CMS -- Coverage of Housing-Related Activities  -- June 26, 2015

 June 26, 2015   

FROM:  Vikki Wachino, Director  Center for Medicaid and CHIP Services  

SUBJECT:  Coverage of Housing-Related Activities and Services for Individuals with Disabilities   
            Brief Orchid Analysis 
    Medicaid Gives Some On Housing & Provides Some Certainty & Predictability for States & Potential Olmstead Plaintiffs.

     The reasoning of the Informational Bulletin is consistent with arguments made on the Orchid website and "More on Key Provisions for Settlement" in the article below,
  • Citing Research on Social Determinants of Health; AND
  • Tying Expanded Coverage of Housing Related Services to Long Term Care Services as Orchid has done in our Target Population for Olmstead Settlement.

     CMS announces the following Housing-Related Services for Medicaid Reimbursement: 
  1. Individual Housing Transition Services - services that support an individual’s ability to prepare for and transition to housing;
  2.  Individual Housing & Tenancy Sustaining Services - services that support the individual in being a successful tenant in his/her housing arrangement and thus able to sustain tenancy; and 
  3. Statelevel Housing Related Collaborative Activities - services that support collaborative efforts across public agencies and the private sector that assist a state in identifying and securing housing options for individuals with disabilities, older adults needing LTSS, and those experiencing chronic homelessness. 
[Bulletin seems to say that "Chronic Homelessness" is a qualifier for Medicaid "housing-related activities" regardless of needing LTSS.  Orchid has argued that most individuals who are chronically homeless do qualify under CO Medicaid's ULTC 100.2]
This Bulletin identifies how these housing-related activities and services can be incorporated into a Medicaid benefit design for individuals needing LTSS and in states’ strategies for transforming systems to achieve optimal community integration.


 Although the focus of this Bulletin is on Medicaid reimbursement, other federal resources are also available to states for housing-related activities, in collaboration with programs funded by the Department of Housing and Urban Development (HUD), the Department of Agriculture (USDA) and other sources. 


 State Medicaid agencies can play an important role in convening state program offices and other partners to identify other non-Medicaid funded sources to support these activities and to collaborate in HCBS systems transformation. 
    "States are increasingly using community-based housing-related services as part of a strategy when implementing Olmstead plans or settlement agreements to provide integrated community living opportunities for people exiting institutional or other segregated settings, as well as those at risk of unnecessary institutionalization due to being inappropriately housed." 

     From an Olmstead Plaintiff's point of view, the Bulletin is very good although NOT excellent.  Medicaid seems to recognize that Housing Is Healthcare, fundamental to Olmstead settlements, and State Medicaid Agencies have a critical role in bringing parties together to facilitate the development of housing and "HCBS Systems Transformation."

       Unfortunately, there is no great plan to provide comprehensive coverage/payment for all this, just a legal duty on the State to cobble something together.

       We'll Take It!