Behavioral Health Rental Assistance Program (CBRA) (December 1, 2021)

Summary

This March 2023 Housing Division report to the Legislature on behavioral health rental subsidies satisfies the reporting requirements in section 129, subsection 85 of the 2021-23 operating budget, which provided $9,864,000 per fiscal year solely for long-term rental subsidies for individuals with mental health or substance use disorders. Combined with a separate $1,980,000 per year, Commerce is distributing $11,251,800 through the Community Behavioral Health Rental Assistance Program (CBRA). The report states that 733 households were served during state fiscal year 2022 and that grantees spent 56% of contracted funds. Its recommendations include collapsing subsections 16 and 85 into a single appropriation and increasing funds in state fiscal year 2024.

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“Behavioral Health Rental Assistance Program (CBRA) (December 1, 2021).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2023-commercereports-behavioral-health-rental-assistance-program-repor-50041710d8/, SHA-256 bb8cd6351638551d49d122845e1a8d37d3b065db0ab5160802945381fd1d43ae.

Full text

Behavioral health rental
subsidies 2022 report

Report pursuant to Sec. 129 (85) of Chapter 334, Laws of 2021
(ESSB 5092)

March 2023
HOUSING DIVISION
OFFICE OF APPLE HEALTH & HOMES AND
PERMANENT SUPPORTIVE HOUSING Report to the Legislature

Mike Fong, Director
V3.2
Acknowledgments

Washington State Department of Commerce
Corina Grigoras, Assistant Director,
Housing Division

Melodie Pazolt, Managing Director,
Office of Apple Health & Homes and
Permanent Supportive Housing

Office of Apple Health & Homes and
Permanent Supportive Housing
Jefferson Spring
jeff.spring@commerce.wa.gov
360-725-2991

1011 Plum St. SE
P.O. Box 42525
Olympia, WA 98504-2525

www.commerce.wa.gov

For people with disabilities, this report is available
on request in other formats. To submit a request,
please call 360-725-4000 (TTY 360-586-0772)

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT
Table of contents
Executive summary...................................................................................................................................... 2

Expenditures ............................................................................................................................................... 3

Challenges .................................................................................................................................................. 5

Program data............................................................................................................................................... 6

Success stories ........................................................................................................................................... 9

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 1
Executive summary
Legislative mandate
This report satisfies the reporting requirements in section 129, subsection 85 of the 2021-23 operating budget:

$9,864,000 of the general fund—state appropriation for fiscal year 2022 and $9,864,000 of the general fund—state
appropriation for fiscal year 2023 are provided solely for long-term rental subsidies for individuals with mental health
or substance use disorders. This funding may be used for individuals enrolled in the foundational community support
program while waiting for a longer-term resource for rental support or for individuals transitioning from behavioral
health treatment facilities or local jails. Individuals who would otherwise be eligible for the foundational community
support program but are not eligible because of their citizenship status may also be served. By December 1, 2021,
and December 1, 2022, the department must submit a report identifying the expenditures and number of individuals
receiving long-term rental supports through the agency budget broken out by region, treatment need, and the
demographics of those served during the prior fiscal year.

This funding is combined with a separate appropriation of $1,980,000 per year in section 129, subsection 16 of
the 2021-23 operating budget for the same use and population. Combined, Commerce is distributing
$11,251,800 through the Community Behavioral Health Rental Assistance Program (CBRA).

Program highlights
Nearing fully contracted status: State fiscal year 2022 was a robust growth year for CBRA. The
expanded funding from subsection 85 allowed Commerce to start contracts in all 10 behavioral health
regions. Those regional contractors subcontracted to non-profit housing providers in each region's
counties, which took most of state fiscal year 2022 to complete. Sub-granting work is still underway in
Adams, Grant and Pend Oreille counties. Subgrantees are now entering client-level data into the
Homeless Management Information System (HMIS). HMIS setup is still in progress in some counties.

Individuals served: 733 households were served during state fiscal year 2022.

Spending: In state fiscal year 2022, grantees spent 56% of contracted funds, up significantly from state
fiscal year 2021. Underspending is a direct reflection of the pandemic-related challenges grantees faced.
We expect full spending of appropriated funds in state fiscal year 2023.

Recommendations
Collapse subsections 16 and 85 into a single appropriation. This action would streamline administering
the CBRA program, eliminate a margin of error, and simplify the accounting of expenditures.

Increase funds in state fiscal year 2024. A significant funding increase would build capacity to expand
tenant-based rental vouchers and add project-based rental vouchers to the program across the state,
providing needed project-based and scattered-site supportive housing opportunities.

Deposit appropriations from subsections 16 and 85 under section 129 into a dedicated account in state
fiscal year 2024. Funds should be deposited for dedicated use in Fund 26U – Apple Health and Homes
Account. This change would allow unused funds to remain available for later use. It would also allow
greater sustainability for grantees serving clients with long-term care needs.

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 2
Expenditures
The Legislature's appropriation of additional funding in the current biennium provided the opportunity to fund
all 10 behavioral health regions established by the Health Care Authority1 and ensure that housing providers
were contracted in each county within a region. This funding expansion means people with behavioral health
conditions in every county will have access to targeted long-term rental assistance for the first time.

State fiscal year 2022 saw continuous improvement in subcontracting and hiring compared to the prior year.
The COVID-19 pandemic still proved challenging regarding subgrantees recruiting qualified staff, but this year,
all 39 counties acquired a CBRA provider. The amount of time this took contributed to continued under-
spending, but the upward trajectory of spending is steep. We anticipate a full expenditure in state fiscal year
2023. Commerce continues to provide technical assistance to grantees and subgrantees to facilitate
subcontracting and spending and further define program guidelines to stay up to date with best practices.

Table 1: Spending by region, state fiscal year 2022

Region Contracted Unspent funds Percent unspent

Great Rivers $964,119 $279,170 29%

North Sound $1,501,830 $19,827 1%

Greater Columbia $1,354,422 $1,011,166 75%

King $2,317,409 $2,131,330 92%

Salish $643,827 $274,024 43%

Spokane $1,643,284 $789,367 48%

Thurston-Mason $580,189 $177,975 31%

Pierce $1,628,452 $196,429 12%

North Central $218,216 $56,963 26%

Southwest $572,702 $106,190 19%

Total $11,424,450 $5,042,441 N/A

1 The 10 behavioral health regions are established by the Health Care Authority for the provision of Apple Health managed care. The

regions can be viewed on the map found at https://www.hca.wa.gov/assets/free-or-low-cost/service_area_map.pdf

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 3
Background on funding alignment with CBRA
The Behavioral Health Rental Subsidies funding is strongly aligned with the CBRA program created in section
129, subsection 16 from the 2019-21 operating budget, which provides $1,980,000 per year for rental
assistance for a similar population. Priority for the existing CBRA funding must be given to people on state
psychiatric hospitals' discharge lists or in local inpatient behavioral health facilities.

With guidance from our assistant attorney general, the Department of Commerce (Commerce) paired the new
fund source with the existing pilot CBRA program, allowing expansion to all of HCA's 10 behavioral health
regions this summer. The statewide implementation of CBRA marks a milestone in expanding permanent
rental assistance to those with behavioral health conditions. This is the first time long-term, state-funded rental
assistance for those with behavioral health conditions was available statewide.

CBRA is a supportive housing program. Participants must be eligible for at least one of several state-provided
long-term supports programs, including Foundational Community Supports (FCS) administered by the HCA.
Utilization of these supportive services by clients must be strictly voluntary. Though supportive housing is
most frequently thought of as project-based housing, there remains a significant deficit of such housing,
despite ongoing capital investments. As a result, the success of CBRA is dependent on private-market rental
housing.

While CBRA allows indefinite assistance with rent, it is commonly used as a bridge subsidy until another long-
term subsidy is secured, commonly a housing choice voucher (also known as Section 8 voucher). The use as a
bridge function extends the option for long-term rental assistance to more eligible clients.

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 4
Challenges
Subcontracting
The COVID-19 pandemic has presented considerable challenges and amplified existing concerns. Many
prospective non-profit subgrantees report being overwhelmed by COVID-19 relief funds and are at or over
capacity in terms of client service. This lack of capacity compared to funds available has caused sub-granting
delays in some regions.

In King County, which has the largest percentage of funds, county staff turnover has presented additional sub-
granting difficulties, as has lengthy procurement processes. In other regions, staff shortages experienced by
subgrantees have hindered sub-granting, resulting in the delay in the provision of rental assistance. Several
regions have consistently left significant amounts of unspent funding at the end of each year. Program staff
provides technical assistance at every opportunity, including holding monthly grantee peer-to-peer meetings
where grantee peers can discuss shared challenges and best practices.

Housing challenges
Finding appropriate rental market housing for CBRA clients is the primary concern cited in all 10 regions. In
most locations, grantees report that landlords are frequently unwilling or unable to work with clients with
complex conditions, including hotels and motels used as emergency housing until permanent housing is
established. Some landlords insist that tenants earn three times the rent, despite a public rent subsidy.
Grantees report that in some cases, clients experiencing a mental health crisis are banned from housing.

Low rental market vacancy rates have significant negative effects on finding suitable housing of any
affordability for clients approved for service, and thus directly affect program spending. Insufficient housing
stock and ongoing staffing challenges are slowing housing placements across the state.

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 5
Program data
The Homeless Management Information System (HMIS) is the primary data collection platform for CBRA.
However, HMIS cannot be configured until subgrantees are in place. Therefore, meaningful data cannot be
derived from HMIS until sufficient time elapses from HMIS setup; this lag in information is characteristic of
new program implementation. The data displayed is current through June 30, 2022. Other data sources are the
Research and Data Analysis Division of the Department of Social and Health Services and the grantees
themselves.

Table 2 shows clients served in state fiscal year 2022 by region. Approximately 55% of those served were
provided long-term subsidies; the remainder were provided a short-term bridge subsidy until a different long-
term subsidy was secured. The high utilization of long-term subsidies is an artifact of the chronic underfunding
of the HUD Housing Choice Voucher (Section 8) program, the only widely available long-term housing subsidy
besides CBRA. This deficit of Housing Choice Vouchers makes programs like CBRA crucial.

Table 3 shows percentages of client treatment needs. Tables 4, 5 and 6 show demographic data for the clients
served. Note that percentages do not total to 100% due to rounding.

Table 2: CBRA clients served, state fiscal year 2022

Served with long-term
Region Total clients served subsidy

Great Rivers 67 39

North Sound 215 139

Greater Columbia 15 9

King 24 6

Salish 97 42

Spokane 140 17

Thurston-Mason 28 14

Pierce 37 37

North Central 45 45

Southwest 65 52

Total 733 400

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 6
Table 3: Treatment need

Treatment need Percent

Mental health 23%

Substance use disorder 5%

Mental health and substance use disorder 70%

No identified treatment deed in the past 24 months 2%

Table 4: Race

Race Percent

American Indian, Alaska Native, or Indigenous 6%

Asian or Asian American 1%

Black, African American, or African 6%

Native Hawaiian or Pacific Islander 1%

White 77%

Multi-racial 2%

Unknown 6%

Table 5: Ethnicity

Ethnicity and gender Percent

Hispanic/Latino(a) 12%

Non-Hispanic/Latino(a) 83%

Unknown 4%

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 7
Table 6: Gender

Gender Percent

Male 54%

Female 37%

Non-binary 1%

Unknown 3%

Not reported 5%

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 8
Success stories
Despite daunting challenges, successful housing placements were made, allowing housing stability for highly
vulnerable persons. The following are two testimonials from grantees:

Greater Lakes Mental Health
We have a client who has made significant improvements. When he came to the program two years ago, he was
living out of his van. He had been living in his van for a couple of years. At the time, he was only receiving Aged, Blind,
or Disabled Cash Assistance Program (ABD) and was unable to obtain a HEN voucher due to funding. He was in a
deep depression that was some days debilitating to him. While going through all of this, he was able to maintain his
sobriety. He was enrolled in a supportive employment program, and they referred him over to us. While working
closely with his HARPS case manager, he was able to obtain a hotel/housing voucher through CBRA. He was able to
stay at the hotel for 90 days while looking for housing. When he was not able to secure an apartment within the 90
days, we were able to get him an extension for another 90 days. This voucher was a lifesaver for him because he did
not have to spend the winter in his van. His case manager assisted him in applying for multiple apartments, and his
credit and criminal record continued to be a barrier. When they continued to hit those barriers, he started to fall back
into a depression. His care team noticed him slipping back, so they teamed up to encourage him not to give up. His
case manager suggested him moving into a clean and sober house to have the extra support. He agreed that would
be good for him. So he called and made an appointment to go see the place and meet the guys in the house. After he
met with them, his spirits had lifted, and he was excited to move in. He is now doing amazing and has recently
secured employment!

Pierce County Alliance
A client was released from an Inpatient Psychiatric facility after 5.5 years in May of 2021. After her release, she
applied for Social Security Disability Insurance (SSDI) and found her own apartment, however, her SSDI income and
housing fund were not sustainable, and she would have eventually ended up homeless due to not being able to pay
her rent. She joined CBRA in December 2021. Being on the CBRA program has allowed her to have a successful
discharge and maintain good mental and physical health, her required mental health appointments have decreased in
frequency, and she is currently attending school pursuing a degree in editing. She shared some of her long terms
goals and stated that she wants to stay in remission, work part-time as a self-employed editor, and pursue a master’s
degree in English. She reported that the CBRA permanent housing program has opened doors for her, and she is able
to focus on her well-being and not have to stress out trying to figure out how to pay her rent. She reported CBRA
housing has also allowed her to slowly acclimate back into society and develop the skills needed to sustain and build
a great life. She reported specifics about how the CBRA program has helped stabilize her mental health, and they are
as follows: decreased stress, having her own space is huge so she can heal herself, she is able to work out six times
per week at the gym, and she was able to enroll in school. She reported that if she did not have the CBRA program,
her stress level would have increased, the likelihood of a relapse would increase, and she would end up back in an
inpatient psychiatric facility if she became homeless.

BEHAVIORAL HEALTH RENTAL SUBSIDIES REPORT 9

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