Using Medicaid to Fund and Shape Tenancy Support Services: Key Considerations From Research in North Carolina and Louisiana

Figures & data

Table 1. North Carolina service provider agencies for the comparative case study.

TSS provider	Target populations	Geographic service area	Primary government funder
Homeward Bound of Western NC	People experiencing homelessness	Primarily urban setting with rural communities in outlying areas of the county	Department of Housing and Urban Development
UNC Center for Excellence in Community Mental Health	People with severe and persistent mental health and/or substance use disorders, including those exiting institutional settings	Mix of urban and rural settings including one of the largest cities in the state and outlying rural counties	NC Medicaid

Note. TSS = Tenancy Support Services; UNC = University of North Carolina.

Table 2. State contexts.

State	State funding for TSS	Target populations
North Carolina	At the time of study, the state of North Carolina funded TSS through: The addition of TSS to Medicaid ACTT service definitions State funding for auxiliary services	TSS provided for households where the head of household is identified as eligible for the Transitions to Community Living Initiative, to include people exiting institutional settings or diverted from institutional settings with severe and persistent mental illness.
Louisiana	At the time of study, the state of Louisiana funded TSS provision through: Medicaid 1915 (C) Home and Community-Based Services Waiver Medicaid State Plan Community Development Block Grant—Disaster Relief Funds Cooperative Agreement to Benefit Homeless Individuals (CABHI)	TSS provided for households where the head of household has a disabling condition including mental health and/or substance use disorders. The population includes people experiencing homelessness and exiting institutional care.

Note. TSS = Tenancy Support Services; ACTT = Assertive Community Treatment Teams.

Table 3. Interview and focus group respondents (n = 89).

Respondent type	Number	Includes	Data source
North Carolina
State health and housing	8	State officials involved in work that includes TSS	Group interviews, plus one individual interview (in person)
MCO housing specialists	10	Housing specialists employed by mental health MCOs	Focus groups (remote)
Agency leader, specialist, clinician
Homeward Bound	9	Administrative leaders (6), housing specialist (1), team leaders (2)	Individual interviews except team leads interviewed together (in person)
UNC CoE	11	Administrative leadership (5), clinicians (2), housing specialist (1), team leaders (2), peer support specialist (1)	Individual interviews (in person)
Case managers
Homeward Bound	10	Case managers from multiple programs	Focus groups (in person)
UNC CoE	9	Case managers from multiple programs	Focus groups (in person)
Client
Homeward Bound	13	Clients from multiple programs	Focus groups (in person)
UNC CoE	10	Clients from multiple programs	Focus groups (in person)
Landlord
Homeward Bound	3	Private (2) and organization-affiliated (1) landlords	Interviews (in person)
UNC CoE	1	Organization-affiliated landlord (1)	Interviews (in person)
Louisiana
State health and housing	3	State officials involved in work that includes TSS	Individual interviews (remote)
Agency leader	2	Agency administrative leadership	Individual interviews (remote)

Note. TSS = Tenancy Support Services; MCO = Managed Care Organization; UNC = University of North Carolina.

Figure 1. Definition of goals of service, threats to goals, and tensions between goals.

Figure 2. Four main elements of state infrastructure supporting effective tenancy support services.