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State health & human service (HHS) agencies are increasingly challenged to ensure community living opportunities for non-elderly people with disabilities. Many states are seeking to expand integrated permanent supportive housing options for this population to assure compliance with the U.S. Supreme Court's Olmstead decision, reduce reliance on expensive institutional care, and prevent and end homelessness among people with disabilities.

Recently enacted legislation modernizing the U.S. Department of Housing and Urban Development (HUD) Section 811 Supportive Housing for Persons with Disabilities program provides a new opportunity for state HHS/Medicaid agencies to form Section 811 partnerships with State Housing Finance Agencies (HFAs) to compete for new Section 811 funds. These partnerships can foster state-driven strategies to create integrated supportive housing opportunities for people with disabilities.

What is Integrated Supportive Housing?

The Americans with Disabilities Act (ADA), as interpreted by the U.S. Supreme Court's Olmstead decision, requires public entities such as states to administer services, programs, and activities in the most integrated setting appropriate to the needs of individuals with disabilities. Supportive housing is an evidence-based, cost-effective approach which combines permanent affordable rental housing with voluntary, flexible and individualized services to assist the most vulnerable people with disabilities to live in the community. Integrated supportive housing approaches locate new housing units in high quality affordable rental properties that primarily assist households without disabilities. To maximize opportunities for community integration, the new Section 811 approach described below requires that no more than 25% of the units in any Section 811 funded property be set aside for people with disabilities.

Role of State HHS/Medicaid Agencies

Some state HHS agencies are already engaged in strategies to expand integrated supportive housing. HHS agencies in states that pioneered this approach have entered into partnerships with their State HFA to create small set-asides of supportive housing units for people with disabilities within affordable rental properties the HFA finances using mainstream affordable housing development resources (e.g., federal Low Income Housing Tax Credits, HUD Home funds, etc.). State HHS agencies in return agree to develop local systems that ensure referrals to supportive housing units when they are ready for occupancy, and linkages to appropriate services and supports funded by Medicaid and other community-based resources. 

These partnerships have allowed states to develop a systematic approach to creating integrated supportive housing:  1) is guided and controlled by state/local policy; 2) can serve several priority populations within one supportive housing system (vs. needing several population-specific projects targeted to different subgroups); 3) leverages major federal mainstream housing and services programs; and 4) ensures the most vulnerable people with disabilities gain access to new housing options that are consistent with consumer choice and aligned with important federal community integration principles.

New Section 811 Opportunities for HHS Agencies

HUD's Section 811 Program is a critical program that assists the lowest income people with significant and long-term disabilities to live independently in the community by providing affordable housing linked with voluntary services and supports.

The Frank Melville Supportive Housing Investment Act of 2010 reformed the Section 811 Program by authorizing a systematic and state-oriented approach to the creation of integrated supportive housing units. The most significant Melville Act innovation is the new Section 811 Project Rental Assistance (PRA) option which - for the first time - provides cost-effective PRA subsidies directly to State Housing Finance Agencies (HFAs).

As the eligible applicant for these PRA subsidies, a State HFA is required to establish a formal written partnership agreement with the state health and human services agency, and (if different) the agency reponsible for the administration or supervision of the State Plan for medical assistance under title XIX of the Social Security Act (i.e., the State Medicaid Plan). Implementation of this type of formal partnership agreement can help state HHS agencies align themselves with related federal policies and programs - including compliance with Olmstead and several new initiatives in the Affordable Care Act - that offer the opportunity to increase integrated supportive housing options for people with disabilities.

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