To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera 565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Partnership HealthPlan of California Community Supports Agreement
End
Recommended Action:
Recommended action
Approve the County’s participation as a Community Supports provider and authorize the Health Services Interim Director, or designee, to enter into an agreement with Partnership HealthPlan of California (PHC) to provide Community Supports services to PHC referred members.
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Executive Summary:
The California Department of Health Care Services (DHCS) has initiated a process, California Advancing and Innovating Medi-Cal (CalAIM) that creates significant changes to the Medi-Cal program. These changes are designed to leverage Medi-Cal to support challenges facing California’s vulnerable populations: homelessness, behavioral healthcare access, children with complex medical conditions, justice involved populations who have significant clinical needs, and the aging population.
CalAIM redesigns Medi-Cal in a manner that creates an integrated person-centered health system addressing the behavioral, developmental, physical, and oral health needs of its members. The system is driven by values and outcomes, creating more consistent service provision across the state. Population health management strategies are utilized and designed to mitigate social determinants of health to reduce disparities and inequities.
The agreement with Partnership HealthPlan of California (PHC) allows the County to serve as a provider of the new In Lieu Of Services (ILOS) benefit, hereinafter referred to as Community Supports, which will provide wraparound services for individuals enrolled in the Whole Person Care (WPC) program; serving beneficiaries who have a serious mental illness and are homeless or at risk of homelessness. Community Supports is the one of the approaches within CalAIM to partially replace WPC. Community Supports services are designed to enable beneficiaries to avoid hospital or skilled nursing facility admission, or delaying discharge from such facilities. The first set of Community Supports benefits include: A) Housing Transition Navigation Services, B) Housing Deposits, and C) Housing Tenancy and Sustaining Services.
Discussion:
California Advancing and Innovating Medi-Cal (“CalAIM”) is a new initiative by the California Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal Members by implementing broad delivery system, program, and payment reform across Medi-Cal. A key feature of CalAIM is the offering of Community Supports or In Lieu Of Services (ILOS), which, at the option of a Medi-Cal managed care health plan (“MCP”) and a member, can substitute for covered Medi-Cal services as cost-effective alternatives.
The Whole Person Care (WPC) pilot ended December 31, 2021. The program known as Enhanced Care Management (ECM) is offered to replace this program in collaboration with Partnership HealthPlan of California (PHC). The Department will continue the WPC program as an ECM provider. The PHC Community Supports agreement allows the County to serve as a provider of Community Supports - wraparound services for individuals enrolled in the ECM/Whole Person Care program - serving beneficiaries who have a serious mental illness and are homeless or at risk of homelessness.
The Community Supports benefits to be provided by the Department include: A) Housing Transition Navigation Services, B) Housing Deposits, and C) Housing Tenancy and Sustaining Services. These services are outlined below.
A) Housing Transition/Navigation Services Overview:
• Housing transition services assist beneficiaries with obtaining housing and include:
• Conducting a tenant screening and housing assessment.
• Developing an individualized housing support plan based upon the housing assessment that addresses identified barriers.
• Searching for housing and presenting options.
• Assisting with securing housing and benefit advocacy.
• Identifying and securing available resources to assist with subsidizing rent, matching available rental subsidy resources to members, to cover expenses.
• Assisting with requests for reasonable accommodation, if necessary.
• Landlord education and engagement.
• Ensuring that the living environment is safe and ready for move-in.
• Communicating and advocating on behalf of the client with landlords.
• Assisting in arranging for and supporting the details of the move.
• Establishing procedures and contacts to retain housing.
• Identifying, coordinating, securing, or funding non-emergency, non-medical transportation to assist members’ mobility to ensure reasonable accommodations and access to housing options prior to transition and on move in day.
• Identifying, coordinating, environmental modifications to install necessary accommodations for accessibility.
The services may involve additional coordination with other entities to ensure the individual has access to supports needed for successful tenancy. Services do not include the provision of room and board or payment of rental costs.
Eligibility Criteria - Individuals who:
• Are prioritized for a permanent supportive housing unit or rental subsidy resource through
• Coordinated Entry System (CES).
• Meet the Housing and Urban Development (HUD) definition of homeless.
• Meet the definition of an individual experiencing chronic homelessness.
• Meet the HUD definition of at risk of homelessness.
• Are determined to be at risk of experiencing homelessness.
• Meet the State’s No-Place-Like-Home definition of “at risk of chronic homelessness.”
B) Housing Deposits Services Overview:
Housing deposits assist with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that do not constitute room and board, such as:
• Security deposits required to obtain a lease on an apartment or home.
• Set-up fees/deposits for utilities or service access and utility arrearages.
• First month coverage of utilities, including but not limited to telephone, gas, electricity, heating, and water.
• First month’s and last month’s rent as required by landlord for occupancy.
• Services necessary for the individual’s health and safety.
• Goods such as an air conditioner or heater, and other medically-necessary adaptive aids and services, designed to preserve an individuals’ health and safety in the home such as hospital beds, Hoyer lifts, air filters, specialized cleaning or pest control supplies etc.
Eligibility Criteria - Individuals who:
• Received Housing Transition/Navigation Services Community Supports in counties that offer Housing Transition/Navigation Services.
• Are prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless Coordinated Entry System.
• Meet the Housing and Urban Development (HUD) definition of homeless.
• Meet the HUD definition of at risk of homelessness
• Are determined to be at risk of experiencing homelessness
• Meet the State’s No-Place-Like-Home definition of “at risk of chronic homelessness.”
Restrictions and Limitations
• Available once in an individual’s lifetime. Housing Deposits can only be approved one additional time with documentation as to what conditions have changed to demonstrate why providing Housing Deposits would be more successful on the second attempt.
• Must be identified as reasonable and necessary in the individual’s individualized housing support plan and are available only when the enrollee is unable to meet such expense.
• Individuals must also receive Housing Transition Navigation services (at a minimum, the associated tenant screening, housing assessment and individualized housing support plan) in conjunction with this service.
C) Housing Tenancy and Sustaining Services Overview
This service provides tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured. Services include:
• Providing early identification and intervention for behaviors that may jeopardize housing.
• Education and training on the role, rights and responsibilities of the tenant and landlord.
• Coaching on developing and maintaining key relationships with landlords/property managers with a goal of fostering successful tenancy.
• Coordination with the landlord and case management provider to address identified issues that could impact housing stability.
• Assistance in resolving disputes with landlords and/or neighbors to reduce risk of eviction or other adverse action.
• Advocacy and linkage with community resources to prevent eviction when housing is or may potentially become jeopardized.
• Assisting with benefits advocacy.
• Assistance with the annual housing recertification process.
• Coordinating with the tenant to review, update and modify their housing support and crisis plan on a regular basis to reflect current needs and address existing or recurring housing retention barriers.
• Continuing assistance with lease compliance.
• Health and safety visits.
• Other prevention and early intervention services identified in the crisis plan that are activated when housing is jeopardized.
• Providing independent living and life skills.
Eligibility Criteria - Individuals who:
• Received Housing Transition/Navigation Services Community Supports in counties that offer Housing Transition/Navigation Services.
• Are prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless CES.
• Meet the Housing and Urban Development (HUD) definition of homeless.
• Meet the definition of an individual experiencing chronic homelessness.
• Meet the HUD definition of at risk of homelessness.
• Are determined to be at risk of experiencing homelessness.
• Meet the State’s No-Place-Like-Home definition of “at risk of chronic homelessness.”
Restrictions and Limitations
• These services are available from the initiation of services through the time when the individual’s housing support plan determines they are no longer needed.
• Only available for a single duration in the individual’s lifetime. They can only be approved one additional time with documentation as to what conditions have changed to demonstrate why providing Housing Tenancy and Sustaining Services would be more successful on the second attempt.
• These services must be identified as reasonable and necessary in the individual’s individualized housing support plan and are available only when the enrollee is unable to successfully maintain longer-term housing without such assistance.
• Many individuals will have also received Housing Transition/Navigation services (at a minimum, the associated tenant screening, housing assessment and individualized housing support plan) in conjunction with this service but it is not a requirement.
All Community Support services provided will be based on individualized assessment of needs and documented in the individualized housing support plan. Individuals may require and access only a subset of the services listed above.
The services provided will utilize best practices for clients who are experiencing homelessness and who have complex health, disability, and/or behavioral health conditions. Examples of best practices include Housing First Harm Reduction, Progressive Engagement, Motivational Interviewing, and Trauma Informed Care.
The Department is in the process of developing a methodology for estimating the number of Community Supports referrals from PHC and the Department’s pre-determined capacity. Community Supports funding will be included in the FY 22-23 Recommended Budget based on the contract rates, member referrals from PHC for Authorized Community Supports, and the Department’s pre-determined capacity. The Department is assessing existing staffing resources from the WPC pilot grant that ended on December 31, 2021, and will include the appropriate staffing level corresponding to the estimated funding level.
The initial term of the agreement with PHC is for a period of three years and shall renew automatically for consecutive one-year terms after the conclusion of the initial term unless the Department provides a 90-day written notice to PHC to terminate and/or renegotiate the agreement.
Prior Board Actions:
On November 16, 2021 the Board A) received a report on the California Advancing and Innovating Medi-Cal (CalAIM) multi-year initiative; B) approved the County’s participation as an Enhanced Care Management (ECM) provider and authorize the Health Services Interim Director, or designee, to enter into an agreement with Partnership HealthPlan of California (PHC) to provide ECM services to PHC referred members at the Per Enrollee Per Month (PEPM) contract rates; and C) adopted a personnel resolution amending the Department of Health Services allocation list, adding a 1.00 time-limited full-time equivalent Program Planning and Evaluation Analyst position and a 1.00 time-limited full-time equivalent Department Analyst position, effective November 16, 2021.
Fiscal Summary
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FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
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Additional Appropriation Requested |
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Total Sources |
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Narrative Explanation of Fiscal Impacts:
Community Supports funding will be included in the FY 22-23 Recommended Budget. No additional appropriations are required for FY 21-22.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Master Services Agreement For Community Supports (ILOS)
Related Items “On File” with the Clerk of the Board:
None