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A number of states are looking to both increase supportive housing capacity and quality. One component of improving quality could be developing more intensive supportive services. Many barriers exist to increasing supportive housing capacity for most communities, including a lack of a Medicaid Authority. Nearly 30 states already have in place some supportive housing services benefit, and CSH’s map can help you find where your state is in the process. This brief provides a detailed summary of state actions and lessons that could be replicated in your state.

Updated September 2024

This brief provides an analysis of how Qualified Allocation Plans (QAPs) prioritize supportive housing development and guidelines that housing finance agencies and state leaders can use to begin closing the supportive housing gap across the country.

The following brief provides an analysis of how Qualified Allocation Plans (QAPs) – which layout each jurisdiction’s plan for distributing Low-income Housing Tax Credits (LIHTC) – prioritize supportive housing development. It also offers guidelines that housing finance agencies and state leaders can use to begin closing the supportive housing gap across the country.

A growing number of states are using their Medicaid programs to address the Social Drivers of Health for Medicaid members. This trend includes Housing Related Services (HRS) such as Housing Navigation, Tenancy Sustaining Services and funds for move in costs. The referral processes and details will differ state to state and CSH is tracking those details with an eye to scaling supportive housing services in our communities.

Interest in these details vary by audience. State medicaid offices are interested in which Medicaid authority, delivery system or payment mechanism is used so they can develop their own programs and build on lessons learned of early adopter states. Health centers as referral sources for these services want to how what are the services, the target population and how to make referrals. Supportive housing providers want to know service definitions, provider requirements and rates to see if it makes sense for their agency to contract for these services.

CSH has summarized publicly available material in a system to answer the key questions via audience and state.

Mental health can be viewed as both a cause and effect of homelessness. It is important to note that Serious Mental Illnesses such as post-traumatic stress disorder, major depression, and anti-social personality disorders are not the primary indicator that a person will experience homelessness throughout the course of their lifetime. When coupled with factors such as substance use, economic instability, limited access to affordable housing, health insurance, and health care providers, adverse childhood experiences, traumatic brain injuries, and societal and internalized stigma can disproportionately lead to episodic and chronic homelessness.  

Many people such as these will need supportive housing to successfully stabilize in the community. When serving  those experiencing homelessness, behavioral health providers need to keep in mind the need for:   

• Flexibility, particularly in outreach and engagement strategies 
• Partnerships with homeless and housing organizations 
• The value of peers, especially as it relates to outreach strategies 
• Financing that sustains their efforts 

 Health centers, primary and behavioral health service providers, and housing providers will learn about the research and evidenced based practices for serving this population.  The guide will cover the central role of peer support and outreach and engagement strategies.  Finally, the guide will cover the financing possibilities and challenges of supporting outreach and engagement efforts.  

Opioid Use Disorder (OUD) continues to be one of the greatest public health challenges in our communities. Recent data shows a national 2.8% increase in overdose deaths between August 2022 and August 2023.1  The White House has recently released the Challenge to Save Lives from Overdose  to add to our country’s evolving response. The complexity of the issue means that addressing the overdose crisis requires a multi-pronged strategy that includes prevention, harm reduction, treatment and recovery services. Federally Qualified Health Centers (FQHCs) are at the front lines of these efforts, serving over 3.3 million patients with substance use disorder in 2022.2 

As of February 2022, 48 states have accepted settlement for various lawsuits brought against pharmaceutical opioid distributors and one manufacturer in response to the national opioid and overdose crisis. Commonly referred to as the “Opioid Settlement funds”, approximately $26 billion have been distributed to states and local governments to support a range of activities addressing the root causes and impact of the opioid crisis. Beyond the Approved Uses Guidance, there is wide latitude for how to use these funds. The national Opioid Settlement Tracker is a resource that can help Health Centers and Primary Care Associations determine the process for how these funds are allocated and any pathways to influence that process. Housing creation, including supportive housing and recovery housing are cited in the national settlement agreement as potential approved uses. This analysis will focus on how and where funds are being leveraged to support housing access and other services that benefit health center patients. 

To better understand operational challenges and how supportive housing providers view them, CSH recently conducted a survey and received more than 500 responses from 44 states, D.C. and Puerto Rico. The survey responses make it clear that collectively we must act quickly to strengthen the supportive housing field. This report walks through the challenges that were elevated by respondents and concludes with ideas about solutions.

Due to limited resources, fewer community connections, and more exposure to the elements, people experiencing unsheltered homelessness have a heightened risk of injury and severe health issues. This is especially true during times of disaster and public emergency. As many communities learned from the COVID-19 pandemic, meaningful outreach and linkage to care for unsheltered individuals is vital for public health. This national webinar highlighted emerging practices in reaching unsheltered populations, with a focus on the importance of peer specialists with lived expertise. Attendees learned and discussed relevant strategies for health and housing-focused outreach to people experiencing unsheltered homelessness.

This publication aims to increase the recognition of housing as an evidence based, multifunctional intervention for people with HIV experiencing homelessness. Housing is a strategic and powerful driver for improving clinical outcome measures on a client, clinic, and systems level. This publication will elevate key findings in research, best practices, and community strategies where housing as an intervention for HIV linkage to care has been realized and implemented.

Readers of this publication will gain an understanding of the critical importance that housing has in relation to linkage and retention in HIV care, insights into patient-centered approaches for assessing and addressing housing needs, and explore challenges, barriers, and strategies at both patient and community levels to address housing instability in the context of HIV care. 

Medical Respite Care (MRC), also known as Recuperative Care, is acute and post-acute care for people experiencing homelessness who are not ill enough to remain in a hospital but are too ill to recover on the streets. This model of care has grown rapidly in recent years, with more than 145 known programs nation-wide. As more communities develop and increase MRC services, so does the importance of building capacity to support consumers during their time in MRC and after discharge to housing, shelter, etc. This webinar highlighted opportunities for providers, community partners, and stakeholders to connect individuals transitioning out of MRC with resources and wrap-around services that they need. 

This webinar took place on June 17, 2024.

This national webinar provided an overview of best practices developing or strengthening health and housing partnerships to support aging patients experiencing long-term homelessness. Participants will understand how long-term homelessness accelerates aging, the types of partnerships that are essential to supporting aging patients, and the community housing models that support the needs of aging patients.

This webinar took place on June 12, 2024.