States recognize that supportive housing directed at the right population can improve health outcomes and reduce Medicaid spending. They also recognize that supportive housing services need to be financed in a way that is more sustainable than short term government and philanthropic grants that have been the historical funding sources. Therefore, states, localities and health services payers such as managed care organizations are experimenting with ways to more comprehensively finance outreach and engagement, tenancy supports and other tenancy sustaining services.

1. SUMMARY OF STATE ACTIONS
Medicaid & Housing Services
Updated November, 2018
INTRODUCTION
States recognize that supportive housing directed at the right population can improve health outcomes and reduce
Medicaid spending. They also recognize that supportive housing services need to be financed in a way that is more
sustainable than short term government and philanthropic grants that have been the historical funding sources. Therefore,
states, localities and health services payers such as managed care organizations are experimenting with ways to more
comprehensively finance outreach and engagement, tenancy supports and other tenancy sustaining services.
The previous administration approved a number of 1115 research and demonstration waivers to cover tenancy support
services including CA, IN, MA, MD and WA. CSH is involved in supporting a number of these program and is watching
closely for lessons learned that can be applied to other states.
The new administration has moved to shift the focus to a strategy using 1915I State Plan Amendments or SPAs. IL’s 1115
waiver was approved by the Trump CMS to include Tenancy Support Services in the second year of implementation, but
the state was requested to structure the benefit similarly to a 1915I SPA rather than having the flexibility commonly found
in 1115 waivers. 1915i SPAs are shorter, more focused and discrete and can be approved more swiftly and easily than
the commonly large scale 1115 waivers. For budgeting purposes, states must know how many people will meet criteria for
the service, as 1915i SPAs require that all persons who meet the state defined “needs based criteria” must receive the
service. One of many challenges for states will be to define their population in a discrete manner that allows predictable
budgeting for the state portion of services funding. Housing resources will need to be aligned with these services, and the
supportive housing provider community will need assistance and guidance to step up and deliver these services through
the health care delivery systems in their states.
The table below highlights actions states and other entities have taken to improve service delivery and financing of the services
delivered by supportive housing providers.

2. SUMMARY OF STATE ACTIVITY
State/City Program Model Medicaid Mechanism Target Population Status
California
Whole Person Care
Pilots managed
through county
health departments:
can fund outreach
and engagement,
formation of
partnerships to
integrate care, and
tenancy
support/sustaining
services.
1115 Medicaid Waiver
(Whole Person Care pilot)
New prospective tenants and existing
supportive housing tenants, so long
as meet eligibility criteria. Persons
can receive care coordination
services that are not tenancy
focused, if person is stably housed
but has complex care needs.
Whole Person Care: State
Summary at
https://nashp.org/wp-
content/uploads/2017/07/Hansen-
Slides.pdf expires Dec. 2020
Health Homes
Programs managed
by Managed Care
Organizations: can
fund outreach,
engagement,
housing navigation,
and tenancy support
services
Health Home State Plan
Amendment (Health Home
Program), with amendment
to existing 1115 Medicaid
Waiver (to have
administered through
MCOs)
Whole Person Care: Counties can
choose to include a focus on
population Homeless or at risk of
homelessness.
The state has approved 25 WPC
pilots, with the first beginning in
2016. The list can be found at
http://www.dhcs.ca.gov/provgovpar
t/Documents/WPCApplicationStats
.pdf .
Health Home Program: People with
two chronic conditions or one serious
mental illness who are either
homeless or could exit institutions
with available supportive housing.
Heath Homes Program began in
San Francisco in July, 2018. San
Bernardino and Riverside counties
will begin in January, 2019 and an
additional 26 county pilots will
commence in July, 2019.
http://www.dhcs.ca.gov/services/D
ocuments/HHP_Revise_Implement

3. _Sch_4.4.18.pdf
Florida
Pilot Program in 5
Central Florida
Counties
1115 Waiver Amendment 21 and Older Waiver Amendment in discussion
between CMS and the state.
https://www.medicaid.gov/Medicaid
-CHIP-Program-Information/By-
Topics/Waivers/1115/downloads/fl/
fl-medicaid-reform-pa4.pdf
Services include
Pre-Tenancy,
Tenancy Sustaining
Services and Mobile
Crisis Management
and Peer Support.
Significant Behavioral Health needs
including SMI and SUD.
Homeless or at risk of
Homelessness.
Noted as a pilot program, Program
cap is noted as “42,500 member
months”.
Hawaii
Waiver amendment
focused on services
to increase
supportive housing
capacity for the
state.
1115 waiver Behavioral Health, physical illness or
a substance use diagnosis and
chronically homeless.
Waiver approved by CMS
10/31/2018.
https://www.medicaid.gov/Medicaid
-CHIP-Program-Information/By-
Topics/Waivers/1115/downloads/hi
/hi-quest-expanded-ca.pdf

4. Persons living in institutions, who
cannot be discharged due to a lack of
appropriate housing plan for
discharge.
After health plan assignments,
people eligible for the service, will
be assigned a service coordinator
from the health plan that will work
with them to obtain services and
housing. Face to Face interview
with the service coordination and
beneficiary is required.
Living in Public Housing and at Risk
of eviction AND has a qualifying
condition/ diagnosis.
CMS in 2018, is indicating will
approve the waiver amendment,
but will require HI to structure the
benefits similar to a 1915i SPA.
Benefit to be managed by the
state’s Managed Care delivery
system.
https://medquest.hawaii.gov/en/me
mbers-applicants/already-
covered/health-plans.html
Illinois
Waiver focused on
Behavioral Health
Transformation.
1115 Waiver Significant or HIGH Behavioral
Health needs and Homeless or at risk
of Homelessness.
Approved 5/7/18; effective 7/1/18.
Capped at serving 2250 in year 2,
raising to a maximum of 3,750 in year
5.
https://www.medicaid.gov/Medicaid-
CHIP-Program-Information/By-
Topics/Waivers/1115/downloads/il/il-
behave-health-transform-ca.pdf
https://www.illinois.gov/hfs/info/111
5Waiver/Pages/default.aspx
ACIS (tenancy supports) pilot to be
implemented July 2019.
https://www.medicaid.gov/medicaid
/section-1115-
demo/demonstration-and-waiver-
list/?entry=40098

5. Services include
Pre-tenancy
services, move in
services. Security
Deposits not noted.
Tenancy Support Services are 1/
10 pilot programs. Start date for
these services is in year 2 (July,
2019).
IL also
implementing
Integrated Health
Homes through
SPA. Will need to
be alignment with
ACIS pilot
implementation and
IHH, no specifics
available yet.
SPA All Medicaid enrollees to be assigned
to IHH by July 2019. 4 tiers in total.
Top three tiers represent 300,000
people. They will be enrolled in IHH
starting January 2019. Tier A
includes those with high behavioral
health needs and high physical
health needs. State will determine
tier placement.
Services will be administered by
the state’s Managed Care
Organizations.
https://www.illinois.gov/hfs/SiteColl
ectionDocuments/StatewideHealth
ChoiceIllinoisPlans5418.pdf
Indiana
Waiver focused on
Market Driven
Health Reforms
1115 Waiver Medicaid Beneficiaries with SUD
treatment needs
A component of the Healthy
Indiana Plan 2.0
https://www.medicaid.gov/medicai
d/section-1115-
demo/demonstration-and-waiver-
list/?entry=25478
Significant cost
sharing
requirements.
Persons eligible for “Addiction
Recovery Management Services”
State working on benefit
implementation.
Maryland
Use Medicaid for
Tenancy Support
Services per
6/26/15 IB
1115 Waiver Persons who are either experiencing
homelessness or transitioning to the
community from an institution or at
high risk of institutional placement; In
a Nursing Home for at least 60 days.
Waiver Approved by CMS. County
driven, as counties are required to
put up what has historically been
‘state match’ funding as well as the
aligned housing resources.
https://mmcp.health.maryland.gov/
Pages/Assistance-in-Community-
Integration-Services-Pilot.aspx
Initial program capped at 300 people.
Round one awards can serve 190
people. Round two adds an
additional community (PG County)
and 110 new slots, bringing the total
to the initial cap of 300.
First round awards went to
Harford, Cecil and Montgomery
Counties, and Baltimore City.
Round 2 pilots include Prince
George's County and an expansion
in Montgomery county.

6. New request to increase cap to 600
persons.
https://www.medicaid.gov/Medicaid-
CHIP-Program-Information/By-
Topics/Waivers/1115/downloads/md/
md-healthchoice-pa2.pdf
MD has RFPed out to counties.
Counties must provider 50% of
services funding and aligned
housing.
Persons served will need to be
determined eligible for Home and
Community Based Waiver
Services and ready to leave
nursing home.
Massachusetts
Medicaid funds
used for tenancy
support services,
billed monthly on a
per diem rate
New 1115 Waivers are
basing the system in ACOs.
State considering the
intersection.
Members who are chronically
homeless or high utilizers of
homeless and health services
Expanded through Pay For
Success Model and offered
through all MCOs.
https://www.medicaid.gov/state-
resource-center/innovation-
accelerator-program/iap-
downloads/webinar2-slides.pdf
Project is called
CSPECH or
Community Support
Program for people
Experiencing
Chronic
Homelessness,
Initial cap of 50 with two providers,
expanded to state wide population in
2016.
CSH Provider Profile at
http://www.csh.org/wp-
content/uploads/2017/01/CSPECH
-Provider-Profile-FINAL-2016.pdf
Pays supportive
housing providers to
deliver housing
based case
management ($17
per day, per person)
Outcomes report
http://bluecrossmafoundation.org/p
ublication/estimating-cost-
reductions-associated-community-
support-program-people-
experiencing
Provider can bill up
to 60 days prior to
lease up for
services.

7. Michigan
Waiver focused on
tenancy support
services to align
with 200 Pilot
Vouchers
1915I State Plan
Amendment
Benefit targeted for individuals with
chronic homelessness and high
utilizing populations within the
Specialty Behavioral Health Service
System
1115 waiver was NOT approved.
Per CMS guidance, State is now
developing a 1915I State Plan
Amendment with similar goals and
populations. MI was a second
round IAP state and is
implementing their action plan
developed as part of that process.
CSH working with the state on a
Crosswalk and Business Plan
Plan is for the benefit to be
managed through the Regional
Behavioral Health authorities.

8. Minnesota
Housing Support
Services to support
transition to the
community,
increase long-term
stability in the
community & avoid
future periods of
homelessness or
institutionalization.
1915I State Plan
Amendment
People with disabilities, including
mental illness, who are homeless or
at risk of becoming homeless, are
living in institutions or other
segregated settings, or are at risk of
living in those settings and adults
who are 65 years or older who are
homeless or at risk of becoming
homeless.
State submitted 1915i state plan
amendment on /2018 to CMS on
8/23/18. Concept paper can be
found at
https://mn.gov/dhs/assets/housing-
stabilization-services_tcm1053-
346907.pdf
Oregon
Housing related
services are options
for State
Coordinated Care
Organizations
1115 Medicaid Waiver Not specified in the waiver.
Communities can choose to include
as an optional benefit under 'health
related services.
Pennsylvania
Tenancy Support
Services for IDD/DD
population
1915I State Plan
Amendment
Those already eligible for IDD
waivers. Process remains the same
as prior to the waiver.
Tenancy support services are now
added to the menu of services
available for persons eligible for
the IDD waiver. No new funding
attached, education of providers on
best practices in supportive
housing or alignment with housing
resources.
Rhode Island
Part of the
Governor’s
Reinventing
Medicaid Initiative to
improve
coordination and
decrease costs in
Medicaid.
1115 Medicaid Waiver Focus on chronically homeless
population. Used a SAMHSA CABHI
grant as start up for the project. Also
includes elderly transitioning from
Nursing Homes and Youth
transitioning from Foster Care.
State has completed Home
Stabilization Services Certification
Standards. Standards are at
http://www.eohhs.ri.gov/Portals/0/U
ploads/Documents/ReinventMedic
aid/HomeStabilizationCertStds042
816.pdf
Requesting support
for Home
Stabilization
Services
Shifting from FFS to an MCO model. Rhode Island expects their 1115
waiver approval shortly.
http://www.eohhs.ri.gov/Reference
Center/MedicaidStatePlanand1115
Waiver/WaiverExtension.aspx

9. Shifting current
Supportive Housing
Services funding
from grant and
McKinney to
Medicaid.
Payment mechanism is a per diem
model.
http://www.eohhs.ri.gov/Portals/0/U
ploads/Documents/1115Waiver/Su
mmary1115WaiverExtension03231
8.pdf
In some cases using
Community Mental
Health Centers as
Administrative
Services
Organizations
(ASO) for
Supportive Housing
Providers.
Some case management but a focus
on Peer Recovery Models
Services are for 24 months only and
include Housing Search services.
Washington
State
Foundational
Community
Supports or services
in supportive
housing.
1115 Waiver WA Health Authority projected need
at 4,000 eligible persons across the
state.
Waiver approved and
implementing as of 1/1/2018.
https://www.hca.wa.gov/assets/pro
gram/foundation-community-
supports-faq.pdf
Persons who are currently homeless
are eligible as engaged for supportive
housing. Providers cannot use the
benefit for current residents.
Providers are paid a per diem rate
of $105.
Amerigroup is the third party
administrator. Their provider
manual for these services can be
found at
https://providers.amerigroup.com/d
ocuments/WAWA_TPA_ProviderM
anual.pdf