aging Out of Foster Care Medicaid Redesign Affordable Housing Work Group 39

40. Olmstead: Institutional Care Medicaid Redesign Affordable Housing Work Group 40

41. Aging Nursing Home Diversion/Aging Homelessness • Accessible units • Services titrated to geriatric needs Geriatric Health Services • Brooklyn Community Housing and Services • Public Housing Authorities Medicaid Redesign Affordable Housing Work Group 41

42. National SIF Developments Legislative Progress: Utah, New Jersey, Maryland, Connecticut, Santa Clara County, Los Angeles County Procurement: New York State, New York City, Cuyahoga County, Minnesota Pilots: New York City, Massachusetts Federal Movement: Department of Labor, Second Chance Act Medicaid Redesign Affordable Housing Work Group 42

43. Procurement Efforts Massachusetts • State savings target • Intersection of homelessness and healthcare • Legislative appropriation of success repayment trust • Minnesota • Intersection of healthcare and state correctional costs • Human Capital Performance Bonds Cuyahoga County, Ohio • County cost drivers Medicaid Redesign Affordable Housing Work Group 43

44. A Significant Social Issue Medicaid Redesign Affordable Housing Work Group 44

45. Timeline for Implementation (MA) Medicaid Redesign Affordable Housing Work Group 45

46. Massachusetts Roles Medicaid Redesign Affordable Housing Work Group 46

47. SIF’s Role in Broader Procurement Procurement B SIF II Procurement A SIF I Medicaid Redesign Affordable Housing Work Group 47

48. Questions for Discussion • Q&A • Which of the sectors that have been identified by MRT Affordable Housing Workgroup are the best fit for social innovation financing? • The Governor’s budget has identified $100M in funding for repayment of social impact financing, what recommendations could MRT make to access that funding? • Are there opportunities outside of MRT that should be considered for SIF? Medicaid Redesign Affordable Housing Work Group 48

49. Next Steps • Implement Salient Tracking to study Medicaid savings through the MRT initiative; • Implement the 2013-14 MRT Supportive Housing Allocation Plan; • Reconvene the MRT Affordable Housing Workgroup in the Fall.