Affordable, accessible and integrated housing: Who's responsibility is it anyway

Efforts to rebalance Medicaid long-term care systems have found support in both major political parties. Rebalancing is a major policy initiate in the Deficit Reduction Act (DRA) of 2005. Thirty-one states and the District of Columbia have implemented Money Follows the Person Rebalancing Demonstrations (MFP). MFP is the largest Medicaid demonstration in history, funded by $1.75 billion. A major barrier to achieving MFP outcomes is the lack of affordable, accessible and integrated housing for elderly and non-elderly persons with disabilities transitioning from nursing facilities and Intermediate Care Facilities (ICFs). An affordable housing crisis is looming that has the potential to render MFP outcomes unattainable. Will public and community health professionals begin to ‘own' the removal of barriers to housing? There are at least two approaches and seven strategies for increasing the supply of affordable, accessible and integrated housing. (1) So called ‘top-down' approaches require collaboration among community/public health agencies and state housing finance authorities in order to develop a coordinated system that links service providers with housing needs to housing agencies and providers with affordable housing resources. This approach requires involvment in processes used to develop affordable housing, including ConPlans and Qualified Allocation Plans. (2) So called “bottom-up' approaches require relationships to be built with each local public housing authority in an effort to create additional subsidized housing. Both ‘top-down' and ‘bottom-up' approaches will likely be required if MFP outcomes are to be achieved and community health professionals are to provide leadership in rebalancing state long-term care systems.