Building Connections Between Medical Respite Care and Permanent Housing

To better integrate services for people experiencing homelessness, healthcare, and homeless services organizations must work together. In California, county stakeholders are pursuing cross-sector partnerships to improve coordination of services and better meet the health and social needs of people who are unhoused. These cross-sector partnerships are facilitated in large part by CalAIM, California’s Medicaid transformation initiative.

Illumination Foundation, CalOptima Health, and the Orange County Health Care Agency (OCHCA) are partnering to smoothly transition people experiencing homelessness from recuperative care (medical respite) into permanent housing. The three have joined together as part of a grant from California Health Care Foundation’s “Partnerships for Action: California Health Care & Homelessness Learning Collaborative,” which supports cross-sector teams of healthcare and homeless services organizations to improve care delivery and health and housing outcomes for Californians experiencing homelessness.

In early September, representatives from the three organizations were part of a webinar titled: Collaborating Across Sectors to Transition People from Recuperative Care into Permanent Housing which did a deep dive into how their organizations are partnering to ensure smooth transitions from medical respite care into permanent housing for CalOptima Health beneficiaries who are experiencing homelessness. The session highlighted their partnership approach, challenges they’ve encountered and how they navigated them, and the program's impact to date.

Organization participants were Jordan Hoiberg, Director of Housing Services, Illumination Foundation; Danielle Cameron, MPH, Director of Program Development, CalAIM, CalOptima Health; and Sharon Boles, PhD, Research, Policy, and QA Analyst, Office of Project Management and Quality Improvement, Orange County Health Care Agency. Meryl Schulman, Senior Program Officer at Center for Health Care Strategies, welcomed participants and provided an overview of the Learning Collaborative and Julia Dobbins, MSW, Director of Programs & Services, National Institute for Medical Respite Care of the National Health Care for the Homeless Council, offered reflections based on her experience supporting medical respite programs nationally. 

Some key takeaways and benefits from the partnership have been: 

Housing Partnerships

1. The OCHCA’s partnership with Orange County Housing Authority provides access to 10 Mainstream Voucher Program housing choice vouchers each month (age 18-62). 

2. Illumination Foundation’s partnership with CalOptima Health allows for access to a designated funding source for housing navigation, deposit assistance, and tenancy sustaining services.

3. Illumination Foundation’s partnership with CalOptima Health offers additional, ancillary community supports such as Day Habilitation and Short-Term Post-Hospitalization helps ensure success of housing interventions. 

4. Effective use of CalOptima Health HHIP funding for the Whatever It Takes program allows Illumination Foundation to access additional resources to remove barriers to housing. 

5. CalOptima Health’s partnerships with Chrysalis (workforce services) and Illumination Foundation helps ensure adequate program staffing.

Data Sharing

Data sharing offers strategies for success and represents potential for evolution and growth of the project. 

1. Illumination Foundation and CalOptima Health comparing data allows for targeted provision of services and targeting of interventions.

2. Increased sharing of claims data could further benefit targeted service provision by allowing for effective implementation of progressive engagement service models and insights into needed interventions.

Need for Productive Partnerships

1. Effective implementation of CalAIM requires greater collaboration between Managed Care Plans (MCPs), Community-Based Organizations that provide healthcare services, and existing homeless services infrastructure. 

2. MCPs and emergency healthcare providers have traditionally operated in a silo, only interacting with homeless services as it relates to immediate discharge planning needs and in a limited role as a funder of homeless services strictly related to clinical need as opposed to a funder attempting to address social determinants of health. By developing MCPs into more robust funders with resources to address social determinants of health, the state has created opportunities for services targeted not just toward populations with higher morbidities than the general population but individuals in high risk populations that are at even greater risk of disproportionate use of emergency resources and negative health outcomes. 

3. MCP funding, Community-Based Organization service provision, and housing provider access to subsidies are all key components to driving down emergency service utilization and mortality rates among households experiencing homelessness.

The goal of the Illumination Foundation, CalOptima Health, and the Orange County Health Care Agency Partnership for Action is to successfully house 20 people who are high utilizers of emergency medical services each program year and to ensure high rates of housing retention after one year in housing. To date, their success rate has been twice that, demonstrating the effectiveness of such partnerships. 

To watch the webinar and download the slides, please click here.