Evaluation of the Minnesota Supportive Housing and Managed Care Pilot

The Minnesota Supportive Housing and Managed Care Pilot evaluation suggests that it is possible to end homelessness for the most marginalized single adults and families in America with housing and intensive supports. Although this population has experienced long spells of homelessness exacerbated by physical health problems, mental illness, chemical dependency and traumatic stress, this evaluation found that stable housing, recovery and reintegration into community life are possible. The intervention of supportive housing—housing and services focused on the unique needs of people exiting homelessness—broke the cycle of homelessness.

Pilot Program Details

• The program engaged participants with highly complex needs, averaging five years of homelessness prior to enrollment. Participants’ homelessness was exacerbated by medical problems, mental illness, chemical dependency, traumatic experiences, and for some, children with special needs.
• Working successfully with this population required patience, persistence, flexibility, and a deep respect for program participants. The Pilot created an intensive service model featuring low caseloads (fewer than 10 households per staff member) and a range of in-house, specialty service providers, including housing specialists, nurses, and child development workers.
• Pilot participants experienced significant increases in housing stability, and smaller improvements in other outcomes over the 18 months covered in the study. After 18 months, participants had significantly improved residential stability, experienced fewer mental health symptoms, and use of alcohol and/or drugs declined as well.
• The Pilot had a small impact on the overall level of mainstream service costs for participants, relative to the comparison group, and caused desirable shifts in the types of mainstream services used. While costs for single adults increased relative to the comparison group, adults in families saw cost offsets, and children were nearly cost neutral.

Generally, the results suggest a desirable move away from costly and disruptive institutional services and toward necessary, routine health care that improves quality of life. For adults in families, cost offsets were driven primarily by a reduction in inpatient medical care. Increases in outpatient mental health utilization were also seen for adults in families. For children, the largest change in costs was an increase in outpatient medical utilization.