AHCCCS calls for waiver amendment to improve homeless health outcomes – State of Reform


Medicare and Medicaid Service Centers (CMS) ad Arizona submitted an 1115 waiver amendment request on Monday to improve health services for its homeless population. The Arizona Health Care Cost Containment System (AHCCCS) submitted the request on May 27.

the change request – that the AHCCCS call the Housing and Health Opportunities (H2O) demonstration – look at “iimprove health care delivery and health outcomes for AHCCCS members who are homeless or at risk of homelessness by using strategies designed to address identified gaps, expand existing evidence-based practices and reduce barriers to housing.

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According to data from the US Department of Housing and Urban Development, between 2017 and 2019, the number of homeless people in Arizona jumped 12% to more than 10,000 people. During this period, the limited capacity of the shelters resulted in a 43% increase in the number of people not accommodated.

The AHCCCS estimates that the average annual cost of care for homeless Medicaid members is $ 23,090 – a cost approximately $ 16,082 higher than the average cost of care for Medicaid registrants in general. The modification request specifies:

The AHCCCS recently assessed the crisis, inpatient and behavioral health care utilization of 30,363 members identified as homeless. One-third of these members made three or more emergency room visits and 38% made three or more hospital stays during the 18-month period under review.

For homeless people registered with a severe mental illness (SMI) designation, the average annual cost of care was $ 66,784.

In a letter to CMS administrator Chiquita Brooks-LaSure, AHCCCS director Jami Snyder writes that the new waiver amendment is designed to complement the agency’s existing housing program. Using state dollars, the current program provides rent subsidies to nearly 3,000 homeless people each year. Snyder says the existing program has improved results and reduced costs.

“The state’s investment in permanent supportive housing programs has paid off, resulting in significant reductions in emergency department visits, inpatient admissions and use in crisis situations, as well as increased use of less expensive preventive care. “

The change request would advance this initiative, Snyder writes, by strengthening homeless outreach strategies, securing resources to support housing stability for members, and improving enveloping housing services and supports to gain support. better health outcomes.

As part of its awareness-raising objectives, the AHCCCS is seeking authorization to cover reintegration services for people with severe behavioral and physical problems who are at high risk of homelessness when they leave school. prison or prison. Services would start a month before release “to build community ties and ensure they receive the necessary coordination of care, physical and behavioral health services, medication and medication management, and support. social essential when they are released into the community ”.

Arizona’s current 1115 exemption expires on September 30, 2021. If approved, the amendment will apply concurrently with the agency’s requested renewal period of October 1, 2021 through September 30, 2026.

the federal comment period for the modification request runs from June 7 to July 7, 2021. Just two comments have been published so far, both in support of the amendment.

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