Federal, State, and Local Collaboration between Housing and Health
A new Abt study suggests a collaborative housing program spanning two federal agencies and state and community stakeholders might have a substantive, positive long-term impact on a population with many unmet healthcare needs. In March 2020, the results of our evaluation of the Section 811 Project Rental Assistance (PRA) Program was released.
The PRA provides rental housing assistance with coordinated access to home and community based services (HCBS) to non-elderly people with disabilities. The program is a joint initiative between the U.S. Department of Housing and Urban Development (HUD) and the Centers for Medicare & Medicaid Services, and requires collaboration between state housing and health agencies, community-based services providers, and private owners of HUD-assisted housing. PRA offers community-based, integrated housing where people with and without disabilities live, and serves people who have extremely low incomes and high health care needs . Participating state agencies prioritized their PRA funds to support those who might otherwise be unnecessarily institutionalized or homeless.
Abt assessed the effectiveness, outcomes, and costs of the PRA model compared to other HUD rental assistance programs that assist people with disabilities, and compared to individuals receiving Medicaid but not receiving HUD assistance.
Overall, the study found that those receiving any HUD assistance fared better than Medicaid recipients without housing assistance. In addition, the study found:
- PRA assists people who are different from those with disabilities in HUD’s other housing assistance programs. PRA residents have lower incomes, have more chronic and disabling conditions, and are more likely to have had long-term stays in inpatient settings prior to receiving housing assistance.
- PRA residents live in more urban neighborhoods than the comparison groups. PRA units have greater access to public transportation and are in neighborhoods with greater walkability and amenities, but PRA residents report feeling less safe in their properties and neighborhoods.
- PRA delivered rental assistance at a similar or lower cost than other HUD programs for similar populations, but administrative costs are higher.
- After receiving assistance, PRA residents had lower rates of long-term inpatient care than the comparison group of individuals not assisted by HUD, but had higher usage of in-home case management services. These findings suggest lower overall healthcare costs if these trends continue.
Our report recommends that future evaluations of the Section 811 PRA program look at longer-term outcomes to assess the PRA’s benefits over time and for a larger number of program participants.