Increased access to affordable health insurance lowers costs for families to reduce their financial burden.

Medicaid expansion creates possibility of 100% coverage of people experiencing homelessness.

New services and care delivery models create possibility for comprehensive, coordinated, wrap-around health care and social services.

The Affordable Care Act’s Role in Ending

and Preventing Homelessness

• The Affordable Care Act (Obamacare) gave states the opportunity states to expand Medicaid to all individuals at or below 138% of Federal Poverty Level regardless of disability or household status

• Over 600,000 Pennsylvanians are now eligible for health care coverage through Medicaid. Can sign up at any time of the year.

• No asset test, no criminal record restrictions. Must be under 65. Over 65 you are Medicare eligible.

• People can sign up in 4 ways

◦ Online, via COMPASS: www.compass.state.pa.us.

◦ By telephone: (866) 550-4355.

◦ By mail.

◦ In person, at the local County Assistance Office.

Application Processing

• Under state law, Medicaid eligibility determinations must be made within 30 days of application.

• DHS must send a notice.

• Applicants who are turned down may appeal and request fair hearings within 30 days.

• Check the status of your application by calling:• (215) 560-7226 in Philadelphia.• (877) 395-8930 in all other Pennsylvania counties.

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Help with Applications

• People who have trouble applying online or by phone can get help with their applications.

• Same number for phone or in-person help via Certified Application Counselors:

(855) 486-9331

• Callers will get help with the application, or an appointment for face-to-face help.

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»Changing as we speak…

»Expanded eligibility to people regardless of “proven” disability status. Income requirements are now sole eligibility factor.

»Split Medicaid Recipients into 3 groups

◦ Healthy PA PLUS- all those Medically Frail

› Those with chronic medical conditions

› Those with Behavioral Health Challenges.

◦ Healthy PA- This week’s announcement means that all these people will be put into the Healthy Plus category shortly.

◦ The Private Coverage Options or PCO

»DHS (formerly DPW) did not release how persons were placed with which plans.

»Community Legal Services in Philadelphia has filed three law suits

◦ One suit charges that people are being put into incorrect categories, e.g.. If you or someone you work with has Behavioral Health Challenges, they should be put in Healthy Plus. Many were not.

◦ Second suit charges that the cuts in benefits are not legal. People in Healthy Plus will see a slight decreases in service. People in Healthy PA will see significant decreases in eligibility for services.

»Eligible People who signed up for Medicaid In December were not enrolled accurately for their behavioral health coverage.

◦ http://www.pennlive.com/midstate/index.ssf/2014/12/as_state_expands_medicaid_glit.html◦ http://www.pennlive.com/opinion/2015/01/healthy_pa_is_letting_people_w.html

• Not exactly…

• The previous administration signed contracts with insurance companies in the fall, that will be very expensive to break.

• The previous administration has starved the County Assistance Offices of staff and these changes will need a significant number of highly trained staff to implement.

• Changes could take as long as 18 months to implement.

• Did I hear something about funding for Housing?

But Governor Wolf is here and he can

fix it NOW, right?

• Eligibility

• Supportive Services Funding

• Learning whose most vulnerable and chronic and vulnerable in your community.

• Did I hear something about funding for Housing?

Opportunities in Medicaid for Ending

Homelessness

• Eligibility determined by the County Assistance Offices.

• Managed Care is in place for Medicaid recipients across the state- and for over 85% of Medicaid recipients nationwide

• PA has a ‘Carve Out’, which means that Physical Health and Behavioral Health is managed by different Managed Care Organizations. VERY helpful in ending homelessness.

• DHS web site listing the MCOs operating in PA and where in the state. http://www.dhs.state.pa.us/cs/groups/webcontent/documents/communication/s_002108.pdf

»The state Medicaid Plan says what services are required to be offered to PA Medicaid recipients.

»To receive services, a person or a provider must request them AND the MCO must determine that the services are “medically necessary”.

»You can request a of PA’s plan at the following web site http://www.dhs.state.pa.us/publications/medicaidstateplan/

• Assertive Community Treatment for persons with Serious Mental Illness or SMI (IN in PA)

• Targeted Case Management, also requires SMI (IN in PA)

• Certified Peer Specialists (IN in PA)

• Psychiatric Rehabilitative Services (NOT IN PA, but can be offered as a supplemental service)

• Health Homes- NOT in PA currently but a possible future option.

• Eligibility matters: What plan are people covered in now? Are they Medicaid eligible in the future?

• Does our agency have a license to provide the services? Are we “in network” for the services with the MCO covering our prospective residence?

• The services are not building based but person based. Works much better with a scattered site than project based model. Best practices often recommend different providers for housing and services.

• Information requirements: Likely to need a completely different IT system. One that can generate Medicaid claims.

• And what is our rate? How much will we be paid? Paid on a per service basis. Its Health Care.

»What MCOs cover the people experiencing homelessness in your community? They decide

◦ what services are offered in detail.

◦ who receives them

◦ how much providers are paid to deliver them.

» Whose on the boards, advisory boards etc.

»In Behavioral Health, the BH-MCOs report to the county commissioner for Mental Health.

»Who do you want to serve?

»How can you save the MCO money? All are concerned about people who use a lot of services.

»Can you help them find people who have dropped out of care, usually except for ER visits?

»Do you have the necessary licenses?

»Make a business case for them to collaborate.

◦ http://www.chcs.org/media/SH_Medicaid_Bz_Case_081712_brief.pdf

»Political support never hurts.

»Because we had a Behavioral Health Carve Out AND a non profit as the BH-MCO, Philly was able to..

◦ Expanded Housing First to over 500 units◦ Invested MCO profits in housing subsidies, serving over 200

people and projected to serve another approximately 400 shortly.

◦ Developed psychiatric rehabilitative services, which are NOT in the state Medicaid plan but are a classic ‘supportive service’.

◦ Developed Drug and Alcohol case management services.◦ Partnered with the local housing authority to serve move an

additional 1200 singles and 200 families with BH challenges to PSH.

◦ Working with one of our communities’ largest PSH providers to keep pace with their expansion.

◦ Transitioned over 350 from MH residential services (primarily congregate care) to PSH.

»Contact Info:Marcella.Maguire@phila.govwww.dbhids.org

»Blog: thesmartwaytodotherightthing.wordpress.com

»http://healthymindsphilly.org/blog

»Twitter: @Cella65 @DBHIDS

»Facebook: Department of Behavioral Health and Intellectual disAbility Services