SAMHSA Grant: Enhancing Infrastructure for Homeless Individuals – CABHI-States

2. Delivery of behavioral health, housing support, peer, and other recovery-oriented services.

3. Assist the state Medicaid eligibility agency in developing a streamlined application process for the population of focus and assist providers (e.g., alcohol and drug treatment facilities, homeless service providers) seeking to become qualified Medicaid providers; engage and enroll eligible persons constituting the population of focus in Medicaid and other mainstream benefit programs (e.g., SSI/SSDI, TANF, SNAP).
Grant funds may not be used when individuals have access to other resources that cover the same services (e.g., HUD-Veterans Affairs Supportive Housing [VASH]). Grantees must use SAMHSA funds in a way that is complementary to Medicaid, HUD, VA and other benefits.
In 2010, the U.S. Interagency Council on Homelessness (USICH) approved Opening Doors, a Federal Strategic Plan to Prevent and End Homelessness. One of the goals of this Strategic Plan is to achieve the goal of ending homelessness for veterans and chronic homelessness in general by 2015. SAMHSA is committed in the effort to achieve this and other goals in the Federal Strategic Plan. This program prioritizes veterans who experience homelessness or chronic homelessness and other individuals (non-veterans) who experience chronic homelessness with serious mental illness, substance use disorders or co-occurring substance use and mental disorders.
On a single night in January 2013, there were an estimated 610,042 sheltered and unsheltered people who are homeless nationwide. Of those, approximately 109,132 were experiencing chronic homelessness and approximately 57,849 were identified as veterans experiencing homelessness.
Persons experiencing homelessness have higher rates of substance use and problems with mental health, physical health, legal, and employment issues than those with permanent housing. Although the relationship between housing status and clinical treatment outcomes is a complex one, some studies suggest that associations exist between stable housing, lower utilization of hospital services, and more positive treatment outcomes among certain populations. Permanent housing that is offered following or concurrent with recovery oriented and treatment focused integrated care models can result in improved clinical outcomes.
The linkage between stable permanent housing and behavioral health services is critical for recovery. For many in recovery from substance use disorders, drug-free housing can assist with achieving long-term recovery. Such “recovery housing” can be provided through a variety of models ranging from peer-run, self-supported, drug-free homes to community-based housing that includes a range of supportive services.
SAMHSA has demonstrated that behavioral health is essential to health, prevention works, treatment is effective, and people recover from mental, substance use, and co-occurring mental and substance use disorders. To continue to improve the delivery and financing of prevention, treatment and recovery support services, SAMHSA has identified eight Strategic Initiatives to focus the Agency’s work on people and emerging opportunities. More information is available at the SAMHSA Web site: http://beta.samhsa.gov/about-us/strategic-initiatives. This program specifically aligns with SAMHSA’s Recovery Support Strategic Initiative and addresses, the expected impact on behavioral health disparitites. See Appendix I: Addressing Behavioral Health Disparities).

CABHI-States is one of SAMHSA’s services grant programs. SAMHSA intends that its services grants result in the delivery of services as soon as possible after award. Service delivery should begin by the 4th month of the project at the latest.
CABHI-States grants are authorized under Sections 509 and 520A of the Public Health Service Act, as amended. This jointly funded program will allow enrollment of individuals with substance use disorders or serious mental illnesses and/or co-occurring substance use and mental disorders. This announcement addresses Healthy People 2020 Mental Health and Mental Disorders Topic Area HP 2020-MHMD and Substance Abuse Topic Area HP 2020-SA.
Definitions
For the purposes of this RFA, the term “behavioral health” refers to a state of mental/emotional health and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicidal ideation, and mental and substance use disorders. The term is also used to describe the service systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders and related problems, treatments and services for mental and substance use disorders, and recovery support.
“Mental and substance use disorders” are referred to throughout this document. This phrase is meant to be inclusive of mental disorders, serious mental illnesses, substance use disorders, and co-occurring substance use and mental disorders.
“Permanent Housing (PH)” means community-based housing without a designated length of stay (e.g., no limit on the length of stay). The phrase “permanent housing that supports recovery” refers to housing that is considered permanent (rather than temporary or short-term) and offers tenants a range of supportive services aimed at promoting recovery from mental and/or substance use disorders. There should not be any arbitrary limits for the length of stay for the tenant as long as the tenant complies with the lease requirements (consistent with local landlord-tenant law).
“Homeless” as characterized under the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009, and defined by the December 5, 2011, Final Rule Defining Homeless (76 FR 75994), establishes four categories of homelessness. These categories are: (1) Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution; (2) Individuals and families who will imminently lose their primary nighttime residence; (3) Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or (4) Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.
In addition, for the purposes of this RFA, the term “Homeless” also includes “doubled-up” – a residential status that places individuals at imminent risk for becoming homeless – defined as sharing another person’s dwelling on a temporary basis where continued tenancy is contingent upon the hospitality of the primary leaseholder or owner and can be rescinded at any time without notice.
“Chronic homelessness” as characterized under the McKinney-Vento Homeless Assistance Act, as amended by S. 896 of the “Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 means, with respect to an individual or family, that the individual or family— (i) is homeless and lives or resides in a place not meant for human habitation, a safe haven, or in an emergency shelter; (ii) has been homeless and living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter continuously for at least 1 year or on at least 4 separate occasions in the last 3 years; and (iii) has an adult head of household (or a minor head of household if no adult is present in the household) with a diagnosable substance use disorder, serious mental illness, developmental disability, post traumatic stress disorder, cognitive impairments resulting from a brain injury, or chronic physical illness or disability, including the co-occurrence of 2 or more of those conditions.” In addition, a person who currently lives or resides in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital or other similar facility, and has resided there for fewer than 90 days shall be considered chronically homeless if such person met all of the requirements described above prior to entering that facility.