Louisiana Succeeds in Taking Integrated Permanent Supportive Housing to Scale

 

Louisiana's 3,000 unit Permanent Supportive Housing Program, initially created as part of the state's Road Home hurricane recovery plan, is the nation's first cross-disability, integrated permanent supportive housing (PSH) initiative. To date the PSH program has housed over 2,300 of the most vulnerable people with disabilities across Louisiana's Gulf Coast region.

 

"There are several unique features of this program that have important policy implications," said Marti Knisley of the Technical Assistance Collaborative (TAC). TAC has assisted Louisiana state officials with its program development, implementation and sustainability activities. "This systems-driven PSH initiative is very different from current practice in most communities. The program relies on state-level partnerships to leverage mainstream affordable housing and services funding, and establishment of local infrastructure for outreach and service coordination. Not only is this approach highly replicable and aligned with important federal policy initiatives like Olmstead, the supportive housing services are sustainable through Medicaid."

 

State-level housing and human service agency partnerships between the Louisiana Department of Health and Hospitals (DHH), the Office of Community Development (OCD) and the Louisiana Housing Finance Agency (LHFA) provided the framework for the program's design which includes:

• A pipeline of high quality housing units developed primarily through a PSH set-aside policy which applies to new Low Income Housing Tax Credit developments;




• Housing subsidies (1,000 HUD Shelter plus Care (S+C) subsidies and 2,000 Project-Based Section 8 Housing Choice vouchers) obtained from Congress to ensure affordability for extremely low-income households;




• A formal targeting policy, created by the state in collaboration with homeless and disability advocates, which is helping the state meet several important policy objectives, including preventing and reducing homelessness and preventing and reducing unnecessary institutionalization among a cross-disability population; and




• Locally designated entities responsible for outreach and referrals to housing, relationships with housing owners, and coordination and delivery of best practice community-based housing support services.

These locally designated entities, or "Local Lead Agencies", which are located in the program's six service regions, are critical to the program's success. Nicole Sweazy from OCD said, "Because the program is systematically creating PSH units through a scattered site approach that relies on private developers and landlords, strong local service partnerships are critical. The Local Lead Agencies make timely referrals to fill vacant units and ensure services to support successful tenancies, and property owners and managers know they can rely on immediate response and continuity of services. The housing is highly integrated and a limited number of units in a building may be occupied by program participants, yet many owners wish they could have more of our folks because of the services the program provides."

According to Christine Rhorer from DHH, the program is producing good outcomes. "The state invested in the PSH model based on evidence of its cost-effectiveness and positive outcomes for tenants. Early program data show that we are serving people with complex, multiple conditions with great success. Less than 5% of those housed have been evicted, and we've seen a 24% decrease in average monthly Medicaid costs per person."

PSH program services are based on Housing First principles for service delivery and are flexible, consumer-driven, and focused on helping people get and keep housing and leveraging community-based services to meet tenant needs. The state recently received approval for a 1915(i) state plan amendment, a 1915(b) managed care waiver, and changes to two 1915(c) waivers that effectively embed PSH service requirements into Medicaid covered services. As federal hurricane recovery resources used as temporary services funding begin to expire this year, the state is moving ahead with new PSH service arrangements and a management agreement with the state's new behavioral health statewide management organization, Magellan Health Services. According to Rhorer, "both the service agreements and management agreement are designed to assure the state can maintain its uniform, cross-disability approach to PSH."

"Because it initially targeted areas most affected by the 2005 hurricanes, the PSH program is currently operated in six of the 10 state service regions. "The success of our state level partnerships and implementation of plans for sustainable services funding have us well positioned to expand the program statewide, and we are currently exploring opportunities with DHH such as the new HUD Section 811 Project Rental Assistance Option in order to do this," said Sweazy.

On Thursday, February 16, 2012, from 3:00 - 4:00 pm ET, TAC and Louisiana state officials will be presenting a CSH Webinar: Sustaining Supportive Housing Programs: Medicaid's Role. To register for this webinar, click here.