Inclusive Housing Coalition Housing and Support Goals

In Colorado, approximately 127,000 persons with autism and intellectual and

developmental disabilities (A/I/DD) have requested services and many more are

uncounted. Housing continues to be a top concern for this population and their families.

Several existing barriers and issues press on the systems meant to assist these people and could force individuals with A/I/DD to live in overly restrictive settings,

institutionalization or even homelessness. Like many seniors, individuals with A/I/DD

should have the opportunity to live in settings that may provide daily support and

engagement in activities.

The following identifies issues to be addressed in the coming years:

Shortage of Affordable Housing that is Cognitively Accessible:

People with A/I/DD can and desire to live independently in a variety of settings and there is a continuum of supportive needs. However, finding these appropriate settings is challenging and made more so by the ongoing issue of housing unaffordability in Colorado. According to studies, Colorado faces a shortfall of approximately 100,000 units and record numbers of lower income Coloradans are housing cost-burdened, meaning that more than 30% of income is needed for housing costs. Many individuals with A/I/DD struggle to find an affordable setting that provides support for their needs.

Suggested Actions:

Introduction of new financing resources including a potential state housing tax credit for affordable housing that includes A/I/DD units and programming.

Include A/I/DD in the implementation of recently passed legislation such as SB24-174 regarding housing assessments and action plans and HR24-1360 concerning the Colorado Disability Opportunity Office.

Aging Parent Caregivers:

More than 72% individuals with A/I/DD live with family and more than 20,000 currently live with parents or caregivers over the age of 60 potentially causing a “cliff” situation of people without an appropriate residential setting. And caregivers are deeply concerned that there may not be appropriate care for their loved ones once they are no longer able to continue to provide care.

Suggested Actions:

Prioritization of housing vouchers for individuals in danger of homelessness or institutionalization due to living with an aging caregiver.

Implementation of a process to ensure that individuals living with aging caregivers have a supportive housing option available through creation of new housing.

Waitlists for Medicaid Waivers:

For individuals who do locate an affordable and accessible setting, many still require in-home Long Term Support Services to help with various needs through the Home and Community Based Developmental Disability waiver. Waitlists for the waiver remains extensive with a timeframe of six months for approximately 3,338 individuals.

Suggested Actions:

Develop a strategy to end the waitlist for the HCBS-DD waiver. It is the only waiver with a waitlist and the only one that provides 24/7 access to support for people with A/I/DD. It is a barrier to supportive housing efforts, but not a solution in itself.

Identify ways to enhance the waiver process. Remove remaining silos between waiver funding sources and make the full range of Medicaid waiver services available under a small number of waiver programs from which people can prioritize and customize their personal package of support, including a possible avenue for supportive housing.

Consider inconsistencies with individual-preferred settings that might be strictly defined as segregated and conflict with settings rules.

Reimbursement Rates for Service Providers:

Behavioral related services, personal care, and supported employment can be critical to an individual with A/I/DD living independently in the community. Nearly all service providers rely on Medicaid reimbursement to cover costs. According to a recent Alliance Colorado survey of member service providers, the average hourly cost to provide services is $31.76. Despite some recent increases, Medicaid reimbursement rates still fall well below the average cost to provide services. Also, the current reimbursement structure makes hiring and retaining staff difficult in a competitive labor market.

Suggested Actions:

We support Alliance Colorado’s recommendations to the Medicaid Provider Rate

Review Advisory Committee (MPRRAC) that certain services that fall below 100% of the benchmark established by MPRRAC should be increased to 100% of the benchmark.

Disappearing Housing and Services for Persons with Higher Needs:

The above-described reimbursement rate insufficiency is causing service providers to be unable to serve higher-need individuals in 24-hour staffed settings such as Personal Care Alternative and Group Home residences, which play an important role in allowing adults with I/DD to be part of a community. In 2023, 12 group homes closed as a result of an inability to fund services. As of December 2023, there were 85 licensed group homes in Colorado serving 537 people. This includes the homes operated by the state.

Suggested Action:

In addition to the Alliance Colorado recommendations to the MPRRAC to increase Group Residential Services and Supports rates for support levels 1-6 by at least 10%, we suggest considering flexibility for housing vouchers for individuals who lose group home settings due to closure.

Availability and Flexibility of Housing Vouchers

State and locally administered Housing Voucher programs serve as a critical source of rental support for many low-income individuals. Individuals with A/I/DD, service providers and housing providers have found that the system for allocation of vouchers is not always well suited to meet the needs of the population, is difficult to navigate, particularly for individuals with cognitive disabilities, and often does not provide a needed level of flexibility.

Suggested Actions:

Consider creating a position at no acronym as it is the first mention that helps individuals navigate housing issues such as vouchers and other requirements that come with accessing affordable housing.

Allocation of vouchers should include individuals with A/I/DD who are at a high risk of becoming homeless or institutionalized, including those living with a parent or caregiver over the age of 60. Implementation of a statewide housing navigation system for individuals with A/I/DD and/or their caregivers.