Available Funding Sources
Once parents and their son or daughter with a disability have visualized their home of choice, the next step is to explore how much can be spent on housing. It is essential to look at possible income, including Medicaid Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), work income, and family contributions. Administered by states, in Minnesota Medicaid is called Medical Assistance (MA). Creating a list of expenses is essential. There are no easy answers when it comes to obtaining payment for housing. Eligibility criteria for your daughter or son’s specific disability is a determining factor for most funding.
Federal Medicaid Funding Comes From Both the Federal and State Government
FEDERAL MEDICAID pays for medical services for individuals with disabilities and families with low incomes, including children, pregnant women, and people over the age of 65. The federal Centers for Medicare and Medicaid Services (CMS) administers Medicaid nationwide, provides funding, approves state plans, and ensures compliance with federal regulations. In Minnesota, the Department of Human Services oversees the Medicaid (Medical Assistance) program, administered locally by counties.
MEDICAID HOME AND COMMUNITY-BASED SERVICE (HCBS) is a program that pays for support services so people can live in the community. Minnesotans with disabilities or chronic illnesses who need certain levels of care may qualify for the state’s home and community-based service (HCBS), known as “waivered services.” HCBS waivers allow states the flexibility to develop and implement creative alternatives to placing Medicaid-eligible individuals in hospitals, nursing facilities, or Intermediate Care Facilities for Persons with Developmental Disabilities (ICF/DD).
Home and community-based service waivers also allow states to combine different service options that are not available under regular Medical Assistance. These service options are available to consumers in addition to services covered by Medical Assistance. Because each of the waiver programs was written to meet federal guidelines, each program includes eligibility requirements specific to the type of disability, funding parameters and limits, and separate county or state policies. Waiver funds cannot be used to pay for or supplement room and board costs, but they can be used to pay for additional supports so an individual can live in the community.
Home and community-based waiver programs available to people who meet the eligibility criteria include:
- Developmental Disabilities (DD) Waiver for people with developmental disabilities or a related condition who need the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD).
- Community Alternative Care (CAC) Waiver for chronically ill and medically fragile persons who need the level of care provided in a hospital.
- Community Access for Disability Inclusion Waiver for persons with disabilities who require the level of care provided in a nursing facility.
- Brain Injury (BI) Waiver for persons with acquired or traumatic brain injuries who need the level of care provided in a nursing facility that provides specialized cognitive and behavioral supports services for persons with brain injury or neurobehavioral hospital level of care.
Because each waiver program was written to meet federal guidelines, each program includes eligibility requirements specific to the type of disability, funding parameters and limits, and separate county and/or state policies. For more information on these waivers and supports, contact your county social worker or refer to the Minnesota Department of Human Services website.
CONSUMER DIRECTED COMMUNITY SUPPORTS is a unique service option that gives people more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff. CDCS may include services, support, or items currently available through the Medical Assistance waivers, as well as additional allowable services that provide needed support. CDCS is a service option under several Home and Community-Based programs. CDCS is available as a statewide service for people enrolled in one of these waivered programs: Developmental Disabilities (DD) Waiver, Community Alternative Care (CAC) Waiver, Community Access for Disability Inclusion (CADI) Waiver, or Brain Injury (BI) Waiver.
PERSONAL CARE ASSISTANCE (PCA) provides services to people who need help with day-to-day activities to allow them more independence in their own homes. A PCA is an individual trained to help people with activities of daily living if they have a physical, emotional, or mental disability, a chronic illness, or an injury. PCA service is available to people able to direct their own care.
COMMUNITY FIRST SERVICES AND SUPPORTS (CFSS) has been in the planning stages for several years. It allows for a higher federal match of dollars for the state home care budget for services. In the future, the PCA Choice and Consumer Support Grant will evolve into CFSS. Parent or spouse pay is an option, as well as being able to purchase services that decrease human assistance (for example, building a ramp so a person with a physical disability does not need to be carried or using assistive/monitoring technology to enable a person to complete tasks more independently without the use of staff). Financial Management Support providers were rolled out October 15, 2018. An anticipated date of July 2021 has been set for implementation.
SUPPLEMENTAL SECURITY INCOME (SSI) is a social entitlement program, based on financial need, that provides monthly payments to children and adults who have disabilities, low income, and limited resources.
SOCIAL SECURITY DISABILITY INSURANCE (SSDI) is a social insurance program that workers and employers pay for with their Social Security taxes. Eligibility for these disability benefits is based on work history, and the amount of benefit is based on an individual’s earnings.
HOUSING SUPPORT (formerly known as Group Residential Housing - GRH) is a state-funded program that pays for room and board costs for adults with low incomes who have a disability or are age 65 or older. Recipients live in a licensed facility or an authorized community-based setting, such as their own home. The program aims to reduce and prevent institutional residence or homelessness.
MINNESOTA SUPPLEMENTAL AID (MSA) provides cash assistance to help adults who get Supplemental Security Income (SSI) pay for their basic needs. Some people who are blind, have a disability or are older than 65 but do not get SSI because their other income is too high may be eligible for MSA if they meet the income limit.
People who get MSA are also eligible for help with medical, food and housing costs through Medical Assistance (MA), the Supplemental Nutrition Assistance Program (SNAP) and MSA Housing Assistance programs.
MINNESOTA SUPPLEMENTAL AID (MSA) HOUSING ASSISTANCE helps people with disabilities who pay more than 40 percent of their income toward housing costs so that they have a choice about where they live. It is an additional cash supplement to qualifying recipients under 65 years of age who are relocating into the community from an institution or intensive residential treatment services. It allows recipients to hire, fire, supervise, and manage their PCA or gives a parent or legal guardian the authority to do so. Individuals must be living in their own home or apartment and getting services through a Home and Community-Based Waiver.
GENERAL ASSISTANCE (GA) is a state program that provides payment to individuals with no income and minimal assets. GA is determined at the county level, pending eligibility for SSI.
HOUSING ACCESS COORDINATION (HAC) is a service covered by the waiver that allows an authorized consultant to provide assistance in a wide variety of areas, such as locating and finding housing, obtaining financing, and constructing a home. For more information on these waivers and supports, contact your county social worker or refer to the DHS website section on Waiver Services.
Funding for Mental Health
The Minnesota Department of Human Services (DHS) Mental Health Division works to ensure that programs and services are available throughout Minnesota. People may need assistance in a variety of areas, such as employment, housing, social connections, family relations and other co-occurring conditions. The state does not provide direct services to people with mental health needs. However, DHS Mental Health does provide state and federal funding for mental health treatment.
In Minnesota, counties are responsible for providing publicly- funded mental health services with federal, state, and county funding. In many parts of the state, counties contract with providers to deliver mental health services. A person who qualifies under the Severe and Persistent Mental Illness (SPMI) label (Rule 79) qualifies for supports and services similar to the supports and services an individual would receive if he or she were qualified under the developmental disabilities category.
State-operated services include community-based programs serving people with mental illness, developmental disabilities (dual diagnosis), chemical dependency, and traumatic brain injury. State-operated services include community-based programs serving people with mental illness, developmental disabilities (dual diagnosis), chemical dependency, and traumatic brain injury. Intensive Residential Treatment Services (IRTS) are time-limited mental health services provided in a residential setting to recipients in need of more restrictive settings (versus community settings) and at risk of significant functional deterioration if they do not receive these services. IRTS are designed to develop and enhance psychiatric stability, personal and emotional adjustment, self- sufficiency, and skills to live in a more independent setting.
Medical Assistance and Rehabilitation
The Minnesota Legislature expanded adult mental health services to qualify for federal Medicaid dollars under what is called the Rehab Option for individuals who do not qualify under the Severe and Persistent Mental Illness category. To qualify for services, your son or daughter will need to have a county case manager.
Your county typically contracts with outside agencies to provide a wide array of medical and remedial services, including basic living and social skills, community intervention, medication education, transition to community living and crisis response services. These restorative, recovery-oriented services are provided to help people with mental illness become as self-sufficient as possible. Non- residential based services include: Assertive Community Treatment (ACT), Dialectical Behavior Therapy (DBT), Adult Rehabilitative Mental Health Services (ARMHS) and crisis response services.
Subsidized Housing and the Section 8 Program
Subsidized Housing is a federal rental assistance housing program; the government pays a percentage of the rent for people with low and moderate incomes. The percentage is based on income limits established by the government and varies with different programs. The most commonly available type of subsidized housing is the Section 8 program.
Two kinds of assistance are provided: Project-based and tenant- based. Project-based assistance is designated Section 8 buildings that are primarily privately owned but have been built with federal funds. A list of these buildings is available through your local public housing agency. Tenant-based assistance is provided through “vouchers” or “certificates.” Some apartments and houses in various communities may accept Section 8 vouchers or certificates, which are funded by the U.S. Department of Housing and Urban Development (HUD). With Section 8 certificates or vouchers, a recipient generally pays one-third of his or her income for rent. These certificates and vouchers are portable, meaning an individual can use them in any community in any state.
Virtually all people with disabilities receiving SSI benefits are eligible because their incomes are well below 50 percent of median income. People are eligible if they meet HUD’s definition of “household,” which includes one or more adults with disabilities, as well as elderly and family households. There is often a shortage of housing, and it is common for new applicants to be placed on waiting lists. More important, housing authorities may only take applications at announced times.
Public Housing Agencies (PHAS)
The Section 8 program is governed by federal law and regulations. Additional Section 8 policies are determined by state and local Public Housing Agencies (PHAs) that receive funding from U.S. Department of Housing and Urban Development (HUD) to administer the program. There are an average of more than 50 PHAs per state, which can make Section 8 difficult to understand. There are three types of PHAs. The most common and well-known are the local public housing authorities. The others are state housing agencies and nonprofit organizations.
Vouchers and Certificates
Mainstream vouchers are set aside specifically for people with disabilities. Families apply to the local Public Housing Agency (PHA) that administers this program. When an eligible family comes to the top of the waiting list, the PHA issues a housing choice voucher to the family.
Certificates from the Bridges Program provide a rental subsidy for people with serious and persistent mental illness who are eligible, or can become eligible, to receive a Section 8 Housing Choice Voucher. Their eligibility is based on successful participation in the Bridges Rental Assistance Program and whether they are currently on Section 8 waiting lists.
The Section 811 Supportive Housing for Persons with Disabilities program provides capital funds to acquire, rehabilitate, or construct new housing, as well as rental subsidies to operate housing for low-income households with disabilities. Subsidies for Section 811 are tenant based. Applications approved by HUD for funding must include a supportive services plan designed to meet the needs of people with disabilities. The application process can be complicated and extremely competitive.
On Jan. 4, 2011, President Obama signed the Frank Melville Supportive Housing Investment Act of 2010 into law. This ground- breaking legislation will reinvigorate and modernize the Section 811 Supportive Housing for Persons with Disabilities program. By leveraging other sources of capital funding, such as federal Low- Income Housing Tax Credits, the reformed Section 811 program will now develop thousands more units of supportive housing every year and for the first time create integrated supportive housing units within affordable housing properties.
On March 2, 2015, the U.S. Department of Housing and Urban Development (HUD) announced the award of $150 million in Section 811 Project Rental Assistance (PRA) funds to 24 states, plus the District of Columbia. The Section 811 PRA program assists state housing agencies to expand the supply of integrated permanent supportive housing opportunities consistent with the Supreme Court’s Olmstead decision, the Americans with Disabilities Act (ADA), and best practice models, while leveraging mainstream affordable housing, Medicaid, and other community- based supportive service resources for people with the most significant and long term disabilities.