Minnesota is the first state in the nation to provide a comprehensive policy for the use of Medicaid resources applied toward HSS.
Thirteen other states have either piloted a project or demonstrated capacity to connect Medicaid to housing related services. Another thirteen states are in the process of negotiating or planning a Medicaid housing related program. This means that the nation is looking to Minnesota as an example for advancing policies in other states. It also means that Minnesota is the first to address roadblocks presented by Medicaid’s complex healthcare benefit. Services covered by the HSS benefit include housing consultation, housing transition services, and housing sustaining services.
Implementation Results in Minnesota
Since the program began in July 2020, Minnesota has paid out over $35 million in housing related supports! That figure far exceeds the initial projections for state use of HSS. Notably, the Minnesota Department of Health rolled out the new program during the COVID pandemic. Due to the continuing crisis of extremely limited affordable housing availability, Minnesota’s HSS Medicaid policy presents an opportunity to advance housing stability. HSS is also one of very few avenues to achieve scale in housing supports and systemic connections across housing and health. The outcome is more integrated housing development and increased resident stability.
The Minnesota Department of Human Services reports that:
- There are nearly 10,000 enrolled participants — 4,000 more than the projected number when the program began.
- Almost 450 organizations are certified to provide HSS — Access provider list here: https://mhcpproviderdirectory.dhs.state.mn.us/
- A majority of the program participants are Black, Indigenous, and People of Color, most under age 65.
- Over $35 million has been paid out in HSS reimbursements in two years.
HSS Programmatic Improvements and Key Learnings:
While the implementation of the program has been far from smooth, it has improved significantly since 2020. Approval timelines for participant HSS plans have gone from over a month to under a week (or quicker) in most cases. The Program Manager has been making iterative program improvements and remains committed to working with partners to make critical adaptive changes and ensure an effective, simple, useful, and impactful program. Several shared conclusions and learnings were identified during GMHF’s July Housing & Health Equity event, including:
- There is a need to develop more housing, especially housing for the homeless and at risk of homelessness populations in Minnesota. Seventy-Five percent of the homeless population are Medicaid beneficiaries and enrolled in a managed care plan.
- There was consensus that implementation is very hard and administratively burdensome. However, it is important to pursue and evolve the Medicaid HSS policy over-time.
- If you tried to implement HSS in 2020 and became frustrated, it is time to revisit and try again. Cross-sector innovation among Department of Health, health plans, housing organizations/owners, and service providers is needed to shape HSS for long-term success.
- Capacity Building resources are needed to support organizations on the forefront of implementation.
- Creative braiding of funding is being explored with other sources, including Community Health Workers, the Integrated Community Support program, PSH site management, and coverage for transportation time, especially in rural areas.
- Health plans need to learn more about HSS and integrate the program into a clinical setting as a “prescription” or referral.
- Health plans, property owners, and housing/service organizations need to learn where and how to find vendors providing HSS.
- Providers who do not have experience in Medicaid billing have a clear challenge in getting service reimbursement. Could a central billing intermediary perform this task for multiple providers?
- States can make choices in key areas to help ease implementation, including:
- Who is billed for HSS (Managed Care, 3rd Party admin, or state fee for services; and
- Payment Mechanisms (15-minute increments, Per Diem payments, or member/per month arrangements).
Technical Assistance Team and Resources
The Corporation for Supportive Housing, HSS Technical Assistance team has a listserv for discussions, an email address to ask questions, and a toolkit for HSS Implementation available here.
Many thanks to the network of experts who provided this information to our community of practice.
- Marcella Maguire; Corporation for Supportive Housing, Director of Health Systems Integration
- Heidi Hamilton, MN Department of Human Services, Community Living Supports Manager
- Jim Przybilla, CEO PrimeWest Health – A health plan serving twenty-four rural MN counties
- Patrick Harrington, Housing Matters, Executive Director & Owner
- Adam Fairbanks, Principal of Ei-Consultants, CHS HHS technical assistance team, and Owner of Anishinaabe Endaad, a culturally specific PSH program.
Did you miss the event?
Watch the recording here: Actualizing Housing Stabilization Services