Unlocking Potential in New York State Presentation to National - - PowerPoint PPT Presentation
Health + Housing: Unlocking Potential in New York State Presentation to National Academy for State Health Policy July 24, 2017 Rethinking Care for Medicaid's Highest-Need, Highest- Cost Populations Addressing the Social Determinants of
Presentation to National Academy for State Health Policy July 24, 2017
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Million over 7 years.
Medicaid members.
targets capital construction, rental subsidies and supports, and
evaluation are key components.
High-Cost Medicaid Members Individuals transitioning
homes Chronic Homeless with HIV/AIDS, Mental Health and/or Substance Use Disorders Chronically Addicted Homeless or at risk of homelessness Developmentally Disabled Seniors in Shelter or low- income seniors in the community Physically Disabled Homeless
throughout the State
Institute, DOH Division of Long Term Care, OPWDD)
more units in the pipeline for 2018
conditions
types
Source: McGinnis et al, “Medicaid Redesign Team Supportive Housing Evaluation: Utilization Report 1,” prepared by the SUNY Research Foundation for NYS DOH, May 2017. Note: Not shown are substance use + chronic medical condition (3%) and severe mental illness + HIV (4%). Note: To obtain total percentage of participants with a given diagnosis, sum all percentages that fall into the relevant circle (but may not exactly match text due to rounding). Circles are not sized proportionately.
disabled adults who did not qualify for existing New York City supportive housing programs
hospitals owned by New York City Health + Hospitals
amortized over 10 years. In year one, residents’ average Medicaid expenses fell by $11,800 per person.
ATH provides grants to eligible applicants to make accessibility modifications to existing owner-
persons with disabilities that also receive Medicaid assistance.
substantial difficulty with activities of daily living (ADL)
residence or will be the occupant’s primary residence after modifications are completed
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HIV/AIDS in upstate New York
managers to assist individuals with finding and maintaining housing
at risk of eviction
Assistance and New York City Department of Homeless Services
enrolled in New York State’s Health Home program
conditions, serious mental illness, or HIV/AIDS
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homeless shelters
New York City Department of Homeless Services
diverted from inpatient hospitalization
higher level of support and services than can be provided in their permanent residence
clinical staffing
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management:
level of care; and homeless or unstably housed
development and counseling services; funding for clinical supervision of direct service staff
risk of homelessness; who are Medicaid enrolled; and who meet frequent utilizer criteria (at least two inpatient hospitalizations, five emergency room visits, or one inpatient hospitalization and four emergency room visits in the previous 12 months)
referred by a Health Home, are a resident in a NYS OMH Psychiatric Center or OMH-
Individuals must also be unstably housed or be individuals for whom housing would assist in a hospital diversion
who move from certified residential settings with continuous supervision (“supervised” model residences) to more independent, less restrictive housing (supportive model certified residences or uncertified private apartments with support services such as community habilitation and personal care)
Plan goals in addition to reducing Medicaid spending
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and independently in the community:
who have spent at least 120 consecutive days in a nursing home over the most recent two-year period, are homeless or unstably housed, and have the ability to live safely on the community
placement but serve them in a less medically intensive, lower cost setting. SN-ALPs serve additional, special-needs populations through training and capital improvements.
22 2 4 6 8 10 12
inpatient days
visits 10.1 3.1 6.1 2.3
Decreased Inpatient, ED Use
12 Months Pre-Housing 12 Months Post-Housing 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Any psychiatric inpatient Any inpatient rehab 10.0% 7.2% 7.3% 4.0%
Decreased Percentage of Recipients with Behavioral Health Admissions
12 Months Pre-Housing 12 Months Post-Housing
Study Design
full Medicaid coverage for 1 year pre and post enrollment.
Findings
admissions; 27% fewer with inpatient psych admissions
($6,130 per person)
$23,000-$52,000 per person per year (varied by program)