Transcript Slide 1

Hearing: The Road Home
Testimony Before the CA Assembly
Select Committee on Homelessness
Peggy Bailey
Senior Policy Advisor
Corporation for Supportive Housing
May 10, 2012
csh.org
Supportive Housing:
Saving Taxpayer Dollars
Supportive Housing Reduces Costs to
Public Systems – Business Case
When living in supportive housing, on average, public cost reductions total $4,589 per
month, or 70%, per person.
Potential fiscal savings for the county providing supportive housing to the 10th decile
exceeds $23,000,000, per month for all 5,000 people.
Medicaid Cost Study Findings
•
Downtown Emergency Shelter Center in Seattle showed 41 percent in Medicaid
savings by reducing ER visits and hospital inpatient stays.
•
CSH’s Frequent Users of Health Systems Initiative found that:
• Prior to housing, residents of supportive housing had ER and hospital inpatient
costs over $58,000
• Two years after housing, residents incurred only $19,000
•
Chicago - PSH saved almost $25,000
•
Portland, Maine - Medicaid costs were reduced by almost $6,000
•
Direct Access to Housing in San Francisco found that supportive housing reduced
nursing home costs by $24,000.
* All $$ amounts are per person, per year
Illinois
• AIDS Foundation of Chicago
• Cross referencing chronic homeless clients with
Medicaid
• So far they have 49 people housed who cost Medicaid
$4.6 million in FY 2010. Now we can track the savings
for each person.
• Growing evidence on the need to target clients
Massachusetts
• Home and Healthy for Good pilot (12 providers
participate)
• Funded with State dollars since 2007
• They have housed 555 chronically homeless individuals
(467 Medicaid clients)
• Tenant retention is 82%
• Medicaid costs reduced from $26,124 to $6,056 per
year (this is for the first 119 people housed)
• Average total savings $9,423 per person, per year
(includes the cost of housing)
Frequent Users of Health Services Initiative
(FUHSI) - California
• Local hospitals and service providers collaborated in the development and
implementation of more responsive systems of care to address unmet needs,
produce better outcomes, and reduce unnecessary use of emergency
services.
• 6 year demonstration project in 6 sites in California – Programs and
Interventions diverse, almost all included linkages to housing
Alameda County – Project RESPECT
Los Angeles County – Project Improving Access to Care
Sacramento County – The Care Connection
Santa Clara County – New Directions
Santa Cruz County – Project Connect
Tulare County – The Bridge
Outcomes: Hospital Utilization & Charges
FUHSI Interventions Reduce Expensive Hospital Charges
One Year PreEnrollment
10.3
Average
Emergency
Department Visits
One Year in
Program
Two Years in
Program
% Change
Over Two
Years
6.7
4
↓61%*
Average
Emergency
Department
Charges
$11,388
$8,191
$4,697
↓59%*
Average Inpatient
Admits
1.5
1.2
0.5
↓64%*
Average Inpatient
Days
6.3
6.5
2.4
↓62%*
Average Inpatient
Charges
$46,826
$40,270
$14,684
↓69%*
California Data Show Similar Costs
• 28,340 Medi-Cal (CA Medicaid program) beneficiaries who have been
diagnosed with at least 2 diagnostic categories visited the ED at least five
times in one year or eight times within two years
• In 2007, these individuals cost the Medi-Cal program $20 million in ED
visits, over $360 million in inpatient stays, and over $16 million in
ambulance transports. Total averages $14,000 costs to Medicaid in one
year per beneficiary.
• A smaller subset (1,000+) of these incurred over $100,000 in costs to
Medi-Cal each during the course of the year.
A Small Number of
Very High Risk
Homeless Persons
Average Monthly Costs in All Months by Decile for Homeless GR Recipients
Source: 2,907 homeless GR recipients in LA County with DHS ER or inpatient records
Deciles based on costs in all months whether homeless or housed
$7,000
Probation
Sheriff mental health
jail
$6,000
Sheriff medical jail
At risk for extensive need of health
and justice system services
Sheriff general jail
$5,000
LAHSA homeless
services
GR Housing
Vouchers
$4,000
General Relief
•The most expensive 10% of
homeless persons have
average monthly costs
$6,529. Well over half of
costs incurred were from
health care costs.
Food Stamps
$3,000
Paramedics
Public Health
$2,000
Mental Health
Private hospitals-ER
$1,000
Health Srv - ER
Highest Decile
Ninth Decile
Eighth Decile
Seventh Decile
Sixth Decile
Fifth Decile
Fourth Decile
Third Decile
Second Decile
Source: Economic Roundtable, 2011
Lowest Decile
$0
Health Srv
outpatient clinic
Private hospitalsinpatient
Health Srv hospitalinpatient
The greatest cost savings can be achieved by prioritizing high-risk individuals
State Innovation
New York State – Health Homes
• Approved CMS State Plan Amendment – February
2012 (includes enhanced FMAP for 2 years)
• SPA – targets Behavioral and Mental Health Conditions
• Other phases and populations will also be targeted
• Integrates primary care and many partners, including
housing
• Just getting started
Louisiana – Home and
Community Based Services
• Grew from Katrina and need to address housing for
special needs populations, including homeless people
• Comprehensive reform to maximize Medicaid
investment in supportive housing
• Used many Medicaid mechanisms – including HCBS
1915i state plan amendment, 1915b and 1915c waivers,
and 1115 waiver
• Necessary to target various populations and create
comprehensive benefits
• Will result in 3,000 units (2,300 housed to date)
Massachusetts – Managed Care
• Creation of the Community Support Program for People
Experiencing Chronic Homelessness benefit (C-SPECH)
• Funded by MA’s 1115 and the Community Support
Program (CSP) benefit and included in ASO contract
• Behavioral health ASO – MBHP administers and created
C-SPECH as evidence showed targeted services help
achieve results
• PSH providers bill MBHP for services included in CSPECH
• Estimates $3 million in Medicaid savings for 372 people
*Note:
ASO = Administrative Services Organization
MBHP = Massachusetts Behavioral Health Partnership
Opportunities for California
• AB 2266
• Draws on data showing cost savings, while takes
advantage of Health Home option in ACA
• Would provide 90% federal funding for services in
supportive housing
• Would target people who frequently use hospitals
• No state investment—uses the IL model of designating
providers, who have to identify source of non-federal
match
• Benefits package for Medicaid expansion in 2014