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Background and Important Documents

In 2015, the Centers of Medicare & Medicaid Services (CMS) provided initial guidance on how states could use Medicaid funding for services needed to navigate beneficiaries to housing, and then keep them successfully housed. Leveraging this and subsequent federal instruction, lessons learned from other state Medicaid programs covering housing-related supports, and insights gained through robust multi-year stakeholder engagement, DC received approval from CMS to launch a 1915i State Plan Housing Supportive Services (HSS) benefit in Spring 2022. Federal funding available through this Medicaid benefit enables DC to use Medicaid monies, instead of local funding, to pay for permanent supportive housing (PSH) services, and to reinvest these local funds into the District’s continued efforts to make homelessness rare, brief, and non-recurring.   

PSH and HSS are synonymous when describing the type of services delivered. HSS is funded by Medicaid and available to DC Medicaid beneficiaries determined eligible for PSH through the District’s Coordinated Assessment Housing Plan (CAHP) process. PSH is locally funded and is for DC residents determined eligible for PSH through the CAHP process that are ineligible for Medicaid enrollment. DC residents receiving HSS or PSH services should not experience a difference in service delivery.  

Launching the HSS benefit is the result of 6+ years of collaboration between DC government agencies (e.g. DHS, Department of Health Care Finance, Interagency Council on Homelessness or ICH, Department of Behavioral Health), bolstered by routine and meaningful input from community-based providers and advocates. Leveraging the ‘open-government’ ICH meeting platform, the HSS benefit was designed in a very transparent way--- as indicated by years of public-facing notes and documented community input detailing the evolution in the benefit’s configuration (and re-configuration).   

Recognizing the challenges some smaller and minority-led entities may face in adjusting their operations to bill and successfully receive reimbursement for HSS from DC Medicaid, the ICH worked with the Partnership to end Homelessness to secure philanthropic funders to hire the Corporation for Supportive Housing (CSH) to provide the initial technical assistance these providers would need. 

To learn more about this program, contact Anna Fogel, Deputy Administrator, Permanent Housing Division at [email protected].  

Important Background Documents: