September 2016 - Homelessness
Nevada Medicaid, state partners look to reduce homelessness
Through the Nevada Interagency Council on Homelessness Strategic Plan's goals to provide community-based housing and Medicaid-covered housing support services, new partnerships have been developed. These partnerships link Nevada state and county health and human services, social services, housing agencies and federal agencies. Together these groups are working to provide services and resources to assist the homeless population in gaining permanent housing. These partners are identifying gaps that exist in these resources and develop processes that will help remediate the gaps.
A number of factors have increased Medicaid's involvement with homeless individuals. In 2014, Medicaid expanded its program coverage to include the low-income, childless adult population,which includes individuals who are homeless. The situational issues faced by these new enrollees that impact service provision, service cost and health outcomes include:
- Difficulty gaining discharge from acute hospitals, as there may be no safe, community-based discharge location at the end of required medical care.
- Individuals who are homeless may not want to leave nursing facilities when the only option is to return to living on the street.
- Difficulty with gaining home health or support services because of homelessness.
- Individuals who do not have phone service or a permanent address do not receive outreach that promotes prevention and early intervention services, leading to poor health status and increased utilization of emergency room care.
The Centers for Medicare and Medicaid Services (CMS) awarded Nevada technical assistance through the Innovation Accelerator Program (IAP) to gain help developing "best practice," evidence-based, cost-effective Medicaid services for the homeless. The assistance goals include:
- Learning how to build upon current services, policies and regional programs to maximize outcomes and prevent the development or perpetuation of service silos and duplicative services.
- Understanding how multiple federal agencies' rules impact a collaborative approach to providing Medicaid-funded housing support services in a community-based location.
- Developing collaborative funding mechanisms for Medicaid services.
Homelessness: What more can be done?
Nevada has several ideas on how the federal government can assist the state in ending homelessness:
- Develop systems that identify which Medicaid beneficiaries are experiencing or at risk of experiencing homelessness.
- Develop ways to promote comprehensive, across-agency program evaluation. For example, does the program support improvement in health, educational and employment outcomes and/or incarceration rates?
- Align and add flexibility to eligibility requirements of agencies that provide funding and targeted initiatives addressing affordable housing and specific populations' housing needs.
- Advocate for increased technical assistance from the U.S. Interagency Council on Homelessness (USICH) and Housing and Urban Development (HUD) on mixed finance/mixed income development and maximizing existing federal resources. An example would be expanding the Dedicating Opportunities to End Homelessness (DOEH) initiative communities to other states.
- Support continued or enhanced Medicaid-funded services as beneficiaries gain employment and income to help sustain their success.
- Provide the homeless, especially those who have not received medical care in many years, direct entrance into support services and continuity of care. Increase options for such service.
- Support additional resources and technical assistance in implementing coordinated-entry systems for beneficiaries to gain housing and housing support services. This step will help Continuum of Care entities to efficiently assess and connect people to housing and service intervention.
- Encourage more non-federal partners to participate to expand these resources.