In California, managed care plans (MCPs) are seeking more effective ways to partner with homeless service providers to better address the health and social needs of people experiencing homelessness. In particular, under CalAIM, California’s Medicaid transformation initiative, MCPs are encouraged to provide new Community Supports services — including, for example, housing services and medically tailored meals — to help address members’ health-related social needs. MCPs have flexibility regarding which Community Supports to offer and how to partner with homeless service providers to successfully provide these services.
The Center for Health Care Strategies (CHCS) recently spoke with Kris Kuntz, Program Director of Housing and Homeless Strategy at Anthem Blue Cross, about how MCPs can partner with homeless service providers to enhance care and services for people experiencing homelessness. Kris spent many years working to address homelessness prior to joining Anthem, including at the Regional Task Force on Homelessness, San Diego’s Continuum of Care (CoC) lead agency, and Father Joe’s Villages, a large homeless services provider in downtown San Diego. Kris, along with his colleagues at Anthem Blue Cross, HealthNet, CalViva, and the Kings Tulare Homeless Alliance (KTHA), are part of Partnerships for Action: California Health Care & Homelessness Learning Collaborative, led by CHCS and made possible by the California Health Care Foundation. This blog post is a product of the Partnerships for Action initiative.
Q. How does your prior experience help you engage with homeless services providers interested in working with managed care plans?
A. I’ve been working with Anthem for two-plus years now, but my work previously was in the housing and homelessness world. Years ago, I worked for a nonprofit in San Diego that ran shelter programs, supportive housing programs, and did street outreach. During my time there, I was involved with a pilot that connected people experiencing chronic homelessness, who were also high utilizers of the hospitals and jail systems, to supportive housing. We saw people who had been homeless for decades get off the streets and into their own housing, and we saw their overall wellbeing improve. We asked ourselves: “How do we sustain this program?” This was my first eye-opening experience about how housing organizations and Medi-Cal managed care plans can work together to provide services that improve care and quality of life for people experiencing homelessness with high health care needs.
In my current role at Anthem, I’m still working on homelessness, just from a different angle. Having worked for a large homeless services organization, which is now a contracted CalAIM provider, a CoC, and local city and county governments, I can speak the housing language, and I understand the homeless system and some of the problems within it to maneuver through the different technical aspects connecting people to housing.
Q. What are the key elements for a successful partnership between managed care plans and homeless service providers?
A. Open communication, trust, and good relationships are key, it doesn’t matter what setting you’re in. To be a good managed care partner is to listen to the homeless-sector partners, understand their needs and challenges, and rely on the experience of homeless response system partners in considering how the health plan can help.
Offering housing navigation, paying people’s deposits, providing housing case management once people are housed, are all things that the homeless system has been doing for many years. Managed care plans offer a new way to pay for those services under CalAIM.
Q. What work has Anthem done in Kings and Tulare Counties to provide Community Supports, and how did you engage with the local CoC?
A. KTHA acts as the CoC lead agency for both Kings and Tulare counties. A few years ago, KTHA was having challenges with utilizing mainstream housing vouchers, which assist non-elderly people with disabilities. During this time, I was working with Anthem as a consultant, and we reached out to KTHA and the Tulare County Public Housing Authority to better understand what was happening. I found out that KTHA had the vouchers, the clients, and the housing locators that were finding units, but didn’t have the money for deposit assistance and other move-in costs. That’s where we stepped in. Anthem provided a grant to KTHA that they could use for Anthem members who had a voucher in their hand and had a unit identified. Essentially, Anthem paid people’s deposits and move-in costs. Both the Tulare County Public Housing Authority and KTHA were happy because vouchers started to get used and we were happy because our members were getting housed. If you fast forward to today, what we provided in grant funds to KTHA is now what we can cover under CalAIM.
Q. How are CalAIM and related state funding opportunities facilitating these partnerships between managed care plans and homeless service providers?
A. I think there are tons of opportunities through CalAIM, not only integrating CalAIM into the existing homeless response system to pay for services, but also expanding the system to reach and serve more people.
The Porterville Navigation Center in Tulare County is a 40-bed low-barrier shelter program historically funded by the city of Porterville and through different federal and state sources. The Navigation Center recently changed operators and moved to an organization called Kings View, which is one of Anthem and Health Net’s contracted Enhanced Care Management (ECM) and Community Supports providers. The Navigation Center has started providing ECM services, housing navigation, recuperative-care, short-term post-hospitalization housing and is looking to include sobering center services in the future. This is a perfect example of how CalAIM has allowed for both expansion of services and sustainability.
Q. How can managed care plans contribute to the financial sustainability of services provided by homeless service organizations while ensuring care is both person-centered and effective?
A. At Anthem, we look to partner with local housing and homeless organizations that use best practices, like housing-first, trauma-informed care, and motivational interviewing, to provide services. Then we consider if they have different city, county, or CoC grants to pay for these services and how a new revenue stream could enhance what they’re doing, serve more people, and ideally be sustainable.
For example, the City of Tulare was awarded one of the state’s Encampment Resolution Funds (ERF) grants to address a large encampment along the railroad tracks that runs through the city. Through this grant, Tulare has been able to provide limited housing navigation, house people, and provide sustainable housing services. That’s all been funded through one-time grant funding. With that funding stream ending, we’ve been engaging the city about how to leverage CalAIM along with their ERF grant and expand services. Conveniently, the organization that the City was contracting with for the housing services at the encampment was also contracted with Anthem and Health Net. By coordinating this, there was opportunity to expand services to additional people living in the encampment.
Now, the City of Tulare is working with the organization to expand their housing navigator’s capacity to support that encampment in Tulare County. The organization is going to be billing through CalAIM under their contracts with both Anthem and Health Net to expand those services from one staff covered by the ERF grant to five staff members supported through billing. It took partnership, open communication with the city, identifying the areas of overlap, and figuring out how to combine different state funding sources to expand services to meet the needs of more people.
Q. Finally, we welcome your broad perspective — what will it take for the health care system to meaningfully improve outcomes for people experiencing homelessness?
A. It is key to acknowledge that while health care has a role to play, we can’t improve things on our own. As a health care system payer, we rely on local community-based organizations (CBOs) to be our network, engage our members, figure out the best housing solution, and get them connected to the wraparound support they need. Also, it is important to recognize that CBOs are the experts in supporting people experiencing homelessness. We need to make it easy for them to do their work which means reducing unnecessary administrative barriers to referral and documentation.
For the homeless system, it’s knowing that health plans are increasingly becoming part of the solution in addressing homelessness. This shift of perspective, and the trust-building work that goes along with it, could be a powerful step forward. The health plans have to show up at the table with housing and homeless service providers in our communities — to listen, learn, offer our perspective, and to try and be a good partner.
Going back to the question from earlier, it’s all about relationships. It’s about collaboration. It’s about thinking about what each sector brings to the table and what are our roles and responsibilities. Homeless systems are not able to solve the homeless issue on their own. Just like health care systems are not able to solve the homeless situation on their own. But I think through partnership and coming together, we can hopefully make a dent in the problem.
