Investing in Supportive Housing

Developing supportive housing services in Montana communities through building local partnerships and capacity.

In our work to improve health across the state, we’ve learned that it can be difficult—if not impossible—to improve a person’s health when they lack basic needs such as adequate food, water, and a safe place to live. These upstream factors can impact a person’s health even more than having access to health care. For some people with complex medical issues complicated by mental illness or addiction, homelessness can lead to a devastating and costly need for frequent emergency department use and hospitalization, and all too often, frequent encounters with the criminal justice system. To address this problem, in 2018 we created the Housing is Health Care Initiative. Our goal with this initiative is to improve health outcomes and reduce the associated costs by helping communities plan for and create “supportive housing” programs through collaboration among health care and housing providers and other community services.

Supportive housing pairs affordable housing with services such as medical and behavioral health care, case management, employment assistance, and other social services. For people who are homeless with complex medical and behavioral health conditions, supportive housing has been shown in multiple studies to not only improve health, but also reduce the use of costly emergency services and corrections resources. According to the U.S. Department of Housing and Urban Development, national studies have shown that supportive housing reduced substance misuse among participants by 72%, arrests by 50-90%, and emergency department usage by 50-89%.

As part of the Housing is Health Care Initiative, we invested in community-based planning grants and partnered with the Corporation for Supportive Housing (CSH) to bring together community coalitions tasked with mapping out local resources and developing supportive housing plans. As a part of the planning grants, each community brought together a dynamic team of leaders from local hospitals, community and public health, behavioral health, housing providers, and civic and criminal justice. Using CSH’s FUSE Model (Frequent User System Engagement), coalitions established a planning team, analyzed common data sources, identified the homeless individuals who frequently use emergency department and corrections resources, mapped out local resources, and developed a plan for implementing permanent supportive housing units. For many of our grantee coalitions, this was their first opportunity to come together and develop a plan to address homelessness and its impact on their community.

Our first year of the initiative contributed to a growing momentum for supportive housing at the community and state levels. In 2018, we partnered with the Montana Department of Public Health and Human Services (MT DPHHS) and commissioned CSH to complete two reports, a “Medicaid Supportive Housing Services Crosswalk” and “Montana Business Case for a Supportive Housing Services Benefit.” These reports specifically focus on Montana’s Medicaid program and recommend ways to strengthen the state’s benefit package as it relates to homelessness, detailing the business case for doing so. Using a conservative estimate, the reports found that by providing supportive housing services to the costliest homeless Medicaid beneficiaries, the state could see a cost avoidance of at least $445,788 annually after reimbursing supportive housing providers for their services. This represents a 45% reduction in Medicaid costs for individuals who are chronically homeless and who have costs in the top 10% of Medicaid costs in Montana.

Thanks to the report’s findings, MT DPHHS applied for and was accepted to participate in the Centers for Medicaid and Medicare’s Innovation Accelerator Program. This program provides technical assistance for two years and will help the state design a supportive housing benefit and align policies across Medicaid and housing programs. As part of this project, MT DPHHS brought together partners including the Department of Commerce, the Montana Continuum of Care, and the Montana Healthcare Foundation. Participation in the Innovation Accelerator Program will help MT DPHHS design and implement innovations in the supportive services benefit package that will improve health outcomes and health contain costs.

As for the Housing is Health Care Initiative, we will continue to offer the opportunity to participate in this initiative to new Montana communities seeking to improve health and social outcomes for their homeless population. So far, we are working with leaders in Missoula, Great Falls, Butte, Helena, and Bozeman; we hope to add several new communities to this list in 2019. We will also continue working with MT DPHHS on the Innovation Accelerator Program to help the state identify ways to strengthen Montana’s supportive housing benefits within Medicaid. Finally, as our planning grants mature into viable supportive housing plans, we will look at next steps for helping these projects as they move into the development phase.

We know that supportive housing is the best way to address homelessness or chronic housing insecurity for families and individuals who struggle with substance use disorders, mental illness, and other disabilities. We look forward to continuing our work with community and state partners to improve the health of Montana’s homeless individuals and families while reducing reliance on the emergency services and the high associated costs.