Housing Stabilization Services (Consultation, Transition, Sustaining)

Housing Stabilization Services is a new Minnesota Medical Assistance benefit to help people with disabilities, including mental illness and substance use disorder, and seniors find and keep housing.

Consultation:  

People who do not have waiver or targeted case management or a MSHO/MSC+ care coordinator, but need Housing Stabilization Services, can complete the person-centered planning needed through an enrolled housing consultant. Enrolled housing consultants help a person develop a Housing Focused Person-Centered Plan (DHS-7307) and support the person to select their housing transition or sustaining provider. This service must be distinct from all other services and not duplicate other services or assistance available to the person.

Covered Services:

• Assisting the person to access documentation required for Housing Stabilization Services eligibility
• Developing a Housing Focused Person-Centered Plan based on assessment outcomes
• Supporting the person in identifying their strengths, needs and wants in housing including cultural requirements and/or preferences
• Supporting the person to make an informed choice in their housing transition or sustaining provider
• Offering resource information for services that support non-housing related goals as identified in the person-centered planning process
• Coordinating with other service providers currently working with the person
• Helping the person understand their rights to privacy and appeal information
• Annually updating the person-centered plan as it relates to housing

Transition:

Services that assist a person to plan for, find, and move to a home in the community.

Activities with an asterisk (*) can be provided directly (in person or remotely working directly with the person) or indirectly on behalf of the person. The expectation is that services are primarily provided as a direct service. Documentation must indicate whether the service was provided as a direct (in person or remotely working directly with the person) or an indirect service.

Covered Services:

• Developing a housing transition plan*
• Supporting the person in applying for benefits to afford their housing, including helping the person determine which benefits they may be eligible for*
• Assisting the person with the housing search and application process*
• Assisting the person with tenant screening and housing assessments*
• Providing transportation with the person receiving services present and discussing housing related issues
• Helping the person understand and develop a budget
• Helping the person understand and negotiate a lease
• Helping the person meet and build a relationship with a prospective landlord
• Promoting/supporting cultural practice needs and understandings with prospective landlords, property managers*
• Helping the person find funding for deposits*
• Helping the person organize their move*
• Researching possible housing options for the person*
• Contacting possible housing options for the person*
• Identifying resources to pay for deposits or home goods *
• Identifying resources to cover moving expenses*
• Completing housing applications on behalf of the service recipient*
• Working to expunge records or access reasonable accommodations*
• Identifying services and benefits that will support the person with housing instability*
• Ensuring the new living arrangement is safe for the person and ready for move-in*
• Arranging for adaptive house related accommodations required by the person*
• Arranging for assistive technology required by the person*

Sustaining:

Services that supports a person to maintain living in their home in the community.

Covered Services:

Activities with an asterisk (*) can be provided directly (in-person or remotely working directly with the person) or indirectly on behalf of the person. The expectation is that services are primarily provided as a direct service. Documentation must indicate whether the service was provided directly (in person or remotely working directly with the person) or as an indirect service.

• Developing, updating and modifying the housing support and crisis/safety plan on a regular basis*
• Preventing and early identification of behaviors that may jeopardize continued housing
• Educating and training on roles, rights, and responsibilities of the tenant and property manager
• Transportation with the person receiving services present and discussing housing related issues
• Promoting/supporting cultural practice needs and understandings with landlords, property managers and neighbors*
• Coaching to develop and maintain key relationships with property managers and neighbors
• Advocating with community resources to prevent eviction when housing is at risk and maintain person’s safety*
• Assistance with the housing recertification processes*
• Continued training on being a good tenant, lease compliance, and household management
• Supporting the person to apply for benefits to retain housing*
• Supporting the person to understand and maintain/increase income and benefits to retain housing*
• Supporting the building of natural housing supports and resources in the community including building supports and resources related to a person’s culture and identity
• Working with property manager or landlord to promote housing retention*
• Arranging for assistive technology*
• Arranging for adaptive house related accommodations.*

Eligibility for housing stabilization services if they meet all of the following needs-based criteria:

• Be on Medical Assistance (MA)
• Be 18 years old or older
• Have a documented disability or disabling condition, defined as one of the following:
• A person who is aged, blind or has a disability as described under Title II of the Social Security Act.
• A person with an injury or illness that is expected to cause extended or long-term incapacitation.
• A person with a developmental disability (or related condition) or mental illness.
• A person with a mental health condition, substance use disorder or physical injury that required a residential level of care and who is now in the process of transitioning to the community.
• A person who is determined to have a learning disability according to policy adopted by Department of Human Services (DHS); or a person with a substance use disorder and is enrolled in a treatment program or is on a waiting list for a treatment program.
• Be assessed to require assistance with at least one of the following areas resulting from the presence of a disability or a long-term or indefinite condition:
• Communication, mobility, decision-making; or managing challenging behaviors
• Be experiencing housing instability, evidenced by one of the following risk factors:
  • Homeless. An individual or family is considered homeless when they lack a fixed, adequate nighttime residence; or currently transitioning, or has recently transitioned, from an institution or licensed or registered setting (registered housing with services facility, board and lodge, boarding care, adult foster care or community residential setting, hospital, Intermediate Care Facility for persons with Developmental Disabilities (ICF/DD), intensive residential treatment services, the Minnesota Security Hospital, nursing facility, regional treatment center); or
  • At risk of homelessness. An individual or family is at risk of homelessness when the individual or family is faced with a situation or set of circumstances likely to cause the household to become homeless, including but not limited to: doubled-up living arrangements where the individual’s name is not on a lease, living in a condemned building without a place to move, having arrears in rent or utility payments, receiving an eviction notice without a place to move or living in temporary or transitional housing that carries time limits; or the person, previously homeless, will be discharged from a correctional, medical, mental health or substance use disorder treatment center and lacks sufficient resources to pay for housing, and does not have a permanent place to live; would be at risk of homelessness if housing services were removed
• At risk of institutionalization – meets an instutional level of care/eligible for the following waivers:
  • Brain Injury (BI)
  • Community Access for Disability Inclusion (CADI)
  • Community Alternative Care (CAC)
  • Developmental Disability (DD)
  • Elderly Waiver (EW)

If a person has a CSSP, that is the only documentation that is needed. This document shows proof of disability, proof of assessment, and is also considered a person-centered plan.

If a person does not have a waiver but does meet the qualifications for HSS they will need one document that satisfies each of the following categories:

• Proof of Medical Assistance: PMI or copy of MA card
• Assessment:
  • MNChoice assessment or
  • PSN or
  • Coordinated Entry receipt number
• Proof of disability:
  • PSN or
  • medical opinion form or
  • proof of SSI/SSDI
• Person Centered Plan:
  • CCP (seniors) or
  • Housing-Focused Person-Centered Plan (completed through HSS consultation)