Supportive Housing Insights: Bridging Health and Home with Simmone Ruff

In this episode of WAHNcast, Lakeysha Sowunmi, founding president of the San Diego Women's Affordable Housing Network, chats with Simmone Ruff, Director at CSH Housing Solutions in San Diego. Discover the vital role of supportive housing, from its deep affordability to its essential wraparound services, and how it differs from traditional affordable housing models. Learn how policies like Cal AIM and collaborations with healthcare systems are transforming the landscape, providing sustainable funding, and fostering community health through housing. Tune in for an insightful discussion on overcoming barriers, building partnerships, and driving impactful change in the affordable housing sector.

Episode Transcript

(00:01):
Welcome to WAHNcast, the official podcast of the Women's Affordable Housing Network.
This is our space to connect, get real, and talk about what's really happening in housing.
From bold leadership to resident stories that ground us in purpose.
We're here to amplify voices, strengthen each other, and share the kind of conversations you'd have with a friend who gets it.

(00:21):
Because when our voices are amplified, our communities grow stronger, and so do we. 6 00:00:28,159.932 --> 00:00:29,509.932 Good morning. 7 00:00:29,539.932 --> 00:00:37,399.932 My name is Lakeysha Sowunmi and I am the founding president of the San Diego Women's Affordable Housing Network. 8 00:00:37,729.932 --> 00:00:45,19.932 And today it is my pleasure to welcome a peer, a colleague, a friend, Ms. 9 00:00:45,19.932 --> 00:00:46,339.932 Simone Ruff. 10 00:00:46,339.932 --> 00:00:47,989.932 Welcome to this show, Simone. 11 00:00:48,529.932 --> 00:00:50,19.932 Oh, thanks so much for having me. 12 00:00:50,19.932 --> 00:00:50,329.932 Lakeysha. 13 00:00:50,349.932 --> 00:00:51,459.932 It's my pleasure to be here. 14 00:00:52,149.932 --> 00:00:58,539.932 I actually couldn't wait to just sit down and talk to you because there are so many things going on. 15 00:00:58,659.932 --> 00:01:08,159.932 You're well connected in this affordable housing industry and beyond, and I just love to sit down and listen to you speak about what's going on. 16 00:01:08,779.932 --> 00:01:17,809.932 What you foresee in the future for affordable housing and you are the permanent supportive housing extraordinaire, in my opinion. 17 00:01:18,199.932 --> 00:01:20,899.932 And so I'm so happy to be here with you. 18 00:01:20,959.932 --> 00:01:22,879.932 The day before the 4th of July. 19 00:01:23,389.932 --> 00:01:32,689.932 So just a little bit about Simone Ruff She is the director at Corporation for Supportive Housing here in San Diego. 20 00:01:33,119.932 --> 00:01:34,379.932 She has diverse. 21 00:01:34,699.932 --> 00:01:48,679.932 Experience in housing community and the services field with program expertise in evaluation, organizational development, and supportive housing for diverse populations. 22 00:01:49,374.932 --> 00:01:53,64.932 As the San Diego Program director, Ms. 23 00:01:53,64.932 --> 00:02:04,14.932 Ruff provides training, technical support and advisement to numerous supportive housing developers, providers, and public agencies. 24 00:02:04,584.932 --> 00:02:08,244.932 Prior to her relocation to San Diego, Ms. 25 00:02:08,244.932 --> 00:02:15,474.932 Ruff Worked at Neighborhood Link, senior Link, a multi-service agency in Toronto, Canada. 26 00:02:15,579.932 --> 00:02:16,839.932 In addition, Ms. 27 00:02:16,839.932 --> 00:02:19,779.932 Ruff was the community lead researcher. 28 00:02:20,509.932 --> 00:02:34,519.932 A University of Toronto, Ryerson University Initiative investigating the effectiveness of supportive housing, and she holds a master's degree from York University. 29 00:02:34,939.932 --> 00:02:36,889.932 Again, welcome to this show, Simone. 30 00:02:37,609.932 --> 00:02:44,659.932 Can you talk a little bit about the work that you currently do at CSH? Absolutely. 31 00:02:44,659.932 --> 00:02:44,869.932 Yeah. 32 00:02:44,869.932 --> 00:02:46,879.932 Thank, thanks so much for that warm welcome. 33 00:02:47,329.932 --> 00:02:53,389.932 So I just wanted to share a little bit about the history of CSH and and then also supportive housing at it at its heart. 34 00:02:53,969.932 --> 00:02:57,149.932 And so CSH was founded in 1991. 35 00:02:57,699.932 --> 00:03:03,459.932 And it really came about when our, social Entrepr social entrepreneur in New York. 36 00:03:03,919.932 --> 00:03:14,229.932 Julie Sandor was working with two Franciscan priests in New York City and they were putting together this model of, housing that was affordable with wraparound services. 37 00:03:14,809.932 --> 00:03:20,829.932 And that when you had services that really are client centered, that met people's needs folks. 38 00:03:22,354.932 --> 00:03:28,754.932 And so that was really at the very heart of the beginning of CSH back in 1991. 39 00:03:29,184.932 --> 00:03:35,604.932 And so with her leadership and vision she, founded CSH there was the Pew Charitable Trust. 40 00:03:35,604.932 --> 00:03:42,234.932 Robert Wood Johnson Foundation and Ford Foundation came together to to support the, this new organization. 41 00:03:42,654.932 --> 00:03:49,459.932 And, here we are more than 30 years later really helping communities to create quality supportive housing. 42 00:03:49,739.932 --> 00:03:54,574.932 A lot of the work that we do is focused on what does it mean to have quality supportive housing. 43 00:03:55,124.932 --> 00:03:56,774.932 And, we're active across. 44 00:03:57,144.932 --> 00:03:57,984.932 The country. 45 00:03:57,984.932 --> 00:04:02,394.932 Sometimes we'll do consulting and technical assistance in other parts of the world. 46 00:04:02,764.932 --> 00:04:12,314.932 But we're really looking at, how do you provide that high quality, deeply affordable housing paired with services to create a platform for people to exit homelessness. 47 00:04:13,204.932 --> 00:04:25,604.932 So in my work in San Diego, I really have the privilege and in Orange County the privilege of working with county partners county behavioral health services, county housing and community development services. 48 00:04:25,689.932 --> 00:04:28,779.932 And contracted providers, county providers. 49 00:04:29,169.932 --> 00:04:42,229.932 In thinking about, how can we really do our best work in addressing homelessness for people with disabling health conditions, serious mental illness substance abuse issues, other types of chronic health health concerns. 50 00:04:42,929.932 --> 00:04:46,429.932 And so in, in that I'm working with affordable housing providers. 51 00:04:46,429.932 --> 00:04:49,634.932 Like your organization, community Housing works and others. 52 00:04:50,389.932 --> 00:04:52,459.932 As well as some shared housing providers. 53 00:04:52,459.932 --> 00:04:57,819.932 Shared housing's a really important option for folks, especially folks who wanna live in that more shared setting. 54 00:04:58,269.932 --> 00:05:02,209.932 And so these are really recognizing that when you're. 55 00:05:02,774.932 --> 00:05:13,424.932 Working with folks who have maybe significant chronic, chronic ongoing health conditions and a need for affordable housing, that there's not one, there's not like one model that's gonna fit for everybody. 56 00:05:13,704.932 --> 00:05:16,314.932 So really having that choice and that attention to quality. 57 00:05:18,384.932 --> 00:05:20,274.932 Thank you so much, Simone. 58 00:05:20,304.932 --> 00:05:32,534.932 When I think of CSH, I think of the quote that says it takes a village and the work that you all are doing, on a national level is so impressive. 59 00:05:32,564.932 --> 00:05:33,704.932 It's so needed. 60 00:05:34,124.932 --> 00:05:35,294.932 I do see. 61 00:05:36,29.932 --> 00:05:44,69.932 CSH being a connector as well, just really bringing all of us together in this housing ecosystem. 62 00:05:44,69.932 --> 00:05:53,579.932 So your work is important, your work is impressive, and I really look forward to what the future is going to also hold for this type of work. 63 00:05:54,299.932 --> 00:05:56,429.932 Now, as we talk about. 64 00:05:56,969.932 --> 00:05:58,199.932 Health and housing. 65 00:05:58,259.932 --> 00:06:15,159.932 As we talk about supportive housing, I really want to frame this discussion on, your thoughts and your ideals around what it looks like to really create this space where supportive housing. 66 00:06:16,464.932 --> 00:06:20,214.932 How it differs from other affordable housing models. 67 00:06:20,454.932 --> 00:06:22,824.932 So let's go ahead and jump into the questions. 68 00:06:23,64.932 --> 00:06:32,44.932 So for those that may be new to this conversation I just wanna open it up so that they'll understand at a very basic level. 69 00:06:32,144.932 --> 00:06:37,94.932 By how we define supportive housing, how you define supportive housing. 70 00:06:37,454.932 --> 00:06:38,264.932 Absolutely. 71 00:06:38,264.932 --> 00:06:38,534.932 Yep. 72 00:06:38,624.932 --> 00:06:49,644.932 No, it's important because supportive housing, brings affordable housing at its heart, the housing has to be affordable intentionally, or for folks the income levels that they're at. 73 00:06:50,154.932 --> 00:07:03,174.932 And so one, one thing that distinguishes supportive from affordable housing is the affordability is often lower than you would see in across affordable housing models where you would have a range of 30 to 50% area median income. 74 00:07:03,524.932 --> 00:07:09,44.932 Maybe 30 to 60% area meeting income and only a few at the lowest levels for supportive housing. 75 00:07:09,44.932 --> 00:07:15,24.932 We're really planning for people who are typically their income would be social security income. 76 00:07:15,364.932 --> 00:07:20,404.932 In San Diego, social security income is about 18% area median income. 77 00:07:20,774.932 --> 00:07:22,924.932 Nowhere near the 30% a MI. 78 00:07:23,444.932 --> 00:07:29,604.932 And so knowing that you're providing housing for folks who are at that income level, you really have to think about your planning. 79 00:07:29,894.932 --> 00:07:34,394.932 To make sure that housing is affordable and sustainable for folks over the long term. 80 00:07:34,884.932 --> 00:07:42,74.932 So more deep affordability restrictions on the units that are dedicated to folks who are moving into the supportive housing units. 81 00:07:42,504.932 --> 00:07:45,394.932 Oftentimes there's also rental subsidies. 82 00:07:45,394.932 --> 00:07:50,824.932 So project-based section eight is very helpful or capitalized operating subsidy reserve. 83 00:07:51,244.932 --> 00:07:55,194.932 So there's some additional subsidies and some deeper affordability. 84 00:07:55,614.932 --> 00:07:59,4.932 And the supportive housing units and then of course the services. 85 00:07:59,54.932 --> 00:08:08,894.932 For folks who have kind of complex health needs, you really need that affordability of the housing plus services that are client centered and meet people's needs intentionally paired together. 86 00:08:10,459.932 --> 00:08:20,779.932 For it to work for people to be able to exit homelessness move into stable housing and and retain their housing, stay stably housed and thrive. 87 00:08:20,779.932 --> 00:08:25,599.932 Start, really having time and energy to be working on their goals. 88 00:08:25,649.932 --> 00:08:30,259.932 Whereas when you're just surviving day to day trying to, find a restroom. 89 00:08:30,324.932 --> 00:08:41,14.932 Figure out what food's available to you and then where you can rest because when you're homeless, it's really hard to find a spot to be able to sleep, right? Really to be able to sleep. 90 00:08:41,14.932 --> 00:08:48,494.932 So when you're moving into housing, you're able to have that platform to work on your own goals and think about that thriving framework. 91 00:08:49,214.932 --> 00:08:52,64.932 One of the other elements is just how people work together. 92 00:08:52,64.932 --> 00:08:53,384.932 So you said, it takes the village. 93 00:08:53,504.932 --> 00:08:54,464.932 Absolutely. 94 00:08:54,894.932 --> 00:09:04,224.932 So there's this intentional approach where property management training for property management is really important in support of housing. 95 00:09:04,624.932 --> 00:09:07,964.932 There's growing body of the curriculum out there. 96 00:09:08,324.932 --> 00:09:12,84.932 Trauma-informed property management programs. 97 00:09:12,454.932 --> 00:09:25,194.932 What does it mean to offer property management if you're using a harm reduction framework? Really thinking about the supports for property managers who are working in supportive housing and how they communicate and collaborate with the service providers. 98 00:09:25,554.932 --> 00:09:31,934.932 So there's a slightly there's this additional element in the property management role of coordinating with the service providers. 99 00:09:32,574.932 --> 00:09:33,984.932 Same with the service providers. 100 00:09:33,984.932 --> 00:09:38,574.932 They're providing services to tenants and also really need to collaborate with property management. 101 00:09:38,874.932 --> 00:09:46,564.932 So those are some of the things I, that really stand out as defining supportive housing as something that builds on affordable housing. 102 00:09:46,864.932 --> 00:09:52,824.932 It's like affordable housing and that, the services, the deeper affordability and then overlaying it is this. 103 00:09:53,179.932 --> 00:09:56,359.932 Intention and discipline of collaboration. 104 00:09:56,729.932 --> 00:10:02,809.932 With the goal, everyone has the same goal, the same north star of supporting people to retain their housing. 105 00:10:04,324.932 --> 00:10:04,894.932 Yes. 106 00:10:04,924.932 --> 00:10:07,564.932 And my passion is resident services. 107 00:10:07,564.932 --> 00:10:29,214.932 So as you started talking about the wraparound services and why that's important you have your Amen Corner over here because we could identify folks that need housing welcome them to our community, but then what? What happens next? Those wraparound services are so important to the work that we do. 108 00:10:29,264.932 --> 00:10:30,974.932 Residents feel stable. 109 00:10:30,974.932 --> 00:10:34,334.932 They have this sense of community as well as security. 110 00:10:34,874.932 --> 00:10:35,924.932 A hundred percent. 111 00:10:35,924.932 --> 00:10:36,314.932 Yes. 112 00:10:36,314.932 --> 00:10:41,324.932 And sorry to interrupt Lakeysha, but that's what we, when people move in, is like really hungry for the connection. 113 00:10:41,324.932 --> 00:10:41,384.932 Yeah. 114 00:10:41,464.932 --> 00:10:46,194.932 And, all kinds of activities that really build that sense of community in a property. 115 00:10:46,194.932 --> 00:10:55,24.932 So how do people feel welcome and seen and valued, within the tenant community, within the broader community, and also live, living in their new home. 116 00:10:56,194.932 --> 00:10:56,974.932 Absolutely. 117 00:10:56,974.932 --> 00:11:01,924.932 That's very critical to the success of the individuals that we're serving. 118 00:11:01,924.932 --> 00:11:01,984.932 Yeah. 119 00:11:02,674.932 --> 00:11:17,524.932 Now, as a follow up question to that my next question is, why is housing considered a health intervention in today's policy and funding landscape? Lakeysha, this is right at the heart of why I'm doing this work. 120 00:11:17,624.932 --> 00:11:23,224.932 You mentioned, yeah, my background and i've done a fair amount of work in kind of social determinants of health. 121 00:11:23,714.932 --> 00:11:25,94.932 Housing is healthcare. 122 00:11:25,344.932 --> 00:11:26,364.932 You've probably heard that. 123 00:11:26,739.932 --> 00:11:36,649.932 Instead other listeners I've heard folks really talking about housing as healthcare because you really need that platform, that foundation to be able to engage in other things. 124 00:11:36,649.932 --> 00:11:47,929.932 If it's something that you're looking to learn income, pursuing income, either benefits or earned income housing is that platform that, that you really need to be able to do those other things. 125 00:11:48,434.932 --> 00:11:51,344.932 And that also includes connecting with healthcare. 126 00:11:51,824.932 --> 00:12:03,984.932 So to and, as a system both personally and as a system, it really is in everyone's best interest to pursue pr, pursue primary or like preventative care and not. 127 00:12:04,739.932 --> 00:12:15,639.932 Have to be in this, what we call institutional circuit when you're homeless with a chronic health condition where you might be, accessing a lot of emergency services which can be really traumatic. 128 00:12:15,809.932 --> 00:12:19,144.932 For folks because you're connecting with a health system in a crisis. 129 00:12:20,209.932 --> 00:12:25,289.932 And when you're in housing, you're really able, to have that stability. 130 00:12:25,389.932 --> 00:12:32,689.932 There are services that are offered that, enable you to be able to like, make appointments, somebody to sit down and go through medication that you now had. 131 00:12:32,689.932 --> 00:12:36,14.932 Your, have a refrigerator that you can keep your medication in. 132 00:12:36,584.932 --> 00:12:42,994.932 It's not being stolen, right? There's a lot of theft that happens for folks experiencing homelessness and. 133 00:12:43,949.932 --> 00:12:48,159.932 And so there's, there's so many reasons why housing is healthcare. 134 00:12:48,619.932 --> 00:12:54,569.932 And at the heart of it, when you're thinking about what does it mean to be healthy? Health isn't just the absence of disease. 135 00:12:54,999.932 --> 00:13:01,979.932 Health has this broader definition that means you're, engaged in community that you know you're pursuing. 136 00:13:02,909.932 --> 00:13:07,319.932 Goals related to income and employment or volunteering or school. 137 00:13:07,689.932 --> 00:13:12,579.932 Things that, really fill your soul and and that, you have access to food. 138 00:13:12,579.932 --> 00:13:14,739.932 That's another thing that happens a lot in housing. 139 00:13:14,739.932 --> 00:13:19,929.932 There's a lot of intentional planning around food access because people are at such low incomes. 140 00:13:20,239.932 --> 00:13:22,129.932 So diets really important. 141 00:13:22,399.932 --> 00:13:25,304.932 All of those things happen from that platform of housing. 142 00:13:26,769.932 --> 00:13:27,579.932 Yes. 143 00:13:27,849.932 --> 00:13:30,189.932 Now let's take that a little further. 144 00:13:30,189.932 --> 00:13:34,299.932 So you've broken down the integration of health and housing. 145 00:13:34,839.932 --> 00:13:43,59.932 Now, one hot topic in affordable housing it doesn't matter if you're a nonprofit developer or a for-profit developer. 146 00:13:43,419.932 --> 00:13:48,49.932 Everybody is looking at new policies that are coming down the pipe. 147 00:13:48,359.932 --> 00:13:52,139.932 With the new administration there are different shifts that we're seeing. 148 00:13:52,649.932 --> 00:13:58,819.932 As developers we're always looking for sustainable sources of funding. 149 00:13:59,419.932 --> 00:14:16,639.932 So can we just transition a little bit and talk about some of the ways that Medicaid and MCOs are really supporting developers in the way that we deliver our services and how those services are being funded. 150 00:14:17,149.932 --> 00:14:25,149.932 So what types of services are typically covered? As we look at the healthcare systems Yep, yep. 151 00:14:25,149.932 --> 00:14:28,29.932 No such a timely question and things are very much in flux. 152 00:14:28,79.932 --> 00:14:30,739.932 However this concept of yeah. 153 00:14:30,739.932 --> 00:14:37,519.932 Medicaid, Medicare really in identifying housing related services as being connected to health. 154 00:14:38,349.932 --> 00:15:01,719.932 And it really comes back to this idea of how expensive it is for, emergency institutional care versus interventions that can happen in the community, particularly for people who are housed that, that divert folks from that more expensive institutional care people who are hospitalized, emergency, emergency care, inpatient stay, and. 155 00:15:02,269.932 --> 00:15:15,639.932 So there is that direct connection, over and over again in, in all kinds of studies that really show that you can divert some of that emergency care, that very high level intensity care if you invest in the things that keep people healthy. 156 00:15:15,999.932 --> 00:15:21,359.932 So again, back to that you broader definition of health that does very much. 157 00:15:22,509.932 --> 00:15:31,859.932 Play out when you see how how you know, large numbers of people access the healthcare system if you're investing in community supports related to housing. 158 00:15:32,429.932 --> 00:15:37,649.932 So there's, different states are approaching this in different ways, so there's different options in different states. 159 00:15:38,199.932 --> 00:15:41,9.932 But some of the things some of the things that are options. 160 00:15:42,594.932 --> 00:15:53,134.932 Include personal care, in-home support services so that person that's visiting to help you with activities of daily living things that really help you sustain yourself in housing. 161 00:15:54,224.932 --> 00:15:58,434.932 There's also services related to tenancy in California. 162 00:15:58,434.932 --> 00:16:01,74.932 We call it housing, tenancy and sustaining services. 163 00:16:01,594.932 --> 00:16:06,864.932 Which, the concept is supports that assist you maintaining your housing. 164 00:16:07,204.932 --> 00:16:12,584.932 So housing tenancy, sustaining services helping to make sure you're paying your rent on time. 165 00:16:12,894.932 --> 00:16:13,754.932 Supports that. 166 00:16:14,79.932 --> 00:16:19,959.932 May help you through the annual recertification process, which, can be a little technical for folks. 167 00:16:19,959.932 --> 00:16:25,369.932 They might need a little extra support resources to help prevent eviction again. 168 00:16:25,399.932 --> 00:16:32,394.932 The data really shows that if you can maintain your housing with some supports, you're just saving us so much. 169 00:16:32,734.932 --> 00:16:37,954.932 As opposed to if someone loses their housing, enters homelessness, and then has to like reenter, connecting with. 170 00:16:38,289.932 --> 00:16:39,489.932 With housing again. 171 00:16:40,39.932 --> 00:16:41,604.932 And so we do see. 172 00:16:42,964.932 --> 00:16:43,774.932 This investment. 173 00:16:43,844.932 --> 00:16:45,614.932 So first from Medicaid. 174 00:16:45,614.932 --> 00:16:50,654.932 So from CMS nationally, different states have different agreements. 175 00:16:50,994.932 --> 00:17:00,844.932 And so then once a state has those either supports or benefits related to housing community support services related to housing. 176 00:17:01,354.932 --> 00:17:11,524.932 Then the Managed Care plans, the managed care organizations, then are the ones that the members would be accessing those services through either through a contracted provider. 177 00:17:11,524.932 --> 00:17:15,364.932 Sometimes the Managed Care Organization staff will provide some of the services. 178 00:17:15,364.932 --> 00:17:17,34.932 It really depends on how it's set up. 179 00:17:17,779.932 --> 00:17:36,219.932 The idea really is at a population level, like at a state level, to be able to divert folks from those higher more expensive services that don't, wouldn't need to be in place if the the investments are made when folks are housed and in the community in this more kind of planned pattern of care. 180 00:17:37,509.932 --> 00:17:38,109.932 Yes. 181 00:17:38,159.932 --> 00:17:38,459.932 Yes. 182 00:17:38,699.932 --> 00:17:43,759.932 Now Simone, I heard you speak on a few elements of Cal aim. 183 00:17:43,859.932 --> 00:17:54,629.932 But can you just give us a quick summary of how Cal AIM has really become a game changer for providers and developers? Absolutely. 184 00:17:54,629.932 --> 00:17:54,839.932 Yeah. 185 00:17:54,839.932 --> 00:17:56,39.932 No, it's really exciting. 186 00:17:56,39.932 --> 00:17:58,469.932 And again, we recognize we're in a moment of change. 187 00:17:58,499.932 --> 00:18:08,309.932 So this is at this moment July, 2025 where it's Cal AIM is in California, so it's the California advancing and innovating in Cal aim. 188 00:18:08,799.932 --> 00:18:11,934.932 And, people talk about it as medi Medi-Cal transformation. 189 00:18:12,604.932 --> 00:18:15,534.932 And Medi-Cal is California's Medicaid program. 190 00:18:16,24.932 --> 00:18:27,634.932 And Cal AIM really provides a menu of services for people who are enrolled in the managed care plan to provide community supports related to housing. 191 00:18:28,54.932 --> 00:18:34,4.932 And some of them are one time so assistance with deposits or things that you need when you're moving into housing. 192 00:18:34,494.932 --> 00:18:37,24.932 Maybe you have, deposit that needs to be paid. 193 00:18:37,24.932 --> 00:18:43,474.932 And there's no other source utility bill that you may have, from years past that needs to be cleared before you can set up utilities again. 194 00:18:44,14.932 --> 00:18:46,594.932 So housing deposits are super helpful. 195 00:18:46,594.932 --> 00:18:48,14.932 It's like a, one time thing. 196 00:18:48,614.932 --> 00:18:50,84.932 There's some things that are ongoing. 197 00:18:50,174.932 --> 00:18:54,994.932 So the housing tenancy and sustaining services for the folks who are enrolled can. 198 00:18:55,999.932 --> 00:18:58,849.932 Receive those supports and the provider. 199 00:18:58,849.932 --> 00:19:05,879.932 So that could be the resident service provider of the affordable housing entity, or it could be another provider. 200 00:19:05,879.932 --> 00:19:17,314.932 So if it's the resident service provider or support services provider of the affordable housing organization, then that revenue would flow through your budget. 201 00:19:18,854.932 --> 00:19:29,294.932 Otherwise, if it's a third party provider, then it's an in-kind support that's being provided to your residents and you're experiencing the benefit of that because folks are receiving services and staying, staying housed. 202 00:19:29,964.932 --> 00:19:35,424.932 So that housing tenancy and sustaining services is, ongoing subject to reauthorizations. 203 00:19:36,54.932 --> 00:19:40,164.932 And and depends which managed care plan you're in, how frequent they have to happen. 204 00:19:40,504.932 --> 00:19:41,314.932 But there is. 205 00:19:41,974.932 --> 00:19:51,344.932 You know this for the first time through Medi-Cal, the ability to provide services that are reimbursable through the managed care plan. 206 00:19:52,314.932 --> 00:19:55,975.932 There's also this option called Day Habilitation Services. 207 00:19:57,609.932 --> 00:20:06,679.932 Which, on its surface it doesn't really sound like exactly what it is, but it's, for people who are experiencing homelessness receiving mentoring by a trained care caregiver. 208 00:20:06,679.932 --> 00:20:10,619.932 Care provider and that can happen individually or in group setting. 209 00:20:11,99.932 --> 00:20:16,89.932 So recertifications is a big piece of, annual processes in affordable housing. 210 00:20:16,89.932 --> 00:20:24,459.932 For example it could be like a, a group training for folks who are preparing for their annual inspection. 211 00:20:24,949.932 --> 00:20:29,54.932 It could be, could be like a dialectical behavioral therapy group. 212 00:20:29,524.932 --> 00:20:33,124.932 So that that's another option for services that's ongoing. 213 00:20:33,424.932 --> 00:20:36,364.932 There's a whole range of other community supports and housing. 214 00:20:36,364.932 --> 00:20:39,94.932 People often in California talk about the housing trio. 215 00:20:39,584.932 --> 00:20:43,124.932 And the housing trio is the housing deposits that I had talked about. 216 00:20:43,554.932 --> 00:20:50,514.932 And then housing transition navigation services, which again is typically like a one-time thing when people are connected to housing. 217 00:20:50,809.932 --> 00:20:54,589.932 It's the, those supports from being connected to housing, to moving into housing. 218 00:20:55,869.932 --> 00:21:00,819.932 And then after that the tenant might receive the housing tenancy and sustaining services. 219 00:21:01,339.932 --> 00:21:05,659.932 But in the housing trio the two of them are not like ongoing. 220 00:21:05,719.932 --> 00:21:18,529.932 So you, and I know we've talked about this, Lakeysha is what is that kind of ongoing support? Because we're really recognizing supportive housing is the housing and the services people need both ongoing in order to maintain their housing. 221 00:21:20,524.932 --> 00:21:21,394.932 Yes. 222 00:21:21,514.932 --> 00:21:37,614.932 And as I think about the climate that we are in right now with new policies new legislation, some folks may view this time period that we're in as adversity, but I really think it's opportunity. 223 00:21:37,994.932 --> 00:21:55,454.932 For programs like Cal Aim for us as providers, as developers, to really start thinking out the box I think we are all pivoting in a innovative way and really being creative with these funding sources that we keep talking about now. 224 00:21:55,514.932 --> 00:21:56,849.932 One of the new. 225 00:21:57,714.932 --> 00:22:11,444.932 New trends is housing providers really working closely with he healthcare entities as you've been speaking on when you think about those partnerships, there are definitely non-traditional. 226 00:22:11,904.932 --> 00:22:21,174.932 But do you think that there are a lot of barriers that still exist with these partnerships? And if there are. 227 00:22:21,554.932 --> 00:22:27,14.932 Can you speak to how we could overcome those barriers? Oh, what a great question. 228 00:22:27,14.932 --> 00:22:27,284.932 Yep. 229 00:22:27,894.932 --> 00:22:55,549.932 I think, you started off talking about adversity and, the framework, I think that's really important to keep in mind is, how do we think about doing our best work in this moment? And that's particularly true when things are hard and wonder and really identifying, what's the goal? What is it that's most important to do? And then identifying what are the resources? What are the capacities? Who are the partners that, that are working in this space? And, maybe we can create something new together. 230 00:22:55,919.932 --> 00:22:58,339.932 And that's really happened with Cal Aim. 231 00:22:58,759.932 --> 00:23:00,289.932 And the community supports. 232 00:23:00,319.932 --> 00:23:05,359.932 With Cal aim, I should have also talked about enhanced care management, which is a benefit that's also ongoing. 233 00:23:05,639.932 --> 00:23:13,619.932 And that is an another service that really can support people and is focused on identifying what their needs are and how they can get their needs met. 234 00:23:14,349.932 --> 00:23:15,349.932 And for Cal Aim. 235 00:23:16,354.932 --> 00:23:27,614.932 There, there is an organizational shift that needs to happen if you're not previously a biller to Medi-Cal or, do not have contracts with the Managed Care organization. 236 00:23:27,984.932 --> 00:23:42,4.932 And just as if, you were entering into a new line of business, there's that investment on the back end of structures, processes, expertise that you need in order to engage in, in this new new way of working. 237 00:23:43,129.932 --> 00:23:46,519.932 So what we've seen is, there's a technology component. 238 00:23:46,519.932 --> 00:23:51,509.932 There's the whole kind of billing system and there are organizations that, that's their specialty. 239 00:23:51,509.932 --> 00:23:58,489.932 So we've seen some groups engage with a third party biller who really looks at how the notes are written. 240 00:23:58,519.932 --> 00:24:06,889.932 Are they meeting the managed care plans criteria for what needs to be in those notes in order to justify the billing. 241 00:24:07,849.932 --> 00:24:12,699.932 There's service patterns that have to be in place in order to get reimbursement. 242 00:24:12,699.932 --> 00:24:22,319.932 For example in some managed care plans for housing, tenancy and sustaining services, there needs to be four contacts in the month, of a certain amount of minutes. 243 00:24:22,769.932 --> 00:24:26,99.932 And that needs to be documented appropriately in order to get reimbursed. 244 00:24:26,519.932 --> 00:24:30,459.932 So if, you saw a tenant three times in the month, you don't get any reimbursement. 245 00:24:30,459.932 --> 00:24:40,19.932 So how do you build your staffing pattern? How do you think about offering your services in a way that really meets those needs? So just to try to give you some examples. 246 00:24:40,19.932 --> 00:24:41,789.932 I don't know that there are barriers. 247 00:24:41,789.932 --> 00:24:43,169.932 It's learning a new language. 248 00:24:43,569.932 --> 00:24:47,499.932 You also at the beginning so nicely described the. 249 00:24:47,549.932 --> 00:24:51,509.932 The partnership and the collaboration that needs to happen in supportive housing. 250 00:24:51,969.932 --> 00:24:54,489.932 And I really think about it as being like multilingual. 251 00:24:54,749.932 --> 00:25:00,529.932 You really have to speak like, housing, affordable housing talk, all of the acronyms that come with that. 252 00:25:00,979.932 --> 00:25:04,819.932 There's, the services planning and then there's, the health plans. 253 00:25:04,849.932 --> 00:25:05,209.932 There's. 254 00:25:05,449.932 --> 00:25:12,139.932 A whole range of sectors that do have their own language and set of acronyms. 255 00:25:12,609.932 --> 00:25:14,559.932 And being multilingual is important. 256 00:25:14,559.932 --> 00:25:19,354.932 So this is gonna be another language that an organization, if you're gonna do this work, would need to learn. 257 00:25:20,514.932 --> 00:25:32,844.932 And not to underestimate, like there does need to be an investment and it's gonna take a bit of time to work through what systems are gonna work for your organization, and then you absolutely also need to engage with managed care plans in a way that works for them. 258 00:25:32,994.932 --> 00:25:49,694.932 And and so really my I think my takeaway in all of this is identifying partners in the community who've walked this road or walked a road that's similar and and really leaning into that community who, who have a shared goal in common. 259 00:25:50,909.932 --> 00:25:59,939.932 Yes, I 100% agree with that because we can't talk about the present without talking about the future. 260 00:26:00,209.932 --> 00:26:03,839.932 I think you j you actually just answered my next question. 261 00:26:03,839.932 --> 00:26:09,199.932 So I will go on to the as we are talking about sustainability in scaling. 262 00:26:09,299.932 --> 00:26:11,819.932 What role do local governments. 263 00:26:12,164.932 --> 00:26:20,279.932 In your eyes, what role do they play in really scaling these health and housing initiatives? Yes. 264 00:26:20,339.932 --> 00:26:32,339.932 Yeah, we all have our role, right? So I, on the affordable housing side, the support services side providing the housing, providing the services, figuring out what tools are out there, and then, learning how to use those tools, some of which are really technical. 265 00:26:32,879.932 --> 00:26:36,539.932 Similarly, on the government side, also on the managed care plan side. 266 00:26:36,849.932 --> 00:26:37,359.932 Really. 267 00:26:37,524.932 --> 00:26:40,44.932 Creating spaces to build capacity. 268 00:26:40,414.932 --> 00:26:51,979.932 We've seen on the managed care plan side, there's and statewide, there's been multiple rounds of funding opportunities to be able to build capacity and really think about systems. 269 00:26:53,274.932 --> 00:26:58,884.932 Government and managed care plans have been historically investing in this because it is such a big change. 270 00:26:59,374.932 --> 00:27:05,394.932 People really need, to to invest in in the expertise. 271 00:27:05,484.932 --> 00:27:08,694.932 And then also like the technical systems that need to be in place. 272 00:27:08,694.932 --> 00:27:12,814.932 I'm talking about like software, right? Actual software databases. 273 00:27:13,259.932 --> 00:27:16,849.932 To be able, to, and then integration of databases. 274 00:27:16,849.932 --> 00:27:31,159.932 One thing we haven't touched on is that, there's a big push to look at the homeless management information systems and trying to integrate that with managed care plans and the service provider community connecting to housing as well. 275 00:27:31,739.932 --> 00:27:37,604.932 And so there have been both funding opportunities and and I think those it's important that those continue. 276 00:27:38,664.932 --> 00:27:41,34.932 As well as collaborative tables. 277 00:27:41,84.932 --> 00:27:46,344.932 Count in counties, there are a whole variety of tables that are convening. 278 00:27:46,344.932 --> 00:27:52,404.932 There's technical as they're supported through technical assistance that's provided through the state of California. 279 00:27:52,924.932 --> 00:27:53,79.932 So that. 280 00:27:53,839.932 --> 00:27:57,359.932 So that people can learn each other's languages and how to work together. 281 00:27:57,359.932 --> 00:27:59,669.932 And the county is a really big part of this as well. 282 00:27:59,919.932 --> 00:28:11,309.932 We, work most closely with the county behavioral health services and and there, there's other partners, the, the hospital sector is at the table as well as long-term care facilities. 283 00:28:11,589.932 --> 00:28:13,539.932 Really understanding each other's systems. 284 00:28:13,579.932 --> 00:28:23,459.932 How do people flow from one type of care to another with this emphasis on trying to support people in the community and diverting people from higher levels of care. 285 00:28:23,679.932 --> 00:28:30,299.932 That's where we really see there's been strong leadership both locally at the county level and at the state level. 286 00:28:30,609.932 --> 00:28:32,709.932 And that's really important to continue. 287 00:28:32,709.932 --> 00:28:38,599.932 And for folks who are like new to this there are tables in your community where those conversations are happening. 288 00:28:39,29.932 --> 00:28:42,79.932 And so plugging into those groups I think would be important. 289 00:28:43,329.932 --> 00:28:48,189.932 Yes, Simone, every time I talk to you, I learn so much. 290 00:28:48,249.932 --> 00:28:53,829.932 Even today, I'm over here being inspired, as usual, and just taking so many notes. 291 00:28:54,299.932 --> 00:28:57,719.932 I think today's conversation is just the beginning. 292 00:28:57,719.932 --> 00:29:02,39.932 I could see us really continuing this dialogue. 293 00:29:02,89.932 --> 00:29:03,889.932 Again, for the folks that are new in this. 294 00:29:04,364.932 --> 00:29:09,424.932 Space for folks that want to be involved really wanting to hear more. 295 00:29:09,424.932 --> 00:29:18,634.932 So I will definitely be reaching back out because I think today we scratched the surface and there's so much more to come. 296 00:29:19,24.932 --> 00:29:28,324.932 And as we wrap up, I wanted to know if there was anything else that you would like to share with the audience as just like a key takeaway. 297 00:29:30,789.932 --> 00:29:31,689.932 Thanks, Lakeysha. 298 00:29:31,969.932 --> 00:29:35,179.932 I just really enjoyed this conversation and the time's gone really fast. 299 00:29:35,599.932 --> 00:29:45,629.932 People are, really passionate about this work, so I think it's really, leaning into your passion and connecting with people who are doing similar work, building that. 300 00:29:46,4.932 --> 00:29:46,994.932 Professional network. 301 00:29:47,334.932 --> 00:29:51,424.932 But also conversations like these help me refill my bucket. 302 00:29:51,424.932 --> 00:29:51,484.932 Yeah. 303 00:29:51,844.932 --> 00:29:53,674.932 So being intentional about that. 304 00:29:53,734.932 --> 00:29:59,754.932 I think we all work so hard and we invest all of ourselves in the work that we do. 305 00:30:00,114.932 --> 00:30:01,634.932 And and so one thing. 306 00:30:02,134.932 --> 00:30:11,24.932 In our team that we really try to talk about is making sure that we're also paying attention to what we need to be able to show up and do the work every day. 307 00:30:11,454.932 --> 00:30:19,264.932 And so making sure you know that there's opportunities for self-care also for connecting with folks. 308 00:30:19,704.932 --> 00:30:22,644.932 So that you have that support, whatever that is for you. 309 00:30:23,14.932 --> 00:30:28,844.932 Because when you do those things then I, I think, burnout is real in, in this work. 310 00:30:28,879.932 --> 00:30:36,259.932 And so we just really wanna make sure that it's part of the rhythm of the work, it's intentional and that it's not something that happens. 311 00:30:36,259.932 --> 00:30:45,839.932 If there's time to to really be able to say, yep, I have a plan for how I look after myself so I can show up and do this work. 312 00:30:46,179.932 --> 00:30:49,449.932 And also build community in, in a way that's supportive. 313 00:30:49,879.932 --> 00:30:57,949.932 So you've got that strength of leaning in to a supportive community because we all, we all definitely need that in our different roles. 314 00:30:58,279.932 --> 00:31:00,79.932 So I think that would be my takeaway. 315 00:31:00,79.932 --> 00:31:11,284.932 Lakeysha is just really making sure, especially doing the work for a long period of time that intentionality of we, we can't do this work if we're not if we're not able to bring our whole selves. 316 00:31:11,374.932 --> 00:31:13,654.932 And yeah, bringing our whole selves is a lot. 317 00:31:13,694.932 --> 00:31:14,324.932 It's a lot. 318 00:31:14,384.932 --> 00:31:14,654.932 Yep. 319 00:31:15,269.932 --> 00:31:16,829.932 Yes, I agree. 320 00:31:16,979.932 --> 00:31:21,929.932 Now, how can folks follow up with you if they have additional questions? Oh, yeah. 321 00:31:21,979.932 --> 00:31:24,469.932 Feel free to share my contact information. 322 00:31:24,499.932 --> 00:31:26,569.932 Can we just put that in the Yes. 323 00:31:26,569.932 --> 00:31:27,109.932 In the link. 324 00:31:27,259.932 --> 00:31:27,589.932 Okay. 325 00:31:27,589.932 --> 00:31:27,979.932 Yep. 326 00:31:28,39.932 --> 00:31:37,491.932 So yeah, you can feel free to share my email address, which is simone dot S-I-M-O-N-N-E dot r ru [e-mail]. 327 00:31:38,314.932 --> 00:31:39,704.932 Thank you so much, Simone. 328 00:31:39,724.932 --> 00:31:44,554.932 Thank you for your time, your talent, your energy, and we will definitely be in touch. 329 00:31:45,274.932 --> 00:31:46,484.932 Thanks so much Lakeysha. 330 00:31:46,774.932 --> 00:31:46,984.932 Bye. 331 00:31:46,984.932 --> 00:31:47,674.932 Such a pleasure. 332 00:31:49,139.932 --> 00:31:54,509.932 Thanks for being here with us on W Cast, the official podcast of the Women's Affordable Housing Network. 333 00:31:54,899.932 --> 00:32:03,119.932 Every guest, every story, every listen, helps us keep this space real rooted and resonant, and we're so glad you're a part of it. 334 00:32:03,539.932 --> 00:32:06,419.932 Big thanks to our guests for sharing their time and knowledge with us. 335 00:32:06,854.932 --> 00:32:14,624.932 To our sponsors for making this platform possible and to you for tuning in, sharing and helping us keep this conversation going. 336 00:32:15,314.932 --> 00:32:20,744.932 Be sure to follow rate and share WAHNcast wherever you listen and bring a friend next time we save them a seat. 337 00:32:21,719.932 --> 00:32:21,839.932 I.