247 LARK STREET ALBANY, NY 12210 TEL 518-729-2544 FAX 518-729-2545 WWW.HOUSINGWORKS.

ORG

DEMAND HOUSING FOR HOMELESS PEOPLE LIVING WITH AIDS & HIV

August 13, 2012 Centers for Medicaid and Medicare c/o Jason Helgerson NYS Medicaid Director mrtwaiver@health.state.ny.us To Whom It May Concern: Housing Works is a healing community of people living with and affected by HIV/AIDS. Our mission is to end the dual crisis of homelessness and AIDS through relentless advocacy, the provision of lifesaving services, and entrepreneurial businesses that sustain our efforts. We operate four health centers and over two hundred units of supportive housing serving people with HIV/AIDS, those most at risk of HIV infection, and low income New Yorkers with multiple chronic conditions. More recently, we have actively participated in the development of Health Homes in New York State. We are writing to support the Medicaid reforms advanced through the New York State 1115 Waiver Amendment submitted to the Centers for Medicaid and Medicare (CMS). The Medicaid Redesign Team (MRT) in New York State was a state/community partnership where these reforms were developed over the course of the past year. The focus was on the triple aim: improving quality, improving health and reducing costs. Housing Works has been an active participant in the MRT process, submitting numerous proposals and serving on both the Disparities and Housing Workgroups. Much of our work is reflected in the State Waiver Amendment. As evidenced in the Waiver Amendment, the Governor of New York has carried out an open and inclusive process, soliciting ideas from New Yorkers of all walks of life in the development of reforms that are already saving New York State and the Federal Government billions of dollars, even while offering the opportunity to improve health outcomes for some of the most needy residents. This Waiver recommends using a portion of these savings to reorganize our health system and adding services that will yield even more savings while focusing resources on those who need them the most. We wholeheartedly support this effort and urge CMS to approve the Waiver as expeditiously as possible. Below, we outline some of the most important elements of the Waiver and their impact on our community to underscore our support. Primary Care Expansion Hospital readmissions cost New York State taxpayers $3.7 billion each year. By integrating systems of care with a strong focus on primary care and expanding Patient Centered Medical Homes (PCMH), Medicaid recipients in New York State will be able

247 LARK STREET ALBANY, NY 12210 TEL 518-729-2544 FAX 518-729-2545 WWW.HOUSINGWORKS.ORG

DEMAND HOUSING FOR HOMELESS PEOPLE LIVING WITH AIDS & HIV

to seek care with a physician instead of the emergency room. The result will be better, continuous care, which will lead to better health outcomes and lower hospital costs. PCHM provide a strong primary care foundation for members and co-locates many needed services within the same location. These models need to be expanded throughout the State, especially in Upstate areas where there is an uneven distribution of primary care physicians. Health Home Development Fund New York State has currently approved 35 health homes in 23 counties across the State, with another 15-20 nearing approval in remaining areas, which will serve roughly one million high-cost, high-need Medicaid recipients, including people living with HIV/AIDS. HIV/AIDS is a unique chronic illness because with proper medical care, access to medication, as well as mental health services, the disease can be managed long-term and its transmission risk lessened. However, in the absence of such care, people living with HIV/AIDS may become sick, are more likely to seek treatment in expensive hospitals, and will be more likely to transmit the virus to someone else. One of the obstacles to health home implementation is locating, engaging and retaining members, who are often homeless or move frequently from one place to another. Additional funding could assist health homes in engaging these high-cost, high-need members who desperately need to be connected to the full range of health care services. In addition, additional training for the care managers who will be responsible for enrolling and tracking these members is essential if health homes are to thrive in this State. Technology is also critical to the success of health homes, as is an adequate infrastructure for these new health home networks. The Waiver would provide resources that will allow even small community-based organizationsthat often have the strongest connections to the people in need of these servicesto engage on an equal footing in the delivery of health home care coordination with hospitals and larger institutions. New Care Models Since the majority of readmissions in New York (59%) are from people with mental health and/or substance use issues, we must focus on addressing the needs of this population. New York State would like to create demonstration programs to find creative ways to bring these populations into care. One such idea is expanding peer-based services. Throughout the MRT process a variety of community-based organizations (CBOs) described the strides made in engaging

247 LARK STREET ALBANY, NY 12210 TEL 518-729-2544 FAX 518-729-2545 WWW.HOUSINGWORKS.ORG

DEMAND HOUSING FOR HOMELESS PEOPLE LIVING WITH AIDS & HIV

members in care through the use of peer outreach. Peer-wellness coaching, bridging and crisis outreach have been uniquely successful in engaging and retaining members in ways that health care workers have been unable to match. Housing Works routinely uses peers for education and outreach in a variety of facets in the organization. Enhancing intensive residential services for people with substance use issues to provide for more medical direction within these programs will help to make these programs more successful and hopefully provide space for more individuals requiring the services. Currently, the Office of Alcohol and Substance Abuse Services (OASAS) oversees these programs with State-only funding. However, with additional funds these programs can be expanded to serve more of our high-cost, high-need members to achieve the MRT triple aim. Medical respite programs have been successful in various areas of the country. They provide a safe environment for acute and post-acute medical care for homeless persons who are too ill to recover on the street or in a shelter, but are not ill enough to be in a hospital. This program has the potential to save millions of dollars and provide necessary medical care for the homeless population. Medical respite programs will allow for proper treatment and provide a connection to medical and supportive services outside of the costly hospital setting. Future costs will be saved by a reduction in hospital readmissions and earlier checkout from hospital settings. Supportive Housing Supportive housing services are housing coupled with individual based services. This is an innovative and cost effective way to provide housing, healthcare, mental health services and any other service the individual needs to become healthy. Supportive housing services have been extremely successful in keeping high-cost, high-need members engaged in the health care services they require while providing them with a safe environment to live. Housing has been consistently identified as a cost-saving intervention for people living with chronic illnesses, substance use and mental health issues and the homeless population. People who lack stable housing face increased health issues, premature mortality, and often do not have access to medical or support services, relying heavily on emergency care when necessary. Providing supportive housing services offers these populations a safe and secure home with a connection to high quality health care services, which will result in millions of dollars of savings in emergency room visits and hospital admissions. There is clear and compelling evidence that housing is a medical intervention for homeless people living with HIV/AIDS and other chronic conditions, leading to increased medical stability, improved engagement in care, and increased adherence to medical regimens. In fact, for people living with HIV, stable housing is highly correlated

247 LARK STREET ALBANY, NY 12210 TEL 518-729-2544 FAX 518-729-2545 WWW.HOUSINGWORKS.ORG

DEMAND HOUSING FOR HOMELESS PEOPLE LIVING WITH AIDS & HIV

with reduced risk behavior, making housing one of the most cost effective HIV prevention interventions for people who are HIV-positive and homeless or unstably housed. The above are just a few key examples of the important elements that are included in the New York State Waiver Amendment. These reforms have the potential to completely transform the Medicaid system in New York into a high quality healthcare program with a huge savings for taxpayers. These reforms are a result of State and community partnerships forged over the past year, truly giving the community a voice in reforming the Medicaid system so that it more effectively serves the most vulnerable New York residents. Housing Works urges the CMS to expeditiously approve the New York State 1115 Waiver Amendment request and reform the Medicaid system for the residents of this State. Sincerely,

Charles King Housing Works President and CEO