Health and Housing Strategy for Virginians with Serious Mental Illness: A Report to the General Assembly
Summary
Health and Housing Strategy for Virginians with Serious Mental Illness: A Report to the General Assembly, submitted by the Department of Housing and Community Development in January 2020. The executive summary states that in 2017 the General Assembly requested that the department work with state agencies and other stakeholders to develop and implement strategies to expand Permanent Supportive Housing (PSH) for individuals with serious mental illness (SMI). It describes this as the third report to the General Assembly, covering 2019 accomplishments and recommendations to meet a long-term 5,000-unit need. The table of contents lists background, progress and accomplishments, strategies for continued progress and appendices.
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“Health and Housing Strategy for Virginians with Serious Mental Illness: A Report to the General Assembly.”
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Health and Housing Strategy for Virginians
with Serious Mental Illness:
A Report to the General Assembly
Submitted by Department of Housing and
Community Development – January 2020
Table of Contents
Table of Contents .......................................................................................................................................... 2
Executive Summary....................................................................................................................................... 3
Annual Report on Housing Strategies for the Seriously Mentally Ill............................................................. 5
Background ................................................................................................................................................... 6
General Assembly Request ....................................................................................................................... 6
Permanent Supportive Housing .................................................................................................................... 6
What is PSH? ……………………………………………………………………………………………………………………………………..6
An Evidence-Based Practice ...................................................................................................................... 7
Why is a PSH Housing and Services Strategy Important for Virginia? ...................................................... 8
Assessing Cost Avoidance ....................................................................................................................... 11
Estimates of PSH Need for Virginians with SMI ...................................................................................... 12
PSH as of December 2019 ....................................................................................................................... 13
Progress and Accomplishments .................................................................................................................. 14
PSH Services and Supports - Accomplishments ...................................................................................... 14
Capital Investment in PSH - Accomplishments ....................................................................................... 19
Rental Assistance for PSH - Accomplishments........................................................................................ 21
Enhancing System Capacity - Accomplishments ..................................................................................... 24
Strategies for Continued Progress .............................................................................................................. 28
Strategies to Continue to Expand PSH Housing Supports ...................................................................... 28
Strategies to Expand Capital and Rental Assistance for PSH .................................................................. 31
Strategies to Increase Capital Investment in PSH ................................................................................... 31
Strategies to Increase Rental Assistance for PSH ................................................................................... 34
Strategies to Increase PSH through Existing Affordable Housing Programs........................................... 36
Strategies to Increase PSH through Enhancing System Capacity ........................................................... 37
Leadership Key to PSH Strategy .................................................................................................................. 40
Appendices.................................................................................................................................................. 41
Appendix A Action Plan .......................................................................................................................... 42
Appendix B PSH Steering Committee ..................................................................................................... 63
Appendix C Strategy Group Membership .............................................................................................. 64
Appendix D Committee Relationship Graphic ........................................................................................ 66
2
Executive Summary
Permanent Supportive Housing (PSH) is an evidence-based practice that meets the housing
preferences of many individuals with serious mental illness (SMI) and demonstrates positive
outcomes such as reduced hospitalizations and homelessness, increased housing stability, and
improved behavioral and physical health. In 2017, the General Assembly requested the
Department of Housing and Community Development (DHCD) work with state agencies and
other stakeholders to develop and implement strategies to expand PSH for individuals with
SMI. This third report to the General Assembly provides the state’s 2019 accomplishments as
well as recommendations to continue to expand PSH to meet the long-term 5,000-unit need for
PSH.
During CY 2019, the PSH Steering Committee established five goals to continue to expand PSH:
Goal #1 - Increase Services and Supports to Assist Individuals with SMI to Gain Access to
and Maintain Supportive Housing
Goal #2 - Provide Capital Subsidies to Expand PSH
Goal #3 - Increase Rental Assistance to make Units Affordable
Goal #4 - Increase PSH through Preferential Access to Existing Affordable Housing
Programs
Goal #5 - Strategies to Increase PSH through Enhancing System Capacity
The Committee developed a three-year Action Plan with 57 specific strategies and action items
to reach these goals. The Action Plan was approved by the Interagency Leadership Team (ILT).
The lead state agencies designated for the strategies began providing quarterly updates which
will be shared with the Housing Virginians with SMI Strategy Group.
Working collaboratively, the state agencies that comprise the PSH Steering Committee made
significant progress towards meeting each of these goals. Highlights of the CY 19
accomplishments include:
DBHDS PSH SMI Program Outcomes: The PSH SMI Program currently has funding obligated to
serve 1,027 individuals. Outcomes for the 950 individual participants in the PSH SMI program,
who were housed between February 6, 2016 and July 1, 2019 include:
One hundred forty-seven individuals were discharged from a state behavioral health
hospital into DBHDS PSH, and overall, 228 individuals in PSH had a state hospital
admission in the year before move-in.
At least 95 individuals served in PSH were on the extraordinary barrier list (EBL) in the
year before move-in.
PSH providers are effectively prioritizing individuals with extensive histories of
homelessness and repeated, long-term use of institutional care before move-in.
Eighty-six percent of individuals served in PSH remained stably housed.
Only 6 percent of those served have been discharged to an institutional setting or higher
level of care.
3
State hospital utilization decreased 82 percent the year after PSH move-in, resulting in
avoided costs of $9.5 million.
A DBHDS cross-system cost impact analysis identified a 29 percent decrease in private
hospital, state hospital, jail, and Community Services Board (CSB) costs after one year of
PSH.
After PSH costs were included in this analysis, a total cost reduction of $1,375 was
identified for each individual housed.
VHDA Leasing Preference: In order to have a more significant impact, VHDA modified its CY19
Qualified Allocation Plan to require that every development awarded 9% Low Income Housing
Tax Credit (LIHTC) as well as 4% tax credit funding provide a PSH leasing preference for 10
percent of its units. In 2019, this resulted in tax credit awards for 183 units through the 9% and
270 units through the 4% program.
Virginia Housing Trust Fund (VHTF): Increased FY19 funds for this program allowed DHCD to
expand the number of PSH projects awarded Homeless Reduction Grant services funds in 2019
to 12 and to increase capital funds awarded for PSH to 10 projects with 347 units.
Mainstream Voucher Program: With the support of the state agencies, local Virginia Public
Housing Agencies leveraged 729 federally-funded vouchers to serve non-elderly people with
disabilities who are homeless, institutionalized, at risk of either condition, or who will move on
from a PSH/Rapid ReHousing program
COMPASS Waiver: In anticipation of CMS approval of the Waiver, DMAS initiated discussions
with state partner agencies to begin defining the specific services covered by the housing
supports benefit, refining member eligibility and formalizing protocols for serving High Needs
members.
Enhanced System Capacity: The establishment of the DBHDS Community Housing Office and
the creation and hiring of a DMAS Housing Advisor will help the state move forward more
quickly on the PSH housing and services goals.
Meeting the long-term need for PSH will require the continued support of leadership and the
commitment of state and local public and private entities to make rental units available and
affordable, to target those units to individuals in the state’s priority populations, and to provide
readily accessible supportive services through the ongoing development of systems capacity
and sustainable funding strategies.
4
Annual Report on Housing Strategies for the Seriously Mentally Ill
The following report complies with the 2019 Budget Bill language Item 105 H - Commerce and
Trade – Department of Housing and Community Development
"H. The Department of Housing and Community Development (DHCD) shall develop and
implement strategies, that may include potential Medicaid financing, for housing individuals
with serious mental illness. DHCD shall include other agencies in the development of such
strategies including the Virginia Housing Development Authority, Department of Behavioral
Health and Developmental Services, Department for Aging and Rehabilitative Services,
Department of Medical Assistance Services, and Department of Social Services. The Department
shall also include stakeholders whose constituents have an interest in expanding supportive
housing for people with serious mental illness, including the National Alliance on Mental Illness
Virginia, the Virginia Housing Alliance and the Virginia Sheriff's Association. An annual report on
such strategies and the progress on implementation shall be provided to the Chairmen of the
House Appropriations and Senate Finance Committees by the first day of each General Assembly
Regular Session."
5
Background
General Assembly Request
Through budget language, the 2017, 2018 and 2019 General Assembly charged the Department
of Housing and Community Development (DHCD) with developing and implementing strategies
to increase permanent supportive housing (PSH) for individuals with serious mental illness
(SMI). The General Assembly indicated that strategies could potentially include Medicaid
financing and directed DHCD to include other agencies in the development of strategies,
naming the Virginia Housing Development Authority (VHDA), Department of Behavioral Health
and Developmental Services (DBHDS), Department for Aging and Rehabilitative Services (DARS),
Department of Medical Assistance Services (DMAS), and Department of Social Services (DSS)
(Item 105 H). Direction for this effort has been provided on two levels – through the
Interagency Leadership Team, comprised of heads of the agencies described above and through
the Permanent Supportive Housing (PSH) Steering Committee comprised of program directors
and managers of the same agencies.
Further, the General Assembly required DHCD to include stakeholders whose constituents have
an interest in expanding supportive housing for individuals with SMI, naming the National
Alliance on Mental Illness Virginia, the Virginia Housing Alliance and the Virginia Sheriff's
Association. Finally, the General Assembly required DHCD to provide an annual report on such
strategies and the progress on implementation to the Chairmen of the House Appropriations
and Senate Finance Committees. This report is the third DHCD report to the General Assembly
in response to its charge to develop PSH strategies. The 2018 and 2019 reports can be found
here:
https://rga.lis.virginia.gov/Published/2018/RD12
https://rga.lis.virginia.gov/Published/2019/RD100
Permanent Supportive Housing
What is PSH?
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) describes PSH
as “decent, safe, and affordable community-based housing that provides tenants with the rights
of tenancy under state and local landlord tenant laws and is linked to voluntary and flexible
supports and services designed to meet tenants’ needs and preferences.1” PSH is affordable
rental housing that may be scattered site or single site. Support services are available to tenants
but not required and PSH is not a treatment setting. PSH is a cross-system approach that
requires tactical use of resources.
Housing must be safe, decent and affordable. Housing affordability is a critical issue for states
working to comply with Americans with Disabilities Act of 1990, as amended (ADA)
requirements because most individuals with significant disabilities rely primarily on federal
Supplemental Security Income (SSI) payments that average only 20 percent of median income
1 SAMHSA (2010). Permanent Supportive Housing Evidence-Based Practices (EBP) Kit. PowerPoint Presentation:
http://store.samhsa.gov/product/SMA10-4510.
6
nationally. Nowhere in the U.S. can a person with a disability on SSI afford housing at the Fair
Market Rate2. Affordability is created with capital to write down the cost of acquisition,
development or rehabilitation of housing and rental or operating assistance to ensure tenants
pay only what they can afford for rent. The tenant’s limited income also means it is difficult to
save for payment of a security deposit, utility hook-ups or furnishings and tenants often need
assistance with these one-time costs as well.
Services are essential to assist individuals with SMI in gaining access to and transitioning to
housing, and for successfully sustaining PSH. PSH programs generally provide tenancy supports
to help individuals maintain successful tenancies and connect tenants with community-based
organizations for health care, mental health, substance abuse (mental health and substance
abuse hereafter collectively referred to as behavioral health) and other services. States have
options for how to deliver and fund PSH services. It is critical to ensure services are readily
available when needed and available for a long as the individual wants and needs them.
System Supports are essential, to serve as the “glue” that makes PSH work. The delivery of
housing and services requires the collaboration of systems that use different language, rely on
different funding sources and have different measures of accountability. Collaboration and
strategic planning at multiple levels including the state, regional, and local are critical to the
development and management of system supports. Each system’s roles and responsibilities
need to be clear and accountable at the planning stage to ensure the needed collaboration and
communication is functional when programs are ready for implementation.
An Evidence-Based Practice
SAMHSA has identified PSH as an evidence-based practice (EBP) for individuals with SMI.
Research has shown the cost-effectiveness of the PSH model, particularly for people with
extensive or complex needs such as those with co-occurring mental health and substance use
disorder conditions who often experience homelessness, or who are frequent users of costly
institutional and emergency care3. Research has also demonstrated positive impacts of PSH on
housing stability, health, and behavioral health4. In one review of existing research studies, a
consistent finding emerged that the “provision of housing had a strong, positive effect in
promoting housing stability and reducing homelessness.”5
2 Priced Out 2017, Technical Assistance Collaborative.
3 Culhane, D. P. et al. (2002). Public service reductions associated with placement of homeless persons with severe mental
illness in supportive housing. Housing Policy Debate, 13(1):107–163
Larimer, M. E. (2009). Health care and public service use and costs before and after provision of housing for chronically
homeless persons with severe alcohol problems. The Journal of the American Medical Association 301(13):1349
Chalmers McLaughlin, T. (2010). Using common themes: Cost-effectiveness of permanent supported housing for people with
mental illness. Research on Social Work Practice, 21(4):404–411.
4 Rog, D. et al. (2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services 65(3):287-294
Padgett, et al. (2011). Substance use outcomes among homeless clients with serious mental illness: Comparing Housing First
with Treatment First programs. Community Mental Health Journal 47(2):227–232.
Wolitski et al. (2009). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and
unstably housed people living with HIV. AIDS and Behavior 14(3):493–503.
5 Rog, D. et al. (2013). Permanent supportive housing: Assessing the evidence. Psychiatric Services 65(3):290.
7
Other federal agencies, including the Department of Housing and Urban Development (HUD),
the Center for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ), and the
US Interagency Council on Homelessness (USICH) recognize PSH as a best practice. HUD and
CMS for example, have programs or projects in place to promote PSH. HUD has provided funds
annually to Continuums of Care serving chronically homeless individuals – the vast majority of
whom have SMI - to expand PSH. As costs for institutional settings have grown, and alternative
service approaches emerged, CMS recognized and promoted options for states to shift, when
appropriate, the care of individuals in nursing facilities and intermediate care facilities for
individuals with intellectual disabilities (ICF-IIDs) to more inclusive and less costly community-
based alternatives. Initiatives such as Money Follows the Person and the Balancing Incentive
Program, as well as Home and Community-Based Services (HCBS) Waivers became popular
tools to assist states in reducing reliance on institutional settings. In January 2014, CMS put in
place the HCBS Waiver “Settings Rule” that provided strong incentives for state Medicaid
agencies and their Mental Health and Intellectual/Developmental Disabilities counterparts to
develop and promote integrated community-based housing for individuals with disabilities. In
June 2015, CMS issued an Informational Bulletin clarifying that while Medicaid cannot pay for
room and board, the program can assist states with coverage of certain housing-related
activities and services.6 The bulletin was intended to assist states in designing Medicaid
benefits, and to clarify the circumstances under which Medicaid reimburses for certain housing-
related activities, with the goal of promoting community integration for individuals with
disabilities, older adults needing long-term services and supports (LTSS), and those experiencing
chronic homelessness.
Prioritizing the housing needs of individuals with disabilities who are institutionalized or
homeless is not only the most cost-effective strategy for states and the federal government, it
is also a requirement of the ADA. States are increasingly moving toward expansion of PSH
within their housing and services continuums because of its alignment with the ADA’s
integration mandate, as well as with housing preferences and choices for many individuals with
SMI in particular. This is especially true where lack of availability or lack of access to such
options, due in part to a history of reliance on congregate or institutional settings, seriously
limits the housing choices of individuals with disabilities.
Why is a PSH Housing and Services Strategy Important for Virginia?
PSH can be a valuable tool to help the Commonwealth of Virginia address a number of public
policy challenges. First, Virginia has implemented Medicaid expansion, affording access to
health care for up to 400,000 low-income qualifying Virginia residents. Based on other states’
experiences, it is estimated that as many as 35 percent of these individuals will have significant
chronic physical and behavioral health conditions that have previously been un-treated or
under-treated due to their lack of coverage. Many of these individuals are likely to be unstably
housed, adding to the myriad of needs to be addressed to improve their health. In addition to
the array of support services now available to them through Medicaid, PSH can help by
6 https://www.medicaid.gov/federal-policy-guidance/downloads/cib-06-26-2015.pdf
8
improving housing stability, leading to more effective use of healthcare services for this newly
covered population.
Development of a housing and services strategy for individuals with SMI is also important to the
Commonwealth because it will facilitate the timely discharge of individuals from state
psychiatric beds and prevent returns to inpatient care. Virginia is experiencing a census crisis in
its state hospitals due to “bed of last resort” legislation, which has left those hospitals
shouldering a disproportionate share of temporary detention order admissions. Lack of
affordable housing with robust supportive services is a commonly cited barrier to discharge.
PSH is widely recognized as a critical resource to assist states with ensuring individuals are
supported in the least restrictive setting, as required by the Olmstead decision, and with
reducing the use of costly inpatient care.
PSH can help the subpopulation of people with SMI exit homelessness more quickly and
successfully. As illustrated in Figure 1, between CY2010 and CY2019, overall homelessness in
Virginia has decreased 36 percent. Homelessness among various subpopulations including
people with substance use disorders, families, veterans and people experiencing chronic
homelessness has decreased between 39 and 71 percent during this time period. In 2015,
Virginia became the first state in the country to be certified by the U.S. Department of Housing
and Urban Development to have functionally ended veteran homelessness. For people with
SMI, however, homelessness decreased only 22 percent between 2010 and 2019.
Figure 1: Virginia Homeless Subpopulations 2010-2019
2500
2000
1500
1000
500
0
SMI SUD Veterans Families Chronically Homless
-500
-1000
-1500
-2000
2010 2019 Difference
7
7
The 2019 data is preliminary and has not been finalized with HUD.
9
Figure 2: Decrease in Homelessness by Supopulation 2010-2019
Chronically Homless
Families
Veterans
SUD
SMI
-80% -70% -60% -50% -40% -30% -20% -10% 0%
Virginia’s criminal justice system would also benefit considerably from additional PSH capacity.
For justice system-involved individuals with SMI, and co-occurring substance use disorders
(SUD), housing is critical for successful re-entry into the community and sustained recovery
over time. Without safe, affordable housing and appropriate community supports, individuals
with behavioral health disorders are less likely to remain in recovery and more likely to come
back into contact with the criminal justice system, become re-incarcerated, or even
hospitalized.
The 2019 Appropriations Act continued funding for the Jail Mental Health Pilot Program. The
Act required the pilot sites to report quarterly performance data, to include the provision of
appropriate services to jail mental health pilot participants after release, and the number of
inmates re-arrested or re-incarcerated within 90 days after release.
Standardized recidivism data was not collected across the six pilot sites during FY 2019;
however, jail staff members at some sites began collecting preliminary recidivism data. Some
projects shared examples of successful re-entry by program participants, attributing these
successes to individuals rebuilding support systems, obtaining housing and employment,
getting needed medication and restoring benefits. Overall, provision of aftercare services
improved; however, providing safe, affordable housing in the community for released inmates
was identified as on ongoing challenge. The number of inmates who were provided housing
post release reportedly decreased from the first quarter to the fourth quarter of FY2019. The
FY19 Report indicated that “Finding safe and affordable housing remains one of the biggest
challenges facing many participating sites,” and recommended improving housing options for
program participants released into the community. The Report concluded that…” housing is a
crucial element in assuring successful re-entry and reducing recidivism.” All sites are now
collecting recidivism data, which will be analyzed and presented in the FY20 program evaluation
to be reported to the Chairmen of the House Appropriations and Senate Finance Committees
by June 30, 2020.
10
Assessing Cost Avoidance
A housing and services strategy is also important because national and state data suggest that
PSH results in some public cost avoidance.
Opportunities for Cost Avoidance for Virginia as a Result of Increased PSH Data Reflecting the
National Experience
Studies demonstrate that providing PSH can help achieve significant savings by reducing
avoidable emergency department (ED) visits, hospitalizations, readmissions, and other health
care costs – particularly when the assistance is targeted to the most high-cost and highly
vulnerable Medicaid beneficiaries experiencing homelessness.8 Combining affordable housing
with intensive services, including help finding housing, working with a landlord, accessing
physical and behavioral health care, and finding employment, for a high-needs group saved an
average of $6,000 a year per person in health care: 23 percent fewer days in hospitals, 33
percent fewer ED visits, and 42 percent fewer days in nursing homes.9
Data Reflecting Virginia Experiences
Virginia has also conducted evaluations of its own PSH programs and generated findings
consistent with national research. DBHDS has been operating PSH for adults with serious
mental illness with targeted state general funds since 2016.
Before moving into DBHDS PSH, individuals have had long histories of homelessness as well as
crisis contacts and institutional care resulting in multi-system involvement, poor outcomes, and
failed interventions. After move-in into DBHDS PSH, individuals experienced dramatically
improved housing stability and reduced utilization of inpatient care.
Outcomes for the 950 individual participants in the PSH SMI program, who were housed
between February 6, 2016 and July 1, 2019 include:
One hundred forty-seven individuals were discharged from a state behavioral health
hospital into DBHDS PSH, and overall, 228 individuals in PSH had a state hospital
admission in the year before move-in.
At least 95 individuals served in PSH were on the extraordinary barrier list (EBL) in the
year before move-in.
PSH providers are effectively prioritizing individuals with extensive histories of
homelessness and repeated, long-term use of institutional care before move-in.
Eighty-six percent of individuals served in PSH remained stably housed.
8 See The Commonwealth Fund (2014) In Focus: Using Housing to Improve Health and Reduce the Cost of Caring for the
Homeless
http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/october-november/in-focus and
http://aspe.hhs.gov/daltcp/reports/2011/ChrHomlr.pdf
9 Building the Case: Low-Income Housing Tax Credits and Health, Bipartisan Policy Center, Anand Parekh, M.D., and Caitlin
Krutsick, November 2017.
11
Only 6 percent of those served have been discharged to an institutional setting or higher
level of care.
State hospital utilization decreased 82 percent the year after PSH move-in, resulting in
avoided costs of $9.5 million.
A DBHDS cross-system cost impact analysis identified a 29 percent decrease in private
hospital, state hospital, jail, and CSB costs after one year of PSH.
After PSH costs were included in this analysis, a total cost reduction of $1,375 was
identified for each individual housed.
The 2018 Mental Illness in Jails Report analyzed data on the 27,044 individuals incarcerated in
Virginia’s jails in June 2018. Nearly twenty percent were known or suspected to have a mental
illness. Further, 10.42 percent of inmates had an SMI. The reported percentage of inmates with
SMI has increased nearly 74 percent since 2011. Jails also identified 875 inmates who were
homeless, 377 of whom had a mental illness and 277 of whom had a mental illness and co-
occurring substance use disorder. Fiscal Year 2018 jail behavioral health costs were reported at
$23.2 million for the jails that responded to the Compensation Board’s survey.
Estimates of PSH Need for Virginians with SMI
Both the General Assembly and Governor Northam recognize the benefits of PSH. In 2017, the
General Assembly requested the Department of Housing and Community Development (DHCD)
work with state agencies and other stakeholders to develop and implement strategies to
expand PSH for individuals with SMI. By including the High Needs Support Benefit, which
includes supportive housing as well as supportive employment, as part of Virginia’s Medicaid
expansion, the General Assembly acknowledged the important role PSH does and can play for
Virginian’s with disabilities, including SMI.
In November 2018, Governor Ralph Northam issued Executive Order 25, recognizing Virginia’s
unmet housing needs and highlighting the need for PSH as one of his three top priorities. At
the request of the Deeds Commission, DBHDS assessed the number of adults with serious
mental illness who need PSH to address extreme crises such as long-term homelessness,
institutionalization, and frequent use of emergency services and criminal justice interventions.
DBHDS’s assessment established a need for 5,000 PSH units. This is consistent with Executive
Order 25 and is supported by the Administration’s Housing and Supportive Services Interagency
Leadership Team (ILT).
Table 1 illustrates how DBHDS arrived at the need for estimated 5,000 additional PSH units for
Virginians with SMI. It is important to note that while many individuals with SMI would benefit
from PSH, DBHDS’ estimate of need below includes only those who need PSH to address
extreme crises such as long-term homelessness, institutionalization, and frequent use of
emergency services and criminal justice interventions.
12
Table 1: DBHDS Estimates of Need for PSH for Persons with SMI
Current Status of Individual Number of Persons with SMI Data Source
Homeless 51610 The State of PSH in Virginia,
2015 (Virginia Housing Alliance)
Jail 1,056 Mental Illness in Jails Report
(Virginia Compensation Board,
2015)
Assisted Living Facility 824 Auxiliary Grant payments to
localities (2016 Estimate of SMI
based on AG recipients in one
month as provided by DARS)
Unstably Housed - Top 20 2,684 Community Services Board
percent highest utilizers of (including 464 individuals with a (CSB) CCS_3 data submissions
crisis and emergency services state psychiatric facility stay) (DBHDS, 2016)
PSH as of December 2019
As of December 2019, the state has developed 1,162 or 23 percent of the approximately 5,000 PSH
units needed. This includes
1,027 PSH SMI units
90 AGSH units
44 leveraged Mainstream vouchers
Note that the 5,000-unit estimate of need is based on 2016 data that has not yet been updated
to reflect the impact of PSH investment or changes in the population of individuals with SMI in
need of PSH.
10 The 2017 PIT for the State of Virginia (combined data from all Virginia Continua of Care) is 611 persons in shelters and 251
unsheltered persons for a total of 862 homeless individuals with SMI.
13
Progress and Accomplishments
As described above, since the submission of the 2019 report to the General Assembly, DHCD
has been working with its state partners and the Housing People with SMI Strategy Group
comprised of stakeholders to implement the report recommendations. PSH expansion requires
the identification of new or redirected resources for supports and housing as well as systemic
infrastructure such as staffing, policies and procedures. Together, these all must align for
successful expansion.
PSH Services and Supports - Accomplishments
Services are essential to assist individuals with SMI in gaining access to and transitioning to
housing, and for successfully sustaining PSH. PSH programs generally provide tenancy supports
to help individuals maintain successful tenancies and connect tenants with community-based
organizations for health care, mental health, substance abuse (mental health and substance
abuse hereafter collectively referred to as behavioral health) and other services. Like many
other states, Virginia has historically covered housing acquisition and tenancy supports for
individuals with behavioral health disorders using state funds, more specifically through
continued investment of state general funds in DBHDS’ PSH program.
While most of the DBHDS’ PSH program funds are directed to long-term rental assistance, more
than thirty percent of these funds have been used for housing stabilization services, one-time
client assistance, or staff time to administer the rental assistance. Following CMS Guidance to
explore the use of Medicaid Authority to cover certain housing related-services and supports,
Virginia determined it was in the state’s interest to seek Medicaid coverage for many of these
state-funded services, freeing up state dollars to fund additional rental assistance.
On June 7, 2018, Governor Northam signed the 2018 Virginia Acts of Assembly Chapter 2 (2018
Appropriations Act) directing DMAS to submit a Medicaid Section 1115 Demonstration Waiver
seeking federal approval for new Medicaid program features “designed to empower individuals
to improve their health and well-being…,” including a housing supports benefit.
Housing Support Benefit in the Medicaid 1115 Demonstration Waiver
On November 20, 2018, DMAS submitted the application, known as "Creating Opportunities for
Medicaid Participants to Achieve Self Sufficiency" (COMPASS) waiver. The Waiver proposed a
housing supports benefit for a targeted group of high-need Medicaid eligible members,
including individuals with SMI. The Centers for Medicare and Medicaid Services (CMS) then
posted the waiver submission for a 30-day comment period, ending on January 6, 2019. DMAS
began, and as of the writing of this report, continues negotiating the COMPASS waiver Special
Terms and Conditions (STCs) with CMS; the STCs serve as the agreement between the federal
government and the state on the policy for the waiver programs. The extent of the negotiations
has caused DMAS to re-evaluate the process and timeline originally proposed for
implementation of the waiver, including the housing supports benefit.
14
In anticipation of CMS approval of the Waiver, DMAS recently initiated discussions with the HSS
Interagency team to begin defining the specific services covered by the housing supports
benefit, refining member eligibility and formalizing protocols for serving High Needs members.
Interim Strategies Using Existing Medicaid Services and Authorities
As a result of Medicaid Expansion, more than 330,000 Virginia residents now have access to
Medicaid. As of September, 2019, 30,000 of these new members were receiving services
related to a behavioral health diagnoses. An additional 15,000 members were receiving
treatment for a substance use disorder. Absent stable housing, these members can incur
significant costs to the Medicaid program through frequent and extended inpatient admissions,
emergency department visits and use of crisis intervention services.
Since Medicaid expansion occurred prior to the statewide implementation of the housing
supports benefit, the PSH Steering Committee determined that the Commonwealth could
benefit from exploring opportunities to cover housing related services and activities using
existing Medicaid covered services as an interim strategy. The availability of housing support
services helps to ensure successful community integration for individuals with serious mental
illness, including individuals transitioning or being diverted from institutional settings and
individuals experiencing or at risk of chronic homelessness, until the Medicaid housing supports
benefit is in place.
Earlier in the year, DMAS was selected to participate in CMS’s Innovation Accelerator Program
(IAP) focused on promoting community integration through long term services and supports.
IAP provides opportunity for technical assistance through peer states, subject matter experts,
technical assistance and coaching. The coaches assigned to Virginia were the Technical
Assistance Collaborative (TAC), a firm already under contract with VHDA to support the PSH
Steering Committee.
Through the IAP, DMAS and DBHDS identified that Care Coordination (CC), Targeted Case
Management (TCM), Mental Health Skill-building Services (MHSS), Intensive Community
Treatment (ICT) and Peer Support services could potentially be used to deliver some housing
acquisition, transition and tenancy support services until the housing supports benefit is
implemented under the COMPASS Waiver. With the expansion of Medicaid, even more
individuals now have access to those supportive services.
Continued Work on Behavioral Health Redesign
As referenced in the 2019 Annual Report, DMAS and DBHDS in partnership with others, have
initiated efforts to improve the quality of behavioral health services, thereby improving
outcomes for Medicaid recipients. Behavioral Health Redesign was initiated in July 2018,
intended to establish a continuum of Medicaid funded mental health services, and a redesigned
continuum of mental health services that is trauma-informed, evidence-based, and focused on
early intervention and prevention. The initiative intends to improve access to services in
Virginia’s publicly funded behavioral health system, the outcomes of services for recipients and
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the rising cost of behavioral health services by building on system strengths while addressing
gaps in the continuum of community-based behavioral health services.
A proposed continuum of services was developed with stakeholders and released in January
2019 to serve as a guide post for movement forward. Community Mental Health and
Rehabilitation Services will become Intensive Community-Based Supports that are tiered based
on the intensity of an individual’s needs and include evidence-based best practices. This
approach is well aligned with evidence-based PSH.
While more individuals are now eligible for or accessing existing behavioral health services that
support individuals to acquire and maintain housing stability, providing effective housing
acquisition, transition and tenancy sustaining services presents several challenges that both
DMAS and DBHDS acknowledge. Provider capacity is already insufficient for certain behavioral
health services in some regions. Other services appear to be over-utilized with minimal
outcomes for recipients. Until the Behavioral Health Redesign effort is completed and fully
implemented, a consistent, effective, thorough supportive approach to PSH is limited.
If redesign is approved, DBHDS will prepare existing providers to deliver effective, high quality
services that will support the delivery of supportive housing. The agency has held a number of
training sessions on a Community Housing supplement to Wellness Recovery Action Plans, a
tool that is designed to assist individuals in to be more involved, and ultimately successful, in
their recovery as it relates to housing. DBHDS is also planning to partner with a CSB to secure
provider education and training that will support individuals to successfully transition from
structured settings to independent living.
Building on Community Guide as a Successful Model for the Housing Supports Benefit
Community Housing Guide (CHG) is a new service offered in Virginia’s redesigned Medicaid
Waivers for people with developmental disabilities. The service is intended to provide direct
assistance to promote individuals’ self-determination through brokering specific community
resources that enable individuals to access and participate in integrated, independent housing.
Community Housing Guides:
Support an individual’s move to independent housing by helping with transition and
tenancy sustaining activities;
Collaborate with the support coordinator, regional housing coordinator, and others to
enable the individual to achieve and sustain integrated, independent living; and
Promote people’s self-determination by brokering community resources to help
individuals connect to and participate in integrated, independent housing.
In April, DBHDS engaged TAC’s assistance with developing a training curriculum for CHGs.
DBHDS staff drafted training modules and developed a process to pilot the training with
potential CHG providers. The training was piloted in late November/early December 2019 with
provider agency staff representing all five DBHDS regions. DBHDS and DMAS envision building
on the feedback from the training pilots to improve both the CHG training as well as future
training for providers of the housing supports benefit.
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Non-Medicaid Supportive Housing Services
Medicaid Expansion has afforded many more individuals with behavioral health disorders
access to healthcare coverage, however there will continue to be some Virginians who may not
qualify for the COMPASS Waiver Housing Support benefit. The PSH Steering Committee
identified and focused on increasing other key resources that can be used to support individuals
with SMI in accessing and sustaining successful independent living.
Expansion of PSH Supports through DBHDS’s PSH Program
Almost all of the growth in individuals with SMI served in PSH has been made possible through
continued investment of state general funds in DBHDS’ PSH program. The $17.2 million
invested in FY20 is expected to serve at least 1,200 individuals. DBHDS has already awarded
funding to nineteen agencies (18 CSBs and one non-profit), including 4 new providers in FY20.
An additional round of funding intended to align with HUD awards for new Mainstream
Vouchers is expected later this fiscal year. To date, individuals use state-funded rental
assistance to secure rental housing available on the private market.
While most DBHDS PSH funds are directed to long-term rental assistance, more than thirty
percent of these funds are used for housing stabilization services, one-time client assistance, or
staff time to administer the rental assistance. Once the COMPASS Waiver is approved and the
Medicaid housing benefits are phased in, many of these state-funded supports will be
reimbursable under the waiver. It is estimated that the newly established Medicaid PSH benefit
will then allow DBHDS to provide rental assistance to serve approximately 200 individuals with
state funds for services that could be re-purposed as rental assistance.
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Table 2: PSH SMI Units by Region
Leveraged
DBHDS PSH AGSH Unit Voucher
PSH Provider Unit Count Count Count Total Units
Region 1 - Northwest 173 0 20 193
Northwestern 30 0 0 30
RACSB 30 0 0 30
Rapp-Rapidan 28 0 20 48
Region Ten 55 0 0 55
Valley 30 0 0 30
Region 2 - Northern 182 0 0 182
Arlington 44 0 0 44
Pathway Homes 138 0 0 138
Region 3 - Southwest 168 90 4 262
BRBH 75 40 0 115
DPCS 42 0 0 42
Mt Rogers 45 35 4 84
Southside/Piedmont 6 15 0 21
Region 4 - Central 172 0 0 172
D19 30 0 0 30
Henrico 30 0 0 30
RBHA 112 0 0 112
Region 5 - Tidewater 330 0 20 350
Chesapeake 15 0 10 25
Hampton NN 114 0 0 114
Norfolk 131 0 10 141
Virginia Beach 72 0 0 72
Grand Total 1,027 90 44 1,161
Expansion of PSH Supports through State Housing Trust Fund
Up to 20 percent of the Virginia Housing Trust Fund (VHTF) may be used for competitive grants
to help reduce homelessness through Homeless Reduction Grants. These grants may be used to
provide temporary rental assistance not to exceed one year, housing stabilization services in
supportive housing for chronically homeless households, and predevelopment assistance to
support long-term housing opportunities for chronically homeless households. Because these
grants rely on annual state appropriations, there is some concern that providers are reluctant
to request funding for on-going services. Through the FY18 competitive process, DHCD selected
13 projects for funding; five of these were existing PSH providers seeking new support services.
During calendar year 2018, these five programs served 233 people experiencing chronic
homelessness.
With increased VHTF funding in the FY19 and FY20 budgets, DHCD was able to expand the
number of PSH projects awarded funds in 2019. DHCD awarded funding to 12 PSH projects as
well as pre-development funds for two PSH projects. These projects are currently being
implemented.
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Virginia Department of Veterans Services
Virginia has long made it a priority to reduce the number of Veterans’ experiencing
homelessness, targeting resources to reduce chronic homelessness since 2013. These efforts
have proven successful, reducing Veterans’ homelessness by 51 percent in 2019, with an even
greater reduction in chronic homelessness. The Virginia Department of Veterans Services
(DVS)attributes its success to aligning services and housing resources, both internal to the
department as well as external partners:
DVS, through the Virginia Veteran and Family Support (VVFS) Program, employs
approximately 40 Resources Specialists statewide that serve as navigators to assist
Veterans in need of services including those with SMI in connecting to Continua of Care
(CoCs), PSH programs, and BH services. Some Resource Specialists are located with
Community Service Boards, strengthening their ability to connect veterans with needed
services and supports.
DVS also administers the DVS Homeless Veterans Fund through donations provided by
the Veteran Service Foundation. These funds assist in covering “gap” expenses such as
security deposits for homeless veterans and prevention resources (rent arrears, utility
assistance, etc.) for previously chronically homeless veterans.
Fifteen PHAs and the VHDA have a total of 1,600 Veterans Affairs Supportive Housing
(VASH) vouchers.
Provider Capacity Development
In Virginia, existing providers of PSH vary and include CSBs as well as non-profit agencies. Some
of these agencies have history providing PSH, but their services may not meet the standards for
evidence-based practice. Others may be aware of the expectation to provide housing for
individuals with SMI but have no history of service provision outside of 24-hour, structured
residential programs. Still other agencies may be delivering PSH but are not enrolled as
Medicaid providers and lack the infrastructure and the expertise to bill Medicaid for services.
In order to begin enhancing existing provider capacity in anticipation of the approved housing
supports benefit, DBHDS partnered with the Virginia Housing Alliance and the Corporation for
Supported Housing to conduct two PSH capacity-building trainings. Trainings were held in
Fairfax and Henrico, and the audience included CSBs, non-profit supportive housing providers,
and property managers. Training topics included fidelity to the evidence-based practice
standards for PSH and organizational capacity building to bill Medicaid for a potential housing
supports benefit.
Capital Investment in PSH - Accomplishments
Given low vacancy rates and strong demand for rental housing across much of the state, it will
be difficult to scale up PSH without new production of PSH units. At the state level, there are
two capital programs that are primarily responsible for new affordable rental production that
benefit people with SMI - the Affordable and Special Needs Housing (ASNH) and the Low
Income Housing Tax Credit (LIHTC) programs.
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Expansion of PSH through DHCD’s Affordable Housing and Special Needs Program
With the ASNH program, developers can apply to access any of four funding sources through a
single competitive application process: federal HOME and National Housing Trust (NHTF)
programs as well as VHTF and DHCD’s state funded PSH program. Combining the funds into one
proposal process makes requesting funds significantly easier for developers, especially smaller,
nonprofit developers who are more likely the to be seeking these sources.
In 2018-2019, the General Assembly increased funding for the VHTF. These additional funds,
combined with increases in the federal HOME and National Housing Trust Fund programs,
resulted in increased funding for the ASNH program. In addition to the 10 projects funded in
the most recent round, the Homeless Reduction Grant program funded pre-development for
two PSH projects. It is important to note that from 2013 to 2019, of all the affordable housing
units (3,017) funded through VHTF, 45 percent (1,344 units) are PSH units.
Table 3: PSH Funded by Virginia Housing Trust Fund 2013-2019
Number PSH Projects Number PSH Units
Year
2013-2014 6 203
2015-2016 8 373
2016-2017 6 346
2017-2018 4 75
2018-2019 10 347
Total 34 1344
Expansion of PSH through VHDA’s Low Income Housing Tax Credit Program
The LIHTC program is considered the driver of affordable rental housing production (as well as
rehabilitation) across the country. This is also the case in Virginia. Since VHDA’s inception in
1972, the organization has financed nearly 160,000 rental units.
Since 2015, VHDA has committed to assisting DBHDS in meeting its housing goals for people
with intellectual and/or developmental disabilities under the state’s settlement agreement with
the U.S. Department of Justice (DOJ). This commitment has resulted in LIHTC allocations to
projects in which owners committed a marketing preference for the Settlement Agreement
population.
As discussed in the last report to the General Assembly, VHDA reviewed the need for PSH for
people with SMI and other populations. In order to have a more significant impact, VHDA
modified its CY19 Qualified Allocation Plan to require that every development awarded LIHTC
funding provide a PSH leasing preference for 10 percent of its units. No specific population is
tied to the leasing preference. Rather, VHDA has linked the leasing preference to populations
covered by a Memorandum of Understanding (MOU) entered into by the state agencies
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represented on the PSH Steering Committee. Such an arrangement will allow the state to
modify its target populations as needs may change over the project’s compliance period. VHDA
is in the process of putting the MOU in place. The initial populations that will be covered by the
MOU are persons with Intellectual or other Developmental Disabilities (I/DD) who are eligible
under the state’s Settlement Agreement with DOJ and people with SMI prioritized by DBHDS.
The 29 properties funded in the 2019 competitive tax credit round will produce approximately
183 units required to provide the leasing preference11; this is close to the estimated annual 200
units anticipated in the last report to the General Assembly. Another 18 properties receiving 4
percent credits will be producing an additional 270 anticipated units. It should be noted that
this level of 4% credit activity is unusually high and not likely to continue in future years.
Units funded in CY19 will most likely not begin to become available for occupancy until later in
2020. It should also be noted that some affordable rental developments receive funding
through both VHDA’s tax credit and DHCD’s ASNH programs. Given the high costs of developing
rental housing in Virginia, it is not surprising the additional capital would be necessary to
provide the deep affordability needed by people with significant disabilities whose sole source
of income is SSI.
Rental Assistance for PSH - Accomplishments
Rental assistance is critical to ensure PSH can serve people with disabilities who are extremely
low-income (ELI), including people with disabilities whose sole source of income might be SSI.
Beginning in January 2020, an individual whose sole income is SSI will receive $781 per month.
The FY20 HUD Fair Market Rents for an efficiency unit range from $482 per month in Lee and
other rural areas to $1,457 in the Arlington and Alexandria. Whether 62 percent of an
individual’s income in rural Virginia or 187 percent in the metropolitan area, these rents are
unaffordable without state or federal rental assistance.
Expansion of PSH through DBHDS’s PSH Program
As described above, almost all of the new PSH units for individuals with SMI have been created
through continued investment of state general funds in DBHDS’ PSH through its rental
assistance component. The $17.2 million invested in FY20 is expected to serve at least 1,200
individuals in PSH. Even with this expansion, some CSBs will not have access to this resource,
and no communities have been funded at a level to fully meet their assessed PSH need.
Expansion of PSH Supports through the Auxiliary Grant Program
Virginia’s Auxiliary Grant (AG) Program is an income supplement for recipients of Supplemental
Security Income (SSI) and certain other aged, blind, or disabled individuals residing in an
assisted living facility (ALF), in an adult foster care (AFC) home, or in a supportive housing (SH)
setting through a licensed service provider that is approved by DBHDS and certified by DARS.
11
The 29 funded properties include forward funded deals from innovation, new construction and ASH.
21
Supportive housing was added as an approved setting to the AG Program in 2016 and
emergency regulations for the new setting were issued in 2017, followed by final regulations in
2019. In the AG Program, supportive housing is defined as “a residential setting with access to
supportive services for an AG recipient in which tenancy … is provided or facilitated by a
provider licensed to provide mental health community support services, intensive community
treatment, programs of assertive community treatment, supportive in-home services, or
supervised living residential services...” In July 201912, the General Assembly made
modifications to the program intended to enhance use of the AG Program for PSH. As a result
of the legislative change, eligibility for Auxiliary Grant in Supportive Housing (AGSH) no longer
requires the individual to first be an ALF resident. The legislation also increased the number of
allowable PSH participants from 60 to 90, and, if there are a minimum of 30 persons on the
AGSH waiting list as of October 2020, the AGSH program cap will increase to 120 persons.
DBHDS has entered into AGSH provider agreements with Mt. Roger's CSB, Blue Ridge
Behavioral Healthcare, Southside CSB, and Piedmont CSB. In December 2019, AGSH providers
were serving a total of 29 individuals.
Table 4: AGSH Program and PSH SMI Program Providers
Provider AGSH PSH Date Provider AGSH PSH Date Est.
Est.
Arlington FY 2016 Pathway Homes FY 2016
(Alexandria,
Fairfax, Prince
William)
Blue Ridge FY 2018 Piedmont FY 2020
Chesapeake FY 2020 Rappahannock - FY 2018
Rapidan
Danville- FY 2018 Rappahannock FY 2020
Pittsylvania Area
District 19 FY 2018 Region Ten FY 2018
Hampton- FY 2016 Richmond BHA FY 2017
Newport News
Henrico FY 2018 Southside FY 2020
Mt. Rogers FY 2018 Valley FY 2019
Norfolk FY 2016 Virginia Beach FY 2017
Northwestern FY 2019
Expansion of PSH through the Mainstream Housing Choice Voucher Program
The FY17 and FY18 HUD Appropriations included a total of $400 million for new federal rental
assistance under the Mainstream Housing Choice Voucher (HCV) program. Only persons with
disabilities between the ages of 18 and 61 are eligible for these vouchers. In spring 2018, HUD
12
C.657 and C.658 of the 2019 Acts of the Assembly.
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issued a Notice of Funding Availability (NOFA) for $100 million of the $400 million appropriated
to the program; 10 Virginia agencies were awarded $3,443,153 to fund 412 Mainstream
vouchers. In spring of 2019, HUD issued a second NOFA for $150 million. In order to increase
the number of Virginia PHAs responding to the NOFA, the PSH Steering Committee held two
outreach and engagement events. The first was a webinar prior to the NOFA release, featuring
several Virginia PHAs already administering the program. An in-person event, held after the
NOFA was released, was attended by over 70 PHAs, cities, nonprofit housing and CSBs. The ILT
offered a support letter to those PHAs that would commit to serving the state’s target
populations; nine PHAs requested and were provided with such a letter.
As illustrated in Table 5, these outreach efforts were successful. Sixteen PHAs were awarded
729 Mainstream Vouchers. Seven of the nine PHAs requesting an ILT support letter were
awarded Mainstream Vouchers. This letter commits the housing agencies to prioritize the
vouchers for the state’s target populations including persons with disabilities who are residing
in institutions or at risk of institutionalization and those who are homeless; many of these
individuals will be persons with SMI.
Table 5: Virginia Agencies Awarded FY19 Mainstream Funding
Agency Awarded Mainstream Funding Number Funding Awarded
Vouchers
Alexandria Redevelopment and Housing Authority 36 $ 524,669
Bristol Redevelopment and Housing Authority 30 $ 131,012
County of Albemarle/Office of Housing 15 $ 113,312
Danville Redevelopment and Housing Authority 100 $ 466,776
Fairfax Redevelopment and Housing Authority 41 $ 619,409
Hampton Redevelopment and Housing Authority 50 $ 386,856
Harrisonburg Redevelopment and Housing Authority 50 $ 276,774
James City County Office of Housing and Community 20 $ 147,996
Development
Lynchburg Redevelopment and Housing Authority 30 $ 144,443
Newport News Redevelopment and Housing Authority 63 $ 467,307
People Inc. of Southwest Virginia 24 $ 83,238
Portsmouth Redevelopment and Housing Authority 60 $ 500,962
Prince William County Office of Housing and Community 60 $ 840,514
Development
Richmond Redevelopment and Housing Authority 60 $ 491,285
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Roanoke Redevelopment and Housing Authority 30 $ 165,046
VA Beach Dept. of Housing and Neighborhood Pres. 60 $ 516,017
Total 729 $ 5,875,616
Enhancing System Capacity - Accomplishments
While affordable housing, tenancy supports and community-based services are critical to
expanding PSH for individuals with SMI, even these resources are not sufficient to ensure an
expanded PSH system will be successful. State and local/regional structural systems supports
are key to ensuring an effective PSH system, one that provides a fidelity-based service, targets
the state’s priority populations, fills units in a timely manner and maintains owner confidence
by addressing tenant issues that arise.
PSH Tracking and Metrics
During 2019, the PSH Steering Committee put into place several frameworks to track activities
and outcomes related to the Steering Committee work.
Action Plan
The PSH Steering Committee developed a detailed, 19-page Action Plan with goals, strategies
and action steps to achieve the goals, agency responsibilities and timeframes. The five goals
are:
Goal #1 - Increase Services and Supports to Assist Individuals with SMI to Gain Access to
and Maintain Supportive Housing
Goal #2 - Provide Capital Subsidies to Expand PSH
Goal #3 - Increase Rental Assistance to make Units Affordable
Goal #4 - Increase PSH through Preferential Access to Existing Affordable Housing
Programs
Goal #5 - Strategies to Increase PSH through Enhancing System Capacity
A current version of the complete Action Plan is provided in Appendix A.
Executive Order 25 Metrics
As described above, in November 2018, Governor Northam issued Executive Order 25,
recognizing Virginia’s unmet housing needs and highlighting the need for PSH as one of three
top housing priorities. DBHDS’s conducted an assessment of need for PSH; the assessment
established a need for 5,000 PSH units. The PSH Steering Committee developed a
comprehensive plan to put as many PSH units in place as efficiently as possible. This thoughtful,
realistic plan relies on a combination of new federal and state funding for both capital and
rental assistance as well as strategies to redirect or prioritize existing resources for the target
population. The ILT voted its support for the plan, and state agency budget requests have
aligned with plan goals.
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State Level Systems
DHCD working with its partners made a number of enhancements to strengthen PSH systems at
the state level.
First, the existing interagency PSH Steering Committee was expanded to include the DSS and
the VDVS. See PSH Steering Committee member list in Appendix B. The Housing individuals
with SMI Strategy Group membership was also expanded. The goal with expansion was to
enhance stakeholder input especially from the criminal justice sector. The expanded member
list is in Appendix C.
DBHDS began to implement its new Office of Community Housing. The new cross-disability
office reports directly to the Chief Deputy for Community Behavioral Health Services,
highlighting both the importance the Administration places on housing for people as well as
providing opportunities to ensure Secretariat leadership is fully aware of housing challenges
and opportunities. This new formation provides an excellent opportunity to continue to
coordinate resources and activities across the Division of Community Behavioral Health Services
and the Division of Developmental Services including but not limited to two areas described
above - referral systems and outreach/marketing to developers.
DMAS has hired a Housing Advisor with experience in affordable housing and affordable
housing policy in both New York and Virginia. The Housing Advisor provides technical advice on
the COMPASS waiver and will oversee the implementation of support services to access and
maintain independent living options. The role also works closely with several state agencies and
six MCOs to develop and implement strategies that allow for the growth of PSH across the
Commonwealth.
The state agencies and VHDA also began to revise an existing MOU to reflect new activities of
the PSH Steering Committee including the leasing preference in tax credit units. DBHDS and
VHDA also began to design a referral protocol for the units with leasing preferences anticipated
to become available beginning in later 2020.
Local/Regional Level Systems
DBHDS’s PSH program has demonstrated the importance of local/regional housing specialists in
developing and maintaining tenant-landlord relationships and ensuring their region has as an
effective system in place to identify interested, eligible applicants and to assist these individuals
to locate and apply for housing, including making requests as needed for reasonable
accommodations. Currently, all regions have some housing specialist capacity – however
limited. DBHDS has continued to expand local PSH Program Housing Specialists to ensure all
consumers in DBHDS PSH-funded programs have access to this service.
In 2019, DHCD conducted five sessions around the state to secure community input into HUD’s
Consolidated Plan’s Annual Action Plan which includes the Community Development Block
Grant, HOME and the National Housing Trust Fund. The sessions included a focus on PSH
during which DBHDS co-presented with DHCD on PSH efforts and needs in Virginia. The
feedback from the input sessions related to PSH including increasing the maximum amount for
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ASNH awards, making more funds available for services, and more training for "how to do" PSH
for developers.
As described above, the state also conducted outreach and training sessions to inform PHAs of
the need for PSH and the ways they could participate, including but not limited to applying for
Mainstream Vouchers.
Alignment with other State Activity
During CY19, the PSH Steering Committee continued working to align PSH funding, policies and
systems across partner agencies.
Evictions
While the issue of evictions is not included in the scope of this effort, some of those individuals
who get evicted are people with serious mental illness. The 2019 General Assembly included in
its budget funding for DHCD to conduct an analysis of the high rate of evictions in Virginia which
will include a review of best practices of eviction prevention and diversion programs, an
assessment of the communities with the highest eviction rates, an assessment of existing
resources to assist those who are struggling to pay rent and an assessment on legislation
passed during the 2019 General Assembly Session that made policy changes at the state level
which went into effect July 1, 2019 including an assessment of the mandatory eviction diversion
program to be implemented on July 1, 2020. At the time this annual report was being compiled,
DHCD was in the process of developing an update to the General Assembly.
Governor’s Coordinating Council on Homelessness
The Governor’s Coordinating Council on Homelessness (GCCH), co-chaired by the Secretary of
Commerce and Trade and the Secretary of Health and Human Resources, is focused on ending
homelessness in the Commonwealth of Virginia. Several populations have been identified as
priorities including people who are chronically homeless many of who have serious mental
illness. The GCCH tracks trends in homelessness overall and within specific populations. Based
on preliminary numbers of the 2019 Point in Time Count, the Commonwealth has reduced
overall homelessness since 2010 by 36.3 percent and homelessness among people with serious
mental illness by 21.9 percent. Compared to 2018 the number of people with serious mental
illness increased slightly by 4 percent. The GCCH focus on reducing homelessness among those
who are chronically homeless aligns with the work of the PSH Steering Committee, and in order
to maximize this alignment, the GCCH meets periodically with the ILT – the most recent
meeting was held on November 4, 2019. Appendix D includes additional information regarding
these committees and their coordination.
Olmstead Strategic Plan
Olmstead Strategic Plan has been updated to support partner requests to HUD for preferences
in HCV or PH for persons with SMI as part of voluntary affirmative Olmstead planning and
implementation efforts.
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Discharge Planning for Successful Reentry
A number of different initiatives whose goals are to facilitate reentry of people with psychiatric
disabilities from jail have been funded by the General Assembly. The DCJS’s Jail Mental Health
pilot program described above is one example. CSBs have also been funded with Forensic
Discharge Planning Grants to provide reentry in jails. Provided in conjunction with internal
service delivery at the jail, forensic discharge planning begins with the screening and
assessment of psychiatric, medical, social services, employment, and residential needs, as well
as risk factors, as soon as possible after an individual’s admission to jail. Discharge planning
includes the development of discharge plans which prioritize goals and objectives that reflect
needs. It also consists of care coordination with community providers and community
supervision agencies, including the exchange of treatment records, communication of
treatment needs, and linkage of clients with available services and support options upon
release. Discharge planning begins as soon as possible upon entry into the jail and prior to
release, and it should continue into the community until the individual is connected with the
appropriate services and supports. Forensic discharge case management services are provided
for no less than 30 days following an individual’s release to the community, and up to 90 days
until that individual is stable and connected with community based services.
Forensic Discharge Planning utilizes the APIC [Assess, Plan, Identify, and Coordinate] and RNR
[Risk, Need, Responsivity] models, which have been shown to improve clinical and legal
outcomes for individuals being released from jail who have behavioral health disorders. In
collaboration with DCJS, all staff from the Chesapeake and Highlands programs have also been
trained in the Offender Screening Tool risk assessment. Further, with the support of DBHDS
staff, the majority of forensic discharge planners have undergone training for the SOAR, to
increase access to the disability income benefits program.
These programs are only in their first year of operation and therefore do not yet have outcomes
to report; outcomes are expected to be included in next year’s report.
Alignment with SDOH activity
During CY19, the PSH Steering Committee began to increase its focus on alignment with
partners implementing social determinants of health (SDOH) projects. There are numerous
emerging efforts to secure the hospital/health care sector interest in housing including
Partnering for a Healthy VA Initiative with the Virginia Hospital and Healthcare Association, Pew
Calling All Sectors and VDH’s Community Paramedicine/Mobile Integrated Healthcare. These
population health initiatives have the potential to impact individuals with SMI by building a
housing-informed safety net further upstream to prevent vulnerable individuals from losing
their housing.
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Strategies for Continued Progress
Even with the significant accomplishments over the last year, people with SMI continue to live
on the streets and in shelters and languish in jails and other institutions for lack of PSH. In order
to scale up the housing component of PSH, the following three elements are key:
Effective, reliable housing supports: Many affordable housing providers are willing to
discuss the possibility of PSH preferences or projects when reliable services are made
available to help ensure lease compliance. While already discussed above, we cannot
over-emphasize the importance of support services as the state’s best selling point to
engage housing agencies.
Increased capital funding: Lack of rental housing stock and/or tight markets have
inhibited use of vouchers both in rural parts of VA as well as high cost areas such as
Northern Virginia. Significant capital investment in affordable housing stock generally
and PSH specifically is as critical, if not more so than rental assistance at this time.
Increased rental assistance: Project-based rental assistance is needed to ensure new
place-based PSH is affordable to people with SMI who are extremely low-income (ELI).
Tenant-based rental assistance is needed because time to acquire and construct or
rehabilitate affordable rental housing can be lengthy, and rental markets are more
accessible in some parts of the state – and are likely to become more accessible with
increased development.
Outlined below are the strategies the PSH Steering Committee members will utilize in the
coming year to continue to secure the necessary capital and rental assistance from a variety of
existing and new state and local resources.
Strategies to Continue to Expand PSH Housing Supports
Obtain CMS approval of the Housing Supports Benefit
Though Virginia has made considerable state investments in the PSH-SMI program, there
continues to be more demand than capacity. To maximize the use of state resources to
increase access to affordable housing, the Commonwealth will best be served by securing CMS
approval of the COMPASS Waiver. Following approval of the Special Terms and Conditions,
DMAS and CMS will negotiate formal documentation outlining how the demonstration’s
programs will be implemented, operationalized, monitored, and evaluated.
During this time, DMAS and DBHDS will continue to work collaboratively to strengthen the
system’s capacity to implement the housing supports benefit. The Governor’s budget proposes
additional implementation funding to support the high needs support benefit.
DMAS and its state partners will also continue to participate in IAP. The Commonwealth was
selected to continue to participate in the IAP Partnerships Implementation Track. DMAS
requested coaching and technical assistance focusing on the following areas for the six-month
extension period.
28
COMPASS:
Engaging stakeholders in the design and development of the housing supports benefit
Aligning outcome measures to assess the impact of housing supports benefit including
data elements related to healthcare outcomes
DMAS working with partners to establish implementation schedule
Assessing provider capacity to deliver housing supports benefit
Providing resources to care coordinators to identify members with housing need and
make initial referral to address, e.g. what an assessment looks like and what the critical
factors are that we need to capture in the assessment
Data Sharing: Peer learning with Michigan, Oregon, Delaware and Louisiana.
Engage Stakeholders in the Design and Development of the Housing Supports Benefit
As with any attempt to implement a major system’s change, there is considerable value in
engaging the persons most impacted to be part of the change process. DMAS has experienced
the positive impact that stakeholders bring to the table with Behavioral Health Redesign. Not
only will engaging stakeholders provide a better product, it will also garner stakeholders’
support for implementing the services.
Assess and Strengthen Provider Capacity to Deliver the Housing Supports Benefit
DBHDS has been working to increase the number of PSH providers and quality of services to
deliver a high quality housing support benefit. This work is time well-spent and should continue
to expand provider capacity in areas of unmet need, identify existing providers’ strengths in, as
well as their needs for, supporting individuals with SMI towards greater independence.
Alternative providers should also be explored to address not only service demand, but also to
address the need for additional Human Resources. The PSH Steering Committee recognizes the
value of certified Peer Recovery Specialists in the provision of housing supports.
In 2020, DBHDS anticipates increasing the number of individuals served by existing providers
and establishing additional PSH providers in the Chesapeake, Piedmont, Rappahannock Area,
and Southside CSB catchments. In addition, DBHDS Office of Community Housing plans to
partner with a CSB to secure technical assistance from national experts to provide training and
technical assistance (TA) to DBHDS PSH providers across the state to ensure implementation of
high fidelity PSH that demonstrates positive outcomes and maximizes the use of resources.
Focus areas for TA will include an examination of best practices in transitions of care from
hospitals and jails to PSH.
Align outcome measures to assess the impact of the Housing Support benefit including data
elements related to healthcare outcomes
Virginia is preparing to implement the COMPASS Housing Support benefit as part of a much
larger systems’ enhancement. STEP-VA, Behavioral Health Redesign and Medicaid Expansion
are all intended to improve services and access to care for highly vulnerable individuals with
29
SMI. The Commonwealth has stated the intended outcomes of each effort, and not
surprisingly, these initiatives are intended to improve access to care, the quality of care and to
reduce the overall cost of care. Measures assessing the impact of the Housing Support benefit
must be consistent.
The impact of PSH has been researched both nationally and in Virginia. People with SMI living
in PSH are more likely to use behavioral health services routinely as opposed to when in crisis,
are more likely to use primary care as opposed to emergency department visits, to have fewer
days spent in a state psychiatric hospital, to have overall lower costs for care, to have fewer
days spent homeless which also leads to improved health outcomes. Assessing the outcome of
the COMPASS Housing Support benefit should include these measures.
Continue Exploring Interim Strategies to fund Housing Supports via Existing Medicaid Covered
Services
It can be challenging to promote the use of “existing Medicaid services” to provide housing
acquisition, transition and tenancy sustaining services at the same time that DMAS and DBHDS
are involved with services redesign. Housing units are coming on line and the availability of
supportive services will be essential for the successful transition to PSH for individuals with SMI.
PSH-SMI program funds can continue to fund support services, but at the expense of less rental
assistance, meaning fewer individuals will secure housing. Using existing Medicaid services,
even conservatively, can free up PSH program funds to serve as additional rental assistance. The
Governor’s budget provides additional implementation funding and language to support
behavioral health redesign to achieve these goals. The Governor’s budget proposes an
additional $3,028,038 the first year and $10,273,553 the second year from the general fund and
$4,127,378 the first year and $14,070,322 the second year from nongeneral funds to effect the
changes required
Virginia has a number of Managed Care Organizations (MCOs) that are known nationally for
their interest and investment in supporting high risk/high need individuals in stable housing
including United Healthcare, Magellan and Anthem. DMAS will continue to explore how to tap
into this experience and expertise to better meet the needs of their members. DMAS will
continue to work with the MCOs to explore greater flexibility in using existing services,
encouraging the MCOs to provide guidance on how services can be utilized to support
individuals in independent living. MCOs will also continue to provide oversight and monitoring
to ensure quality services are delivered that will improve member outcomes.
DMAS will continue their work with care coordinators and housing specialists at the MCOs to
provide resources to identify and support members with housing needs and make initial
referrals to address the identified needs. Through the ongoing involvement in the IAP
Partnerships’ track, DMAS and its partners will gain access to tools and best practices to support
the assessment of housing needs and enhanced care coordination.
30
Strategies to Expand Capital and Rental Assistance for PSH
Outlined below are the strategies the PSH Steering Committee members will utilize in the
coming year to continue to secure the necessary capital and rental assistance from a variety of
existing and new state and local resources.
Strategies to Increase Capital Investment in PSH
HUD S. 811 Capital Advance NOFA
In October 2019, HUD issued a NOFA for the Section 811 Capital Advance Program. Under this
competitive program, nonprofits can apply for capital funds for supportive housing for people
with disabilities between the ages 18 and 62. Funded units will also be provided with operating
support (PRAC). These funds may be a good match for nonprofit developers awarded 4 percent
or 9 percent tax credits and which have leasing preferences13. These funds are also a good
match for any nonprofit developer interested in the development of integrated PSH for this
population. VHDA will conduct outreach to developers to ensure they are aware of this
opportunity.
VHDA Low Income Housing Tax Credit Program
As discussed earlier in this report, low vacancy rates and strong demand for rental housing
across much of the state make it challenging to scale up PSH and reach the 5,000 goal without
production of new PSH units. VHDA’s 9 percent and 4 percent tax credit programs are some of
the primary tools developers rely on for the production of new affordable rental housing.
As described above, beginning with the FY19 Qualified Allocation Plan (QAP), VHDA has
committed that all 9 percent and 4 percent tax credit projects will be required to provide a
leasing preference for PSH in 10 percent of units. No specific target population is named.
Rather, VHDA has linked the leasing preference to populations covered by the Memorandum of
Understanding (MOU) entered into by the state agencies represented on the PSH Steering
Committee. Such an arrangement will allow the state to modify its target populations as needs
may change over the project’s compliance period. This also means the state agencies and
departments serving each target population must collaborate to develop a protocol for referral
to these housing units; the development of a referral protocol is discussed further below.
13
Note that if funded, these units would not expand the number of PSH units as the developer is already obligated
to provide the leasing preference. However, the program does make the units affordable to the tenant and
decreases financial risk to the owner.
31
In CY20, VHDA estimates 200 units with a leasing preference will be created through the 9% tax
credit program, and estimate another 100 will be created through the 4 percent tax credit
program. As described above, the 4 percent volume was unusually high in CY20 and is expected
to be lower next year.
Virginia Housing Trust Fund
The VHTF impacts PSH growth in two ways. First, services and pre-development costs for PSH
targeted to persons who are chronically homeless are funded through a competition for no
more than 20 percent of the VHTF allocation, generally around $1 million.
Second, the majority of the remaining funds are combined with federal HOME and National
Housing Trust funds to make up the ASNH program competition. The limited allocation of funds
is shared between homebuyer and rental projects, with rental projects making up
approximately 90 percent of the allocated funds.
A substantial increase in VHTF funding will be necessary for the ASNH program to contribute
significantly to scaling up PSH for people with SMI. Governor Northam and the 2019 General
Assembly included in the FY 19 budget an additional $5.5 million and an additional $1.5 million
in the FY 20 for a total of $18 million for the FY 2018-2020 which was a significant boost to help
meet the PSH and affordable housing needs in the state. However, there remains great need
for additional PSH and affordable housing units. To address that need, Governor Northam has
included in his proposed biennium budget an additional $63 million in the VHTF. The proposed
budget calls for an additional $7 million in the current fiscal year (FY20), an additional $23
million for FY 21, and an additional $33 million for FY 22. This funding would bring the total
VHTF allocation to $84 million over three years. Announcing his proposed budget, Governor
Northam stated, “We will continue to work with our partners to address housing instability and
homelessness, provide permanent supportive housing for our most vulnerable citizens, and
expand the supply of quality, affordable living options to meet the needs of a growing and
diverse Virginia workforce.”
Behavioral Health and Developmental Services (BHDS) Trust Fund
Virginia has a special non-reverting fund called the Behavioral Health and Developmental
Services Trust Fund. This Trust Fund consists of the net proceeds from the sale of vacant
buildings and land held by DBHDS and any General Assembly appropriations to the fund. The
DBHDS Commissioner administers this Trust Fund. Among other approved uses, current Virginia
code allows for these funds to be used for financing of "appropriate community housing, for
the purpose of transitioning individuals with intellectual disability from state training centers to
community-based care." Trust Fund moneys have been used for a range of community-based
services, primarily for individuals in the DOJ Settlement Agreement population. DBHDS will
continue to identify opportunities to increase funding allocations to the Trust Fund and include
individuals with serious mental illness as a population eligible to be served in community
housing financed by the Trust Fund.
32
Enhance Housing Development Capacity
Increased resources alone may not be sufficient, however, to scale up PSH. DHCD staff
indicated that competition for affordable housing resources is fierce and that some of the
mission-driven developers who might consider PSH development do not have the capacity to
produce projects that are always competitive.
Developed by VHDA, the “Fundamentals of Affordable Housing Development” class is a two-day
workshop designed to walk housing and community development professionals through the
development process and best practices. These best practices include but are not limited to
organizational and developer capacity, asset mapping, intervention strategies, plan
development, key partnerships, homeownership financing and qualifications, rental financing
and compliance, and evaluation. The class includes hands-on activities including community
design activities and development pro-forma work. This course is intended for beginner and
mid-level professionals in the field of housing planning and/or development. Most recently,
VHDA conducted the class in Southwest Virginia with more than 30 participants from a variety
of organizations including PHAs, Community Action Agencies, Planning District Commissions
(PDCs), non-profit housing organizations, for-profit developers and local governments.
The PSH Steering Committee will explore whether a version of this class could be focused on
PSH development and targeted for CSBs, nonprofit mission-driven developers and other
organizations interested in PSH development.
Strategies to Secure Local Capital for PSH
Thirty localities in Virginia receive an allocation of CDBG and/or HOME funds directly from HUD;
some of these communities also provide local general funds for affordable housing
development. Many PSH projects require multiple sources of grants or deferred payment loans
to make a project affordable. Local HOME or CDBG funding is often one of these sources.
Piecing together funding for projects can be challenging. If DBHDS is able to make additional
capital, rental assistance and/or supports available14 for projects under consideration, the
developer and local funders are likely to be much more receptive to creating projects.
DBHDS has explored such partnership with several local communities. The Virginia Beach
Department of Housing and Neighborhood Preservation, for example, has issued an RFP for
affordable housing that includes investment of DBHDS PSH funds from the Virginia Department
of Human Services for developments that include PSH units. DBHDS will continue to work with
individual communities where there is the possibility of leveraging local funding for PSH for
individuals with SMI.
DBHDS will also continue to participate in DHCD’s statewide input sessions to provide education
to local governments on the need for PSH and the PSH resources available through the state for
communities interested in PSH development.
14
Either directly or through CSBs or another local entity.
33
Strategies to Increase Rental Assistance for PSH
DBHDS PSH SMI Program
PSH SMI capacity is now at approximately 1,027 units. Continuing to grow this demonstrated
successful program will be an essential component to meeting the need for 5,000 PSH units and
receiving all the benefits that accrue to PSH programs including moving people from
institutionalization and homelessness into housing and avoiding associated costs. A continued
increase in the PSH SMI program will be especially important as the VHDA LIHTC units come on-
line starting in 2020; the majority of these units will not have project-based funding and will
need rental assistance to be affordable to clients.
Governor Northam has proposed an additional $22.4 million in his biennial budget for housing
efforts targeted to individuals with behavioral health or developmental disabilities. This
includes $8.5 million for PSH for individuals leaving state behavioral health facilities, $8.9
million for the state rental assistance program serving individuals with developmental
disabilities, and $5 million to acquire or develop clinically appropriate housing options for
individuals leaving state hospitals.
DBHDS will also continue to explore project-basing some portion of the PSH program. Project-
basing has a number of advantages including long term access to high cost area such as
Northern Virginia and better access to housing for persons with criminal backgrounds or poor
tenancy histories.
Section 811 Project Rental Assistance (PRA) Program
In October, HUD released a NOFA for PRA funding; applications are due early February 2020.
This NOFA will provide project-based rental assistance funding to state housing agencies. Funds
are available to be used as project-based rental assistance for housing units integrated within
multifamily properties that are set-aside for extremely low-income persons with disabilities
who are eligible for community-based long-term care services and supports provided under a
State Medicaid Program or other comparable long-term services program. VHDA will be the
applicant with participation of the PSH Steering Committee members. The state applied
unsuccessfully in 2013. A number of critical factors have changed since then, such as increased
collaboration across state agencies and with community partners, better alignment of
resources and VHDA’s tax credit program leasing preference that will improve the likelihood of
a successful application.
The PSH Steering Committee set a goal of 50 PRA units for FY20; the full request will be for 200
PRA or as many as can be secured within the NOFA’s funding cap of $7 million.
Mainstream Housing Choice Voucher (HCV) Program
As described above, in the first round, the state was successful in securing over 400
Mainstream vouchers for people with any disability including people with SMI. DBHDS knows
that at least 10 percent of these went to individuals with SMI who will be served by a DBHDS
PSH provider. In the second round, the state secured 729 vouchers. These vouchers have only
recently been awarded to PHAs, so are not yet issued to participants. Seven of the nine PHAs
34
that were provided ILT support letters and are expected to provide preferences for the state
target populations of people who are institutionalized, homeless or ready to move on. If case
managers actively assist DBHDS clients to apply for these vouchers, they should yield at least as
many PSH units as the last rounds. In FY20, the PSH Steering Committee hopes to secure 50
Mainstream vouchers from local PHAs.
A final HUD Mainstream voucher NOFA is anticipated in early 2020. The PSH Steering
Committee will continue to outreach to PHAs and provide support and incentives for responses
to the NOFA that provide preferences for the state’s target populations. DBHDS intends to
award additional PSH funds in FY20 to communities that are able to use newly awarded
Mainstream Vouchers to create PSH for individuals with SMI. Leveraging these federal
resources expands the impact of state PSH investment.
Not all PHAs or VHDA regions have access to funds for move-in costs such as security deposits,
landlord mitigation funds or furnishings. The PSH Steering Committee will explore ways to assist
local programs in securing such funding where it is not available.
Auxiliary Grant Supportive Housing (AGSH) Program
As described above, the state has expanded the number of AGSH providers. With the
expanded capacity and program eligibility, DBHDS expects to meet the goal of serving 90
persons in SFY20 and to develop a waiting list of at least 30 by October 2020.
The Governor's budget proposes an increase to the Auxiliary Grant rate of $80 per month per
recipient on July 1, 2020. The increase is expected to be offset by balances in the program. An
increase to the rate benefits individuals in the AGSH program by improving housing
affordability and potentially increasing the number of communities that can use the AGSH.
Continuums of Care Rental Assistance
There are 16 Continuums of Care (CoCs) across the state, including 15 independent CoCs and 12
local planning groups (LPGs) of the Balance of State CoC. CoCs and LPGs are tasked with
creating effective community-wide emergency crisis response systems that will ensure
homelessness is rare, brief, and non-recurring. This requires the coordination of federal, state,
local, and private funding. CoCs will be encouraged to apply for specialized resources for PSH
when available from HUD. Many CoCs in Virginia have developed PSH programs available to
people who are experiencing homelessness – generally chronic homelessness – through their
CoC Coordinated Entry System.
TAC anticipates that the FY20 HUD Appropriation will include CoC funds for the development of
new PSH. DBHDS could use the availability of supports to incentivize CoCs to continue to apply
for new PSH projects. The PSH Steering Committee set a goal of 40 CoC-funded PSH units (new
or existing) to serve people with SMI experiencing homelessness in FY20.
35
Strategies to Increase PSH through Existing Affordable Housing Programs
The production of new units and bringing new rental assistance resources into the state are the
preferred strategies for expanding PSH for Virginians with SMI. However, given limitations on
state and federal budgets, and the length of time for new production, increasing access to
existing affordable housing resources is also an important strategy to meet the state’s need for
5,000 PSH units for individuals with SMI.
Public Housing Agency Resources
There are 41 PHAs in Virginia. Of these, two administer only public housing units, 13 administer
only vouchers, and 26 administer both the HCV and public housing programs. The PHAs in
Virginia administer over 52,200 HCVs15 and own and operate a total of 17,897 units of federally
funded public housing16. PHA resources are generally made available to eligible applicants on a
first-come, first-served basis but are allowed to use preferences or priorities to serve local
needs or public policy priorities, as long as these are nondiscriminatory. For example, PHAs are
allowed to offer preferences for people who are homeless, people with disabilities (broadly
defined) and people who are institutionalized. According to the Center for Budget and Policy
Priorities, 17 percent of federal rental assistance (largely housing choice vouchers but also
public housing and HUD-Assisted developments) goes to single adults in Virginia who have
disabilities, compared to the national average of 19 percent.
Per federal regulation (24 CFR Part 982), PHAs may not direct their resources towards people
with specific disabilities, such as ID/DD and SMI, except in accordance with HUD guidance and
as a HUD approved remedial preference.17 Over the next year, the PSH Steering Committee will
explore Virginia’s options for housing preferences to address specific populations, like SMI, and
the opportunities and implications for including such preferences now that SMI has been
included in the Olmstead Strategic Plan. In the meantime, with sufficient marketing and
outreach by CSBs, people with SMI can be well represented in any applicant pool that targets
people who are homeless or who are coming from institutions, both general preferences
acceptable to HUD.
Project-basing HCV offers DBHDS a unique opportunity to target federal funding for PSH for
people with SMI. The regulations covering the project-based component of the HCV program
(24 CFR Part 983), allow PHAs to target resources to persons needing certain services including
disability-specific services. DBHDS should consider identifying PHAs already project-basing or
interested in project-basing this resource and reach out to these agencies to determine
whether there are opportunities to develop PSH for people with SMI. For PHAs with low leasing
15 This estimate does not include the newly awarded Mainstream Vouchers.
16 Data from the state’s IAP Housing Assessment (March 2018).
17 HUD currently limits disability-specific preferences to HUD-approved remedial actions. According to HUD, such remedial
actions must be provided in response to” Olmstead-related litigation or enforcement, including a settlement agreement, court
order or consent decree, or in response to a public entity’s documented, voluntary affirmative Olmstead planning and
implementation efforts.” https://www.hud.gov/sites/documents/PIH2012-31.PDF
36
rates, project-basing vouchers can offer a way to improve leasing rates. The PSH Steering
Committee has set a goal of securing 100 PBV from local PHAs in FY20.
HUD Assisted Housing Resources
There are over 22,000 units of HUD-assisted housing in Virginia that have a project-based
subsidy allowing the tenant to pay only 30 percent of their income for rent. In 2013, HUD
determined that it was permissible for these owners to provide a homeless or move-on
preference18. There has been some effort in Virginia to interest owners in implementing this
preference with limited success. A renewed effort led by DBHDS that includes a discussion of
the array of services made available to DBHDS clients might meet with more success. Helping
clients access even 1 percent of these resources will result in over 200 affordable housing
options. The PSH Steering Committee has established a goal of securing 50 units in FY20
through such a process.
Strategies to Increase PSH through Enhancing System Capacity
As described above, state and local/regional structural systems supports are key to ensuring an
effective PSH system, one that provides a fidelity-based service, targets the state’s priority
populations, fills units in a timely manner and maintains owner confidence by addressing
tenant issues that arise.
Outreach to Hospitals and Healthcare Systems
The PSH Steering Committee will continue to conduct outreach to educate and incentivize the
health sector partner interest in PSH. Outreach will continue to the Virginia Hospital and
Healthcare Association and some of VHHA’s members to identify common beneficial outcomes
of collaboration. DMAS will begin exploring how MCOs may partner with the housing and
supportive services sectors that could result in improved health outcomes. These initial
contacts will be followed up with proposed pilot projects that would demonstrate the value of
the sectors - healthcare, housing and supportive services - collaborating to improve health
outcomes of vulnerable populations.
PSH Inventory
The PSH Steering Committee has identified a strategy for developing a comprehensive PSH
inventory. An inventory would list existing properties that operate as supportive housing, their
owners, number of units, special populations served, and other key features. Such an inventory
would better permit the state to assess provider capacity and to identify existing PSH resources
that might assist with meeting the state's priorities.
Over the next year, the Committee will take the next steps toward implementation including
finalizing the survey tool, identifying contact information for projects and programs to be
surveyed, piloting the tool, determining the data base format and surveying all identified
18
https://www.hudexchange.info/news/hud-releases-resources-on-homeless-preferences-for-multifamily-property-owners-
and-agents/
37
projects and programs. The inventory will build on the work started by the Virginia Coalition to
End Homelessness (now named the Virginia Housing Alliance) in its 2015 report19.
Finalize Shared Referral Protocol
Under the DOJ Settlement Agreement, referrals of persons with Intellectual/Developmental
Disabilities (I/DD) to PSH resources are made through the DBHDS Central Office, but referrals of
people with SMI are made at the local level through CSBs. The expanded target population for
units developed through DHCD or VHDA’s tax credit programs will require additional
coordination on referrals. DBHDS will continue to work internally as well as with VHDA and
DHCD on a streamlined protocol and written policies for referring priority populations to set-
asides and units with leasing preferences. DBHDS will also pilot the referral system with a
housing development that volunteers to participate in such a pilot.
Currently, VHDA initiates contact with properties in the VHDA portfolio as properties
commence lease-up. In doing so, VHDA communicates with the owner and management agent
the requirements for communicating with DBHDS regarding upcoming or current vacant units.
The DBHDS Housing Coordinator and management agent representative are communicating on
an on-going basis. This continues to be an on-going process as the SMI and other targeted
populations are introduced into the process. VHDA and DBHDS have bi-weekly calls regarding
the process and are continuously addressing any issues and concerns.
It is important to note that the LIHTC units are either open to the “general” population or are
targeted for elders. DBHDS will review the pool of potential tenants to specifically identify
elders who are interested in the funded locations. Using a targeted outreach or marketing
strategy will decrease the number of applicants who reject units or are rejected by the owner
for lack of eligibility. DBHDS will collaborate with CSBs and other local entities to develop
strategies to market units to eligible people with SMI prior to the availability of the units.
Occupancy Training
The PSH Steering Committee will explore an effective, efficient way to make training available
to the property managers, case managers and providers in the regions where the tax credit
leasing preference will first roll out. Reasonable accommodation training for property managers
as well as providers has been demonstrated to improve access to housing for people with
disabilities and to decrease conflict among the parties. Training on other topics such as how to
access supportive services, strategies to address hoarding and other common challenges would
also be beneficial and help to prevent eviction.
Continue PSH Alignment with Related Activities
The state has a number of initiatives that have some overlapping goals and strategies. The PSH
Steering Committee will continue to align efforts to house people with SMI with efforts to
house people with I/DD and people who are experiencing chronic homelessness. Each of these
populations has an advisory or coordinating body overseeing or guiding the work. The PSH
19 http://vahousingalliance.org/wp-content/uploads/2015/12/State-of-Permanent-Supportive-Housing.pdf
38
Steering Committee will also seek to coordinate with eviction prevention efforts and general
affordable housing development activities.
39
Leadership Key to PSH Strategy
As described above, there are many opportunities to leverage supports, capital, and rental
assistance resources to expand PSH for Virginians with SMI. No single state or federal resource
is enough to help Virginia meet the need for 5,000 PSH units. Scaling up PSH will require
coordinating multiple housing and service funding mechanisms at both the state and local
levels. This is a challenging task that is likely best achieved when leadership understands and is
willing to support such a task. Leadership is necessary to ensure state agencies collaborate
effectively. Leadership will be necessary at key points such as calling for owners to step up to
serve the state’s most vulnerable populations while guaranteeing that the state will provide
supports to tenants and be available to owners when issues arise. Over the last year, the ILT as
well as the PSH Steering Committee have provided such leadership. However, such leadership
must be sustained over the multi-year period in which resources must be identified, programs
and projects developed and then occupied by the target populations.
On November 15, 2018, Governor Northam signed Executive Order 25, establishing housing
policy priorities to enhance the quality, availability and affordability of housing in the
Commonwealth of Virginia. Permanent supportive housing was one of the three policy
initiatives called out in the Executive Order and is supported by the Governor’s proposed
budget. It is this leadership at the highest levels of the Executive Branch combined with support
from the General Assembly that will provide the tools and continue the momentum to ensure
the state can address the supportive housing needs of people with serious mental illness,
ending homelessness and institutionalization, helping these citizens of Virginia to lead stable,
independent lives in their community of choice.
40
Appendices
41
Appendix A Action Plan
42
Goal #1 - Increase Services and Supports to Assist Individuals with SMI to Gain Access to and Maintain Supportive Housing
Strategy 1.1: Obtain CMS approval of a supportive housing benefit as part of the renewal of Virginia’s 1115 Demonstration Waiver
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
1.1.1 Respond to CMS concerns as DMAS None Obtain CMS approval Begin phase-in of
necessary to obtain waiver of SH and SE benefits benefits within at
approval least one region
1.1.2 Engage stakeholders in the DMAS DBHDS Begin to identify key Convene stakeholder Continue stakeholder
design and development of the stakeholders meetings to gain sessions to gain input
Supportive Housing (SH) benefit input on benefit on benefits
implementation implementation
1.1.3 Issue service definitions, DMAS DMAS/MCOs None MCOs, providers Providers enroll to
Member eligibility criteria, receive necessary provide SH benefits
provider eligibility criteria, rates guidance for service
provision/payment
1.1.4 Align DBHDS, DMAS and DMAS DBHDS Begin identification Rates are Outcomes are
other outcome measures to of outcome determined for assessed 6-12
assess the impact of the measures possibly outcome measures, months after
Supportive Housing benefit including: if applicable, and placement in
State hospital bed Medicaid supportive housing
days expenditures 6-12
Local inpatient bed months prior to
days supportive housing
# days incarcerated to establish baseline
Medicaid costs
CSB data:
community
services, PSH-SMI
service costs
CoC data
1.1.5 DMAS works with partners DMAS DBHDS None If applicable, Phase-in of SH
to establish implementation VHDA region(s) identified continues until SH is
schedule. DHCD for initial phase-in implemented
MCOs where SH expansion statewide
is anticipated and/or
43
there are strong
service providers
1.1.6 Explore opportunity to DMAS DBHDS Continue exploration New Medicaid SH providers are
create new provider type(s) and of services and provider type enrolled/credentialed
credentialing process for housing provider established for to support individuals
transition and housing support opportunities to housing transition with SMI in
services include research and/or housing successful
from other states sustaining services Transition/SH
that reflects the tenancy
needed skills and
expertise and
providers are
credentialed
1.1.7 Assess provider capacity to DMAS DMAS/MCOs None Assess current Region(s) for phase-
deliver SH benefit services DBHDS provider pool for in have sufficient
new services providers to deliver
Develop training and SH benefit to high
provider enrollment need, high risk
process members
1.1.8 Engage MCOs in promoting DMAS DBHDS Educate MCOs as MCOs begin to Assess results of
and supporting access to the SH to state’s SH plans support high MCO targeting.
benefit. Encourage MCOs to Provide MCOs risk/high need Evaluate MCO
support housing transition and with data for members with SMI efforts in addition
housing sustaining services need in their area in need of housing to support high
and how state through SH benefit, risk/high need
would like to see if available members with SMI
need addressed Develop quality in need of housing
measures. through PSH
Assess measures benefit.
44
Strategy 1.2: Maximize use of existing Medicaid services and authorities to fund housing transition and housing sustaining services until SH
benefit is available
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
1.2.1 Community mental health DMAS DBHDS DMAS issues report Providers begin to Providers continue to
services are strengthened, to on BH Redesign and receive training in receive training in
incorporate evidence-based planning process. evidence-based evidence-based
practice per BH Redesign practices practices
1.2.2 Provide clarification to DBHDS DMAS Jointly issue Agencies provide Agencies provide DBHDS staff
identify the roles and information to CMHRS to support CMHRS to support
responsibilities of existing providers on how individuals w/ SMI individuals w/ SMI in
Medicaid services related to existing Medicaid in attaining and attaining and
housing transition and support services can be used sustaining tenancy sustaining tenancy in
services to provide Housing in PSH PSH
Transition and Determine how to
Sustaining Services measure impact of
to individuals with agency efforts
SMI
1.2.3 Provide staff training to DBHDS DMAS Pending Regional trainings Training is repeated DBHDS staff
support appropriate delivery of identification of offered for staff, at least annually
services funds, trainings clarifying their roles
developed and responsibilities
in providing housing
transition and
support services
1.2.4 Address emerging need for DMAS/ DBHDS None Identify and address CSBs/provider
additional service provider MCOs needed provider communities are
capacity capacity identified for
targeted service
expansion/developm
ent
1.2.5 Monitor to ensure the DMAS DMAS/ Care Coordinators CCs will routinely Individuals with SMI CSBs
provision of the full array of MCOs (CCs) will routinely monitor individuals in CCC+ will receive Private
housing supports across multiple monitor individuals with SMI in CCC+ for the full array of providers
staff/providers with SMI in CCC+ for access to housing services and MCOs
access to housing transition and supports to meet
45
transition and sustaining supports their individual
sustaining supports seamlessly to meet needs to access and
seamlessly to meet successfully sustain
their individual housing, if eligible
needs
1.2.6 Individuals are transitioned DMAS/MCO DBHDS Understand Develop a best Individuals with SMI
to a non-Medicaid funding source s current process of practice process receive housing
if CMHRS are still wanted/needed transitioning for transitioning support services as
but determined to no longer be individuals who individuals to a long as the services
“medically necessary.” are no longer non-Medicaid are needed to
eligible for source sustain successful
Medicaid funded Individuals with tenancy in PSH
supports SMI receive
Individuals with housing support
SMI receive services as long as
housing supports the services are
as long as the needed to sustain
supports are successful tenancy
needed to sustain in PSH
successful
tenancy in PSH
1.2.7 Provide resources to care DMAS Begin to develop Incorporate Provide on-going
coordinators to identify members DBHDS policy, procedure training or training
with housing need and make and training that resource
initial referral to address. DMAS to may require information so
establish policy, process and then MCOs to assess this is part of
train staff members’ housing general CC
status at least training.
annually Monitor and
Implement policy assess
and training implementation of
policy and
procedures.
Make adjustments
as needed
1.2.8 Explore with MCOs the role DMAS MCOs Identify at least 1 Explore the
of Health Homes/Behavioral DBHDS MCO willing to opportunity to
46
Health Homes to promote access test BH Health implement a pilot
to supportive housing and to Home project testing/
sustain successful tenancy for hi implementing evaluating the
need/hi cost members. housing supports impact of a BH HH on
Assess potential housing stability and
rates or payments healthcare service
utilization and costs
Strategy 1.3: Explore non-Medicaid options for funding housing transition and housing sustaining services
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
1.3.1 Continue to include support DHCD Develop and issue Develop and issue Develop and issue $1.4 million for
services in PSH as an eligible a Request for FY21 Request for FY22 Request for FY19 and $1.4
activity for the Homeless Proposal Proposal Proposal million for FY20
Reduction Grants portion of the Select grantees. At Select grantees Select grantees
Housing Trust Fund (HTF) (up to least 50 persons At least 50 Projects
20%). served, some of persons served, implemented
whom will have some whom will
SMI. have SMI.
Explore SMI data Projects
collection as part implemented.
of required
reporting
1.3.2 Establish public/private DHCD DMAS Pursue funding from Initiate at least one At least one new Foundations
partnerships in investing in DBHDS health-related pilot project to pilot project is Health
housing and services in areas of VHDA stakeholders to expand housing initiated to expand Systems
high need for PSH including VDH support a position and/or services housing and/or MCOs
support for capacity building, e.g. that would work with capacity to fill needs services capacity to Hospitals
housing development institute the PSH Steering where other funding fill needs where
Committee to (state and federal) is other funding (state
coordinate and not available and federal) isn’t
monitor at least one available
pilot project that
would expand
housing and/or
services capacity,
ensuring an
47
evaluation of the
project that will
assist others in
learning from the
experience
48
Strategy 1.4: Build understanding and awareness of the positive outcomes associated with independent housing options for individuals preparing for
state hospital discharge and the availability of those housing options
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
1.4.1 Issue a data-driven policy DBHDS Issue a policy Contingent on Contingent on
statement that articulates the statement supported funding availability, funding availability,
ability for individuals to with data that double the number double the number
successfully transition from state reflects the ability for of individuals from of individuals in CY
hospitals to supportive housing individuals to CY 19 discharged 20 discharged from
transition from a from each state each state hospital
state hospital to hospital directly to directly to supportive
supportive housing supportive housing housing
1.4.2 Educate state hospital staff, DBHDS Develop educational Hold at least 1 Repeat training
case managers, consumers and materials reflecting educational session annually, updating
families about the opportunity for PSH-SMI program in each state data on the number
successful transition from a state experience with hospital, involving of successful
hospital bed to supportive housing successfully CSB partners placements into
transitioning supportive housing
individuals from
state hospitals to the
community and
available resources
49
Goal #2 - Provide Capital Subsidies to Expand PSH
Strategy 2.1: Expand PSH through the VHDA Low Income Housing Tax Credit Program
Estimated 200 units with leasing preferences annually beginning in FY20; leasing preference for SMI and other populations targeted under
state partner MOU
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources
Agency(s) Involved $$$
2.1.1 Continue coordination between DBHDS VHDA Monthly Monthly check in Monthly check in
DBHDS and VHDA coordination meetings with meetings with
between DBHDS implementation implementation
and VHDA staff. Bi-annual full staff. Bi-annual full
staff meetings staff meetings
2.1.2 Develop MOU on PSH collaboration VHDA DBHDS MOU executed Annual MOU Annual MOU
with appendix related to SMI population as DHCD review review
well as other populations DMAS
2.1.3 Finalize referral process for VHDA DBHDS Develop Release final Review and update
individuals referred to LIHTC units guidance; referral process existing process as
Pilot referral needed
process in one
community
2.1.4 Determine roles and outreach needs DBHDS VHDA Roles and outreach
for CSBs, developers and other DHCD activities identified
stakeholders DMAS in MOU
50
Strategy 2.2: Expand PSH through the Affordable and Special Needs Housing Program
Estimated 56 total PSH projects produced in FY19 and FY20; number of units per project provided after projects are selected.
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources
Agency(s) Involved $$$
2.2.1 Host five input sessions to secure DHCD DBHDS Host five regional Annual five regional Annual five regional
local input into Consolidated Plan and VHDA meetings meetings meetings
Annual Action Plan. Request input related Stakeholder
to PSH development and possible new education and
state resources input re: PSH
2.2.2 Secure additional PSH through DHCD Issue Request for Projects To be determined Approx.
Affordable and Special Needs Housing Applications. constructed/ once projects $33.9 million
(ASNH) Program Estimated 56 rehabilitated selected in CY19 total funds
affordable for ASNH
housing Program for
construction FY19 and
projects selected FY20
for FY19 and
FY20; each
project
contributes from
5 to 100
affordable units
for supportive
housing with
various target
populations
2.2.3 Identify targeted capacity DHCD DBHDS Identify developers Development Development
development that may assist in increased and determine support support
PSH through ASNH program and/or interest in capacity
identify developers well positioned to development
create PSH
51
Strategy 2.3: Expand PSH through Investment of DBHDS funds in capital subsidies
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources
Agency(s) Involved $$$
2.3.1 Explore opportunities to increase DBHDS None Explore If approved,
funding allocations to the Trust Fund for opportunities implement
development appropriate community with DBHDS
housing including housing for people with leadership.
SMI as well as DD who are transitioning If approved,
from institutions, including possibility of develop
proposing amendments to relevant code legislative
sections to add individuals with serious request for
mental illness as a population eligible to be language
served in community housing financed by modification.
the Trust Fund Make request to
increase budget
2.3.2 Explore the investment of carryover DBHDS None Explore whether Continue to make Unknown
and reserve DBHDS housing funds in carryover and investments, if
project capital reserve can be possible.
invested, and if so,
develop policies
and procedures to
identify, secure and
make such
investments
Strategy 2.4: Strategies to Collaborate with Local Communities to expand PSH
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources
Agency(s) Involved $$$
2.4.1 Identify communities with high need, DBHDS DHCD Articulate criteria Implement Continue to
high risk populations and services/ housing VHDA to identify outreach as part implement
capacity to address these populations for DMAS communities of DHCD’s outreach as part of
possible outreach Identify potential modified action DHCD’s modified
communities planning action planning
outreach outreach
52
Finalize Identify
community interested
choices communities
Plan outreach to
take place in
conjunction with
DHCD’s annual
action planning
outreach
2.4.2 Follow-up with interested DBHDS DHCD None Work with Projects come on-
communities VHDA interested line
communities to Continue to work
identify PSH with communities
opportunities. to include PSH in
Identify DBHDS, projects.
CSB and other
agency resources
to support
identified
pipeline projects
Provide
assistance to
projects as
needed
2.4.3 Explore establishment of peer to peer DBHDS DHCD None Goal of holding Goal of holding
shared learning covering the identified DMASVHDA three meetings; one three meetings; one
communities in –person and two in –person and two
conference calls conference calls
53
Goal #3 - Increase Rental Assistance to make Units Affordable
Strategy 3.1: Expand PSH through the DBHDS PSH SMI Program
20
FY19 – 200 household expansion (funds available)
FY20 – 150 household expansion (funds dependent on final budget)
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
3.1.1 Continue to secure funds to expand the DBHDS Allocate Request Allocate funds $5 million for
PSH-SMI program additional funds additional funds from General 375 units
provided by the through budget Assembly and requested in
Assembly development PSH-SMI that FY20 budget
become Medicaid
available when expansion may
Medicaid SH free up funding
benefit is for 350 units in
available CY2021
statewide
3.1.2 Target new funding and/or turnover to DBHDS VHDA Assess Allocate funds to Educate SMI
LIHTC units as they come on-line opportunities areas with new programs as to
to align PSH or existing LIHTC this opportunity
funds with units that can
LIHTC provide
turnover preferential
Lease-up as leasing to
appropriate
program
participants
20
Note: This rental assistance may be used in LIHTC or ASHN projects. If so, avoid double counting units.
54
Strategy 3.2: Explore partnership with local PHAs to support state goals
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
3.2.1 Meet with key groups include VAHCDO to DHCD DBHDS Meet with key Meet with key Meet with key
discuss state priorities and collaboratively VHDA groups groups groups
outreach to PHAs to support state goals. DMAS
3.2.2 Outreach to all VA PHAs to encourage DHCD DBHDS Develop joint Offer support Offer support to DBHDS and CSB
responses to the next Mainstream NOFA(s). VHDA letter from to all PHAs all PHAs identified
Outreach through regional Consolidated DMAS Secretaries choosing to choosing to resources
Planning meetings as well as possible Design and apply apply
communication from leadership to PHAs to execute Explore
encourage applications. Identify what resources outreach to methods to
DBHDS or its local partners bring to the table to PHAs as soon track people
help PHAs successfully apply for these funds as possible in with SMI
including but not limited to identifying clients anticipation of served
and helping them locate and move into housing, NOFA
funds for move-in costs such as security deposits
or furnishings, landlord guarantee program.
Identify best prospects and target these
3.2.3 Identify PHAs interested in project-basing DHCD Identify a pilot Identify two Identify two
Mainstream, other PBV or PSH SMI to serve the project projects projects
target population
3.2.4 Work with PHAs interested in project- DHCD Select low risk Work with PHA Work with PHA
based Mainstream or other HCV to develop a strategy. to provide to provide
low-risk approach to HUD secure approval for Work with PHA necessary necessary
targeting. Determine whether PHA could base to provide documentation documentation
an approach on services related to PBV that necessary and tenant and tenant
would not require HUD approval documentation selection policies selection policies
and tenant and procedures and procedures
selection policies
and procedures
55
Strategy 3.3: Maximize Discharge Assistance funding to support transitions to community housing
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
3.3.1 Examine current Discharge Assistance DBHDS Review DAP
Program (DAP) utilization and explore strategies utilization by
to align this funding with other housing CSB and service
initiatives for individuals with SMI such as PSH type
3.3.2 DBHDS updates DAP information to DBHDS Develop Disseminate
describe how to use DAP to bridge to PSH and information information
other integrated community housing
3.3.3 Ensure CSBs involved in discharge planning DBHDS None Provide remote
receive housing referral training and updated training for CSB
information about resources staff; record and
make available
as staff turnover
56
Goal #4 - Increase PSH through Preferential Access to Existing Affordable Housing Programs
Strategy 4.1: Expand PSH through access to public housing agency resources
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
4.1.1 Through outreach conducted under DBHDS Identify two PHAs Identify two Identify two
Strategy #2.2 above, identify PHAs that would PHAs PHAs
consider adding a preference – including a
capped preference - for people who are
chronically homeless, high utilizers of public
services, and/or people leaving institutions in
the PHA’s HCV or public housing programs.
PHAs might include those with chronic
underutilization of HCVs
4.1.2 Work with the identified PHAs to establish DBHDS Facilitate Facilitate Facilitate
local partnerships between CSBs, service partnering partnering partnering
providers and PHA to identify persons in target between PHA, between PHA, between PHA,
population, assist them to apply and move-in CSB and service CSB and service CSB and service
and to support sustained tenancies providers providers providers
4.1.3 Document and assess success so that DBHDS Document Assess tenant Assess tenant
strategies can be replicated with other PHAs outreach tenure tenure
strategies.
Assess
success
Strategy 4.2: Expand PSH through Access to HUD Assisted Housing Resources
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
4.2.1 Renew efforts to interest HUD Assisted DBHDS Engage Identify one Identify one Free technical
properties in providing a homeless or move-on DHCD/CoC Newport property property assistance
preference in their properties. Consider News willing to willing to available
targeted strategy such as senior properties or partners implement implement through HUD
veterans with disabilities as well as marketing about the TA the move-on the move-on
existing and new Medicaid funded supports they have preference. preference.
received for
57
a moving on As needed, As needed,
initiative. facilitate facilitate
Identify one partnership partnership
property between the between the
willing to CSB, CoC, CSB, CoC,
implement local service local service
the move-on providers providers
preference and property and property
As needed,
facilitate
partnership
between the
CSB, CoC,
local service
providers
and property
4.2.2 Document and assess success of DBHDS DHCD/CoC Review data and Review data and Review data and
preference in order to market to other evaluate success evaluate success evaluate success
properties
58
Goal #5 - Strategies to Increase PSH through Enhancing System Capacity
Strategy 5.1: Track PSH outcomes and utilize data to inform implementation plans
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
5.1.1 Identify data needs (including but not DBHDS VHDA Data needs Finalize Collect data
limited to program evaluation and DMAS DHCD identified data plan. as projects
documentation of program success and cost DARS Develop prepare for
avoidance), how information will be collected, data occupancy.
shared, reported collection Conduct QA
system by review and
Jan. 2020 adjust as
needed
5.1.2 Research creation of a PSH inventory tool DHCD DBHDS Determine Implement tool Analyze using
DMAS appropriate tool tool
DHCD
Strategy 5.2: Develop DBHDS referral protocol for non-LIHTC units
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
5.2.1 DBHDS should continue to work internally DBHDS DHCD None Develop DBHDS
across Divisions as well as with DHCD on a written protocol
streamlined protocol and written policies for for referral
referring priority populations to set-asides and process
units with leasing preferences. Process to
complement DBHDS-VHDA referral process
5.2.2 DBHDS collaborate with CSBs and other DBHDS None Collaborate Market units
local entities to develop strategies to market with CSBs to
units to eligible people with SMI prior to the develop
availability of the units marketing
strategies
Market
units
59
Strategy 5.3: Launch DBHDS Cross-Disability Housing Office
Action Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Agency(s) Involved
5.3.1 Establish office including staffing, DBHDS New Office
organizational chart, roles and responsibilities established
for the office.
5.3.2 Ensure sufficient staffing; provide funds DBHDS DMAS Explore Request funds
for additional DBHDS staffing to conduct Medicaid admin to address
evaluation, monitoring, and provide funds for DBHDS staffing gaps
operational support to assure fidelity to PSH housing
positions
5.3.3 Establishment shared and/or coordinated DBHDS Coordination Coordination Coordination
responsibilities between Behavioral Health and between SMI between SMI between SMI
Developmental Services teams including but and DD and DD Divisions and DD Divisions
not limited to shared referral process for LIHTC Divisions.
units with a leasing preference, education and Identify source
training for housing agencies and service of funds for
providers training
activities.
Shared referral
process
developed
Strategy 5.4: Enhance PSH housing development capacity
Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Action Agency(s) Involved
5.4.1 Explore strategies to increase the capacity DBHDS VHDA Identify capacity Develop and Implement
of CSBs, nonprofit mission-driven developers DHCD building needs implement capacity building
and other organizations to develop PSH capacity- strategy
building
strategy.
5.4.2 Identify funds for identified strategy and DBHDS VHDA Identify funding
implement as soon as possible. See also DHCD
Strategy 1 for philanthropic support for this DMAS
capacity development
60
Strategy 5.5: PSH Steering Committee continues PSH alignment with related activities
Lead Others CY19 Goal CY20 Goal CY21 Goal Resources $$$
Action Agency(s) Involved
5.5.1 PSH Steering Committee continue to DHCD VHDA Monthly Monthly Monthly
meet regularly to ensure plan is implemented DBHDS meetings meetings meetings
on schedule DMAS
DARS
VDH
5.5.2 PSH Steering Committee ensures DHCD VHDA Coordination Coordination Coordination
coordination and alignment with related DBHDS between between between
activities including Governors Coordinating DMAS committees committees committees
Council, SMI Strategy Group, Integrated DARS
Housing Advisory Council (IHAC), Inter-agency VDH
Leadership Team (ILT)
5.5.3 PSH Steering Committee to continue to DHCD VHDA Communication Communication Communication
secure stakeholder input through Strategy DBHDS with with with
Group and other DMAS stakeholders stakeholders stakeholders
DARS
VDH
5.5.4 PSH Steering Committee to continue to DHCD VHDA PSH Steering PSH Steering PSH Steering
include state actors as appropriate DBHDS Committee Committee Committee
DMAS expanded as expanded as expanded as
DARS appropriate appropriate appropriate
VDH
61
Acronyms
SH = DMAS Supportive Housing benefit
PSH = permanent supportive housing
LIHTC = Low Income Housing Tax Credit program
SE = DMAS Supported Employment benefit
MH = mental health
VBH = behavioral health
TCM = target case management
MHSS = mental health skill building
CC = care coordinators (DMAS)
HH = Health Home
62
Appendix B PSH Steering Committee
Name Organization Email
Virginia Department of Housing and
Pamela Kestner Pamela.Kestner@dhcd.virginia.gov
Community Development (DHCD)
Nichele Carver DHCD Nichele.Carver@dhcd.virginia.gov
Elizabeth Spach DHCD Elizabeth.Spach@dhcd.virginia.gov
Virginia Housing Development Authority
Art Bowen Art.Bowen@vhda.com
(VHDA)
Virginia Department of Behavioral
Kristin Yavorsky Health and Developmental Services Kristin.Yavorsky@dbhds.virginia.gov
(DBHDS)
Ashley Hall DBHDS A.Hall@dbhds.virginia.gov
Virginia Department of Medical
Ann Bevan Ann.Bevan@dmas.virginia.gov
Assistance Services (DMAS)
Beth Seward DMAS Elizabeth.Seward@dmas.virginia.gov
Virginia Department for Aging and
Charlotte Arbogast Charlotte.Arbogast@dars.virginia.gov
Rehabilitative Services (DARS)
Carole Pratt Virginia Department of Health (VDH) Carole.Pratt@vdh.virginia.gov
Virginia Department of Social Services
Massey Whorley Massey.Whorley@dss.virginia.gov
(DSS)
Kiara Crawley DSS Kiara.Crawley@dss.virginia.gov
Virginia Department of Veterans
Matthew Leslie Matthew.Leslie@dvs.virginia.gov
Services (DVS)
63
Appendix C Strategy Group Membership
2019 Housing Virginians with Serious Mental Illness Strategy Group
Name Organization Email
Virginia Department of Housing and
Erik Johnston Erik.Johnston@dhcd.virginia.gov
Community Development (DHCD)
Pam Kestner DHCD Pamela.Kestner@dhcd.virginia.gov
Nichele Carver DHCD Nichele.Carver@dhcd.virginia.gov
Elizabeth Spach DHCD Elizabeth.Spach@dhcd.virginia.gov
Virginia Department of Behavioral
Mira Signer Health and Developmental Services Mira.signer@dbhds.virginia.gov
(DBHDS)
Kristin Yavorsky DBHDS Kristin.Yavorsky@dbhds.virginia.gov
Ann Bevan DMAS Ann.Bevan@dmas.virginia.gov
Beth Seward DMAS Elizabeth.Seward@dmas.virginia.gov
Art Bowen VHDA Art.Bowen@VHDA.com
Virginia Department for Aging and
Charlotte Arbogast Charlotte.Arbogast@dars.virginia.gov
Rehabilitative Services (DARS)
Carole Pratt Virginia Department of Health (VDH) Carole.Pratt@vdh.virginia.gov
Virginia Department of Social Services
Massey Whorley Massey.Whorley@dss.virginia.gov
(DSS)
Kiara Crawley DSS Kiara.Crawley@dss.virginia.gov
Tara Ragland DSS Tara.Ragland@dss.virginia.gov
Annette Kelley DSS Annette.kelley@dss.virginia.gov
Missy Currier DSS Missy.currier@dss.virginia.gov
Virginia Department of Veterans
Matt Leslie Matthew.Leslie@dvd.virginia.gov
Services
Kendra Coleman Virginia Department of Corrections
Kendra.Coleman@vadoc.virginia.gov
(DOC)
64
Stephanie Beardslee DOC Stephanie.Beardslee@vadoc.virginia.gov
Sarah Wilson NAMI- Virginia swilson@namivirginia.org
Stephany Melton NAMI- Virginia smelton@namivirginia.org
Brian Koziol Virginia Housing Alliance (VHA) Brian@vahousingalliance.org
Sheriff Steve Draper Virginia Sherriff's Association (VSA) smdraper@ci.martinsville.va.us
Major Laura Hopkins VSA LHOPKINS@ci.martinsville.va.us
Virginia Association of Regional Jails
Mike Edwards medwards@kemperconsult.com
(VARJ)
William “Chris” Smith VARJ smithw@wtrj.org
Superintendent Tim
VARJ tdoss@mprsc.org
Doss
Virginia Association of Community
Sarah Paige Fuller sarah.fuller@norfolk.gov
Service Boards (VACSB)
Joy Cipriano VACSB JoyC@hnncsb.org
Jim Tobin VACSB jtobin@piedmontcsb.org
Virginia Hospital and Healthcare
Jennifer Kelly Jennifer.kelly@uhsinc.com
Association (VHHA)
Amy Clarke VHHA Amy.Clarke@HCAHealthcare.com
Allison Bogdanovic Virginia Supportive Housing (VSH) ABogdanovic@virginiasupportivehousing.org
Deidre Johnson VOCAL – Virginia deidre@vocalvirginia.org
VOCAL – Virginia
Malaina Poore malaina@vocalvirginia.org
Michael Smith Richmond Memorial Health Foundation Msmith@rmhfoundation.org
Suzanne Gore State Health Partners Suzanne.Gore@statehealthpartners.com
Sylisa Lambert-
Pathway Homes lambwood@pathwayhomes.org
Woodard
65
Appendix D Committee Relationship Graphic
66
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