MRT Affordable Housing Work Group
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MRT Affordable Housing Work Group Redesign Medicaid in New York State
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Redesign Medicaid in New York State. MRT Affordable Housing Work Group. March 28, 2013 – 10:00 AM to 1:30 PM New York State Department of Health Albany, New York. Goals for Today. Budget Recap Jason Helgerson, Medicaid Director, Department of Health - PowerPoint PPT Presentation
Transcript of MRT Affordable Housing Work Group
MRT Affordable Housing Work Group
Redesign Medicaid in New York State
Goals for Today
o Budget Recap
o Jason Helgerson, Medicaid Director, Department of Health
o Medicaid Tracking Overview: Salient
o Rebecca Corso, Department of Health
o Moving On Initiative
o Connie Tempel, Corporation for Supportive Housing
o Social Impact Bonds
o Ryan Moser, Corporation for Supportive Housing
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Enacted 2013-14 Budget UpdatePresented by Jason Helgerson
Enacted 2013-14 Budget Update
o Supportive Housingo $86 million in 2013-14 ($5 million reduction from
proposed budget)
o $70 M base funding in 2013-14: $75 M in 2014-15
o $12.5 M in new funding: The budget allows for flexibility to restore as soon as resources are available.
o $3.8 million from hospital and nursing home bed closures in 2013-14.
Enacted 2013-14 Budget Update: Supportive Housing
Funding will support:o Capital funding to expand supportive housing units for
high cost Medicaid Populations;
o Continued rental subsidies and supports funded in 2012-13; and
o The creation of seven new pilot projects to test new supportive housing models.
Salient TrackingPresented by Rebecca Corso
Salient Tracking
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o One goal of the MRT Supportive Housing initiative is to improve health outcomes for high Medicaid users.
o Assumption that providing supportive housing will result in lower Medicaid costs.
o Supportive Housing Data Collection Tool will track users of Supportive Housing programs supported by MRT.
o Tool will allow for evaluating the program’s effectiveness in reducing Medicaid costs.
Salient Tracking
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The Tool is an Excel Spreadsheet. Data to be entered by providers includes:
Salient Tracking
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o Agencies administering MRT supportive housing initiatives will be responsible for working with providers to complete the tool.
o Providers will be required to submit data monthly to their administering agency.
o Agencies will review submitted data and follow-up with providers on any incomplete or incorrect information.
o Agencies will submit completed data into the Medicaid Data Warehouse.
Salient Tracking
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o NYSDOH will draw down the data from the data warehouse using Salient.
o 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.
Salient Tracking
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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.
Salient Tracking
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Other security measures:
o Create secure directories on network.
o Maintain a clean desk – Remove paper records that includes confidential data and secure paper records in a locked area.
o Clear the screen – Lock screens when leaving workstations and orient screens containing confidential information away from individuals passing by the workstation.
o Only authorize access on a need-to-know basis.
Salient Tracking
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o Data tracking is a critical component of the MRT supportive housing initiative.
o Tracking recipients will allow us to prove the cost effectiveness of the MRT supportive housing initiative.
o Savings generated from the initiative can be reinvested in supportive housing programs.
What is Moving On?
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o 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.
o Backfilling vacated supportive housing units with targeted tenancy.
Moving On InitiativePresented by Connie Tempel
Why Moving On?
o Goal of supportive housing is to promote highest level of independence and choice.
o Providers can serve targeted individuals in need of supportive housing services, in alignment with MRT goals.
o Targets scarce resources (supportive housing) to those who need it most when they need it most.
o Increases supportive housing capacity without new construction.
o Consistent with Recovery/Wellness model.
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Moving On - NYC
o Ten years ago few, if any, resources or incentives existed for moving people on.
o 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.
o 2006, The Network found that 40% of SH tenants capable of moving on.
o 2007-2009, DHS created Moving On Initiative.
o 2009-2012, CUCS ran pilot accessing 80/20 units.
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Key CSH Program Components Moving Out
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Key CSH Program Components Moving In
o Long-term shelter stayers
o Had to meet building program eligibility
o Shelters matched with providers
o Shelter operators oriented to SH with bus tours
o Interagency coordination and troubleshooting
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o 100 tenants moved out of 133 engaged
o 766 days average length of homelessness prior to supportive housing
o 67% living in Project-Based Section 8 units
o 22.8% living in unsubsidized units
o Mix of NY/NY, formerly homeless, low-income units
Participant Demographics - Move Outs (CSH)
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Moving Out from Where?
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Where Did They Go?
o More moved to Brooklyn
o 25% moved to a different borough than their supportive housing unit.
o 88.1% moved to a private market apartment.
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DHS Moving On Initiative
o DHS Initiative Program Components: Section 8
$2,000 bonus per placement to providers
Units backfilled with long-term shelter stayers
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DHS MOI Outcomes
The Network’s analysis found:
High Demand
o 1,118 tenants applied
Acceptance Rate
o 58% accepted
o Main reasons for rejection were background check, exceeded income limits, and didn’t meet tenancy requirements (one year in housing)
Low Moving On Rate
o 19% (209 individuals) moved on
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MOI DHS Challenges
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CUCS 80/20 Pilot
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Moving On Pilots Beyond NYC
o New and growing interest in replicating Moving On model: NAEH, USICH, Connecticut, Los Angeles
o 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
Can the household meet these minimum qualifiers?
Has not previously evicted from CHA Housing Has not been convicted of arson Is not a lifetime registered sex-offender Have not been convicted of manufacturing meth in public housing Able to get utilities in their name or willing to negotiate with landlord to
include in rent
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Moving On Assessment Tool: Chicago
Category Criteria
Housing Leaseholder for 3+ years; Without utility or rental arrears
Income Has benefits or employment income for 6+ months
Health Self-reports regularly taking prescribed medications with minimally missed doses OR has no prescribed medications
Supportive Services & Mainstream Resources
Tenant has not required clinical crisis intervention in the past 12 months
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Recommendations for New York Moving On Initiative
KEY COMPONENTSo Rental subsidy
o Prepare case managers – training on assessment/transition
o After care services need to be offered
o Housing locater services to identify quality affordable units
o Appropriate linkages to new community services
o Need to establish and track outcomes and long-term stability
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Recommendations for New York Moving On Initiative
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DISCUSSIONo Is placement one-way? What if tenant fails in new
location?
o Flexible services that can ebb and flow/start and stop?
o How could moving on work with Health Homes?
Social Innovation FinancingPresented by Ryan Moser
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.” – KPMGoOutcomes over outputs
oIncrease scale of innovation
oIncrease efficiency of systems
oAlter risk structure
oUtilize private capital to increase public capacity
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A Note on Terminology
Social Innovation Financing
Pay forSuccess
Contracts
SocialImpactBonds
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Bonding, Tax Credits, SIF
time
$ $Private Sector
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Social Impact Bond Structure
Image: McKinsey & Company, 2012
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Pay For Success Construct
Image: 3rd Sector Capital Partners, 2012
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Key Elements
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FUSE
-$6,000
-$5,000
-$4,000
-$3,000
-$2,000
-$1,000
$0
$1,000
$2,000
5th 6th 7th 8th 9th 10th 5th 6th 7th 8th 9th 10th
Decile
Probation
Mental health jail
Medical jail
General jail
Homeless srv.
GR Housing Vouchers
General Relief
Food Stamps
Paramedics
Public Health
Mental Health
Private hospital-ER
Health Srv - ER
County clinic
Priv. hospital-inpatient
Co. hospital-inpatient
Monthly costs when living in permenant supportive housing
Change from costs before permanent supportive housing
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Child Welfare Involved Families and Youth Aging Out of Foster Care
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Olmstead: Institutional Care
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Aging
Nursing Home Diversion/Aging Homelessnesso Accessible units
o Services titrated to geriatric needs
Geriatric Health Serviceso Brooklyn Community Housing and Services
o Public Housing Authorities
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National SIF Developments
Federal Movement: Department of Labor, Second Chance Act
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
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Procurement Efforts
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A Significant Social Issue
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Timeline for Implementation (MA)
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Massachusetts Roles
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SIF’s Role in Broader Procurement
Procurement A SIF IIProcurement BSIF I
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Questions for Discussion
o Q&A
o Which of the sectors that have been identified by MRT Affordable Housing Workgroup are the best fit for social innovation financing?
o The Governor’s budget has identified $100M in funding for repayment of social impact financing, what recommendations could MRT make to access that funding?
o Are there opportunities outside of MRT that should be considered for SIF?
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Next Steps
o Implement Salient Tracking to study Medicaid savings through the MRT initiative;
o Implement the 2013-14 MRT Supportive Housing Allocation Plan;
o Reconvene the MRT Affordable Housing Workgroup in the Fall.
