In 2016, Connecticut was one of eight states selected through a competitive process to participate in the Centers for Medicare and Medicaid Services (CMS) Medicaid-Housing Partnership Innovation Accelerator Program (IAP). Through this competitively selected initiative, technical assistance was provided to help states design ways to support individuals served by Medicaid in accessing and retaining stable housing and meaningfully engaging with their health goals. Connecticut’s team included representatives from the Departments of Social Services, Mental Health & Addiction Services, and Housing, as well as the Corporation for Supportive Housing and the Partnership for Strong Communities.
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Following on participation in the IAP, the above group expanded for the purpose of modeling the potential benefits to Medicaid members, and associated savings to the state, from covering supportive housing services under the Connecticut Medicaid State Plan. The group was also able to partner with the Coalition to End Homelessness and New York University to match Medicaid claims data and Homeless Management Information System data, to identify a specific group of people who would most benefit from intervention. To our knowledge, this is the first such statewide match in the country.
Based on the above preparatory work, Governor Lamont proposed, and the legislature included, the supportive housing benefit in the state’s biennial budget. Specifically, a Medicaid state plan home and community-based services benefit is being developed that will serve up to 850 individuals who experience homelessness and whose average Medicaid costs exceed $40,000 per year. Savings figures under DSS ($580,000 in FY 2020 and $3.1 million in FY 2021) include the state’s share of Medicaid expenditures. After factoring in the federal share, this proposal is expected to reduce total Medicaid expenditures by $2.7 million in FY 2020 and $13.9 million in FY 2021. Funding is also included in the Department of Housing (approximately $460,000 in FY 2020 and $2.3 million in FY 2021) to support housing vouchers associated with this effort. This effort is called the Connecticut Housing Engagement and Support Services (CHESS) initiative.
DSS has elected to cover these services using a Medicaid 1915(i) State Plan Amendment (SPA) because:
- This is a timely means of implementing services for people with complex and urgent needs;
- This will permit the state to build on efforts that have historically been funded by federal grants and state dollars by including these services under the Medicaid State Plan and gaining federal Medicaid match;
- This will permit coverage under Medicaid, but also enables the state to limit eligibility for services based on targeting criteria;
- This will enable the state to contract with supportive housing providers as Medicaid-enrolled providers and to process claims for their services through the Medicaid Management Information System;
- The state has already successfully used a 1915(i) SPA to target, and gain federal match, for a small number of older adults who were financially, but not functionally, eligible for the Medicaid waiver component of the Connecticut Home Care Program for Elders (elder waiver); and
- The 1915(i) is an efficient SPA vehicle that uses a template and does not typically require extensive negotiation with CMS.