Grant Opportunity: Staff and Agency Enhancement for Home Stabilization and Associated Medicaid Services

Overview of Need

Staff recruitment and retention has been cited as a challenge across industries in recent months, especially in the direct service industry. Specifically, staff shortages in the homeless service provider and healthcare industries have been identified as a critical need. Upfront costs associated with recruiting staff and sustaining positions long term have been cited as areas where additional resources and strategies are needed.  

The number of individuals experiencing homelessness in Rhode Island has increased 15% from the 2022 point in time count. The largest increase was within Persons Unsheltered and in Emergency Shelter. The 2023 point in time count conducted by the Rhode Island Coalition to End Homelessness revealed 1,810 persons experiencing homelessness, compared to the 2022 count of 1,576 persons. The growing number of persons experiencing homelessness in Rhode Island must be addressed using a multitude of strategies, one of which is addressing inadequate staffing within organizations that serve persons experiencing homelessness as part of their mission.  

Recruitment and retention of skilled staff members directly serving persons experiencing homelessness will be addressed in part by this grant opportunity along with strategies aimed at sustaining these positions long term. Unlike the homeless service provider recruitment and retention grant opportunity launched by EOHHS in May 2023, this opportunity aims for a broader reach.  

Grant Opportunity

This opportunity seeks to focus on workforce recruitment, retention, and sustainability through increasing organizational readiness to bill for specific Medicaid services aimed at assisting individuals who are experiencing homelessness.  The overarching goal of this opportunity is to strengthen and sustain workforce capacity in these areas through enhancing provider recruitment and retention efforts and improving electronic health records and technology systems and infrastructure for Medicaid reimbursement. Through this opportunity, EOHHS intends to supplement funding to grow the workforce, specifically focusing on Rhode Island’s home stabilization service providers, community health workers, peer recovery specialists, and clinical providers who deliver medical, behavioral health, and social services in community-based settings such as shelters, encampments, and related venues.  

Applicants for this opportunity must agree to work towards establishing and/or strengthening their partnerships with the State’s Medicaid system. To maximize the integration of healthcare and housing as a social determinant of health, the applicant must strive to sustain at least a portion of their services through Medicaid billing and partnership.  Applicants may wish to review the current details for home stabilization services and the proposed changes in the 1115 waiver proposal to Medicaid pg. 37. 

 
Eligible Activities 

Acknowledging the start-up costs and technical assistance that may be required to fully develop a sophisticated system for Medicaid billing and reimbursement of services targeted to support people experiencing homelessness, EOHHS is issuing this grant opportunity. The opportunity is open to certified home stabilization services (HSS) providers who are not yet billing for all specified services at the time of application. Organizations that are interested in applying and not yet certified as a home stabilization services provider, must become a certified HSS provider by the application deadline, which is projected to be November 10, 2023. This opportunity is intended to support infrastructure development and technology solutions for enhancing EHR systems and recruiting and retaining staff needed to deliver and bill for home stabilization and associated services. Initial funds will be awarded for infrastructure development and planning followed by a phase two award provided when agencies meet certain deliverables including becoming and maintaining certification as a home stabilization provider and billing for home stabilization, community health worker, peer recovery specialist or clinical and/or behavioral health services delivered in a community-based setting. Applicants should be capable of submitting claims to Medicaid for specified services by August 2024 to be eligible for Phase 2 Award.  

The activities conducted from the grant offering are intended to improve staff capacity and agency competency and readiness to deliver home stabilization and related services and establish sustainable billing systems through Medicaid to sustain workforce positions and service delivery longer term. EOHHS has identified three areas in which potential grantees can request funds for Phase 1 Awards: 

• Part or Full-time Consultant who may assess organizational capacity and readiness to bill State Medicaid for Home Stabilization Services, Community Health Worker services, Peer Recovery Specialist services, and Behavioral and Medical Health Services in community- based settings. 

• IT Solutions and Electronic Health Record System for startup costs associated with investigation and establishment of technology needed for record keeping and billing of Medicaid claims. 

• Professional Development via a marketable professional development program for applicable staff. Professional development opportunities should increase the agency’s competency to leverage and bill state Medicaid via individualized training and certification or training and development for agency-wide knowledge and capacity enhancement. 

If awarded applicant meets the requirements under Phase 1 and can demonstrate Phase 1 of the award has been utilized and spent, awardees will be eligible to apply for Phase 2 of the award. Awardees should decide what categories they will request additional funds for in Phase 2. All Phase 1 categories are eligible for Phase 2, plus two additional categories: 

• Retention Bonuses can be based on seniority, performance, equally distributed, or combinations of some or all three of these categories. Retention bonuses can be distributed to direct service workers such as those providing home stabilization services, certified community health workers, or peer recovery specialist or employees responsible for billing Medicaid for delivered services.  

• Recruitment Bonuses to be dispersed after the new employee successfully completes the organization’s probationary period. 

Funding Requirements

• Applicants must be a currently certified home stabilization services provider or become a certified home stabilization provider by the application deadline: November 10, 2023. 

• Applicants billing for all services in the last 3 months (see award terms and conditions) at the time of application are not eligible to apply for this grant. 

• All projects should describe how their efforts align with establishing and sustaining direct service workforce that will support individuals experiencing homelessness or are risk of homelessness. Applicants should indicate if and how they plan to sustain grant activities implemented under this award period. 

• Should the applicant apply for multiple subcategories, they should reference if and how the grants would impact each other in their description and abide by the caps within each subcategory. 

• Grantees will commit to providing updates on grant activity progress during monthly scheduled meetings with the EOHHS Home Stabilization Services Program Director. 

• Grantees will participate actively in a one-time learning collaborative with all Home Stabilization Recruitment and Retention Grant awardees hosted by EOHHS. 

• Phase 1 awards must be spent by August 2024 unless otherwise extended by the State; Phase 2 awards must be spent by March 2025. Ultimately, funding is subject to deadlines imposed by federal entities. 

• All applicants must register with the Ocean State Procures system in order to receive a standard purchase order and any approved funds. Osp Vendor Registration | Rhode Island Division of Purchases (ri.gov). 

 
Award Terms and Conditions

Phase 1 of the grant period will run from approximately 12/1/2023 until 8/1/2024. The complete Phase 1 award will be awarded in part by upfront delivery of funds and reimbursement based according to submission of receipts and actual expenditures. Applicants will become eligible to apply for Phase 2 of funding after establishing infrastructure for Medicaid billing, remaining in good standing as a certified home stabilization provider, and submitting at least one claim for at least one of the following services during the period of the awarded funding: 

1. Home stabilization services (HOO44) 

2. Community health worker (T1016)  

3. Peer recovery specialist  (HOO38) 

4. Medical or behavioral health service delivered in a community-based setting 

Eligible community-based setting locations include:  

• Homeless Shelter: A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). 

• Home: Location, other than a hospital or other facility, where the patient receives care in a private residence. 

• Assisted Living: Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. 

• Group Home: A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration). 

• Temporary Lodging: A short term accommodation such as a hotel, campground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. 

• Outreach Site/Street: A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individual (e.g., street outreach, encampment, senior center). 

• Mobile Unit: A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. 

More information on places of services can be found here: Place of Service Code Set | CMS:  

Funding for Phase 2 is dependent on the performance of the grantee and is not guaranteed. If the Phase 1 awardees meet the requirements of phase 1, they will be invited to apply for Phase 2 funds in approximately July- August 2024. If a grantee is funded for both phases, the grant period will be funded through March 2025. 

Evaluation Requirements

By submitting an application for the award, applicants acknowledge and agree that specified evaluation metrics will be collected by EOHHS for reasons of program evaluation. The grantee will submit the following information to EOHHS quarterly beginning 3 months after receipt of award funds by completing the reporting template provided by EOHHS. Awardees will report on the following activities for which the awarded funds are used in alignment with the funding period: 

• Current staffing prior to award 

• New staff hired (part-time/full-time) 

• Staff vacancies 

• Staff departures 

• Trainings and professional development attended, and certification supported with award funds 

• Number and type of consultant that was leveraged to improve Medicaid billing infrastructure. 

• Type of Electronic Health System implemented or enhanced to improve Medicaid billing and or client record keeping. 

• Number of unique clients who received a billable service during the grant period for: 

  • Home stabilization (as applicable) 

    • Community Health Worker service (as applicable)

    • Peer Recovery Specialist Service (as applicable) 

    • Clinical or Behavioral Health Service delivered in a community-based setting (as applicable) 

• Retention Bonuses (given directly to employees and why/ how – such as time based/performance based, across the board, etc. Please outline the structure of any retention bonuses). (phase 2 only) 

• Recruitment Bonuses (given directly to employees and why/ how – such as time based/performance based, across the board, etc. Please outline the structure of any recruitment bonuses). (phase 2 only) 

Ineligible Experiences

Grant funding may not be used for rent, room/board of any kind, and cannot go directly to activities intended for any purpose other than those described and approved in the scope of work. Phase 1 awards should be spent by August 2024 and any awarded Phase 2 funds must be spent by March 2025 unless the funded period is extended by the State. These award funds are delegated by a federal source that ultimately dictates the timeline of allowable spending. 

Application Information

Agencies should determine which sub-categories of support are the best match for your organization’s existing capacities and areas of opportunity. Applicants may request funds within multiple subcategories.  

To apply for this opportunity, please submit the webform application on the EOHHS website.  Applications will be accepted on a rolling basis between now and November 10, 2023.  

Note that scope and activities are subject to change pending Centers for Medicare and Medicaid Services (CMS) approvals. If you have any questions regarding the application or requested information please reach out to: 

• Rob Ethier Robert.Ethier.CTR@ohhs.ri.gov 

• Victoria Novotny Victoria.Novotny.CTR@ohhs.ri.gov    

Scoring and Award Criteria

Awards will be issued based upon the availability funds and a passing score which is 65 points or over. Awards will be granted based on applicants’ request and the organization’s ability to serve individuals experiencing homelessness. The total award will also depend on the total number of applicants. If funding requests exceed the available funding allotment, awards will be issued based on the highest scoring applicants. No total award will exceed $200,000. 

• Staff Qualifications and Experience 

  • Experienced staff on board at the organization [10] 

  • Experience and successful track record working with target populations including individuals experiencing homelessness and housing insecurity [10] 

  • Experience and successful track record engaging diverse populations, including a focus on underserved communities and non-English speaking populations and others in the community who currently experience disparities in health outcomes related to their housing status [10] 

• Capability, Capacity, Cost Reasonableness  

  • Existing partnerships with local organizations that serve people experiencing homelessness (such as landlords and other housing entities, harm reduction organizations and medical /behavioral health providers etc) [20] 

  • Demonstrated commitment to carrying out equity promotion and/or disparity elimination activities, work to address Social Determinants of Health, and a commitment to person-centered and culturally responsive approaches to homelessness services. [10] 

  • Submitted budget is clear, concise, transparent and includes cost description and justification [10] 

• Readiness 

  • Organizational commitment to delivery of services including:[10] 

    • Home stabilization  

    • Community health worker services 

    • Peer Recovery Specialist services  

    • Medical or Behavioral Health Service delivered in a community-based setting: 

    • Community Based Setting Locations: 

      • Homeless Shelter 

      • Home 

      • Assisted Living 

      • Group Home 

      • Temporary lodging  

      • Outreach site/ street outreach 

      • Mobile Unit 

  • Applicant has relevant experience with the aforementioned services and/or Medicaid Billing for services intended to serve people experiencing homelessness in Rhode Island. Applicant has an established record keeping system or plan to implement such a system for the purposes of tracking service delivery and billing Medicaid.[10] 

• Work Plan 

  • A clear, organized, and well-structured workplan for Phase 1 activities. Milestones are clearly defined with associated tasks and timeline.[10] 

• Bonus Points  

  • Applicant’s Governance is comprised of more than 50% of the ethnicity, race, gender, and sexual orientation of the population it serves, or the applicant is registered as a minority-owned or woman-owned business in the State of Rhode Island. [6]