SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after section 16CC the following section:-

Section 16DD. For the purposes of this section, the term “Medicaid 1115 waiver” shall mean Medicaid 1115 demonstration waivers, as codified in 42 USC § 1315, that allow states to waive certain provisions of the Medicaid law and receive additional flexibility to design and improve their programs. Waivers may provide federal authority for states to expand eligibility to individuals who are not otherwise eligible for Medicaid or the Children’s Health Insurance Program, offer services that are not typically covered by Medicaid, and use innovative service delivery systems that improve care, increase efficiency and reduce costs.

(a) The executive office of health and human services and MassHealth shall expand eligibility of community support programs, as defined in section 31 of chapter 23B, to include long-term medically complex persons experiencing homelessness, as defined in said section 31, based on diagnoses and medical necessity in a manner consistent with Massachusetts’ existing Medicaid 1115 waiver and the Massachusetts Medicaid plan.

(b) Notwithstanding any general or special law to the contrary, the executive office of health and human services and the division of medical assistance shall seek amendments to the existing Medicaid 1115 waiver and plan to broaden tenant-based services as a way of avoiding the high costs of inappropriate utilization of existing systems of emergency and acute medical and behavioral care by these individuals experiencing homelessness.

(c) The executive office of health and human services and the department of housing and community development shall annually analyze MassHealth claims data in relation to homeless management information systems data related to Medicaid costs associated with those persons experiencing homelessness and report these findings to the clerks of the house of representative and the senate no later than 3 months following the end of each fiscal year.   

SECTION 2. Chapter 23B of the General Laws is hereby amended by adding the following 3 sections:-

Section 31. As used in sections 31 to 33, inclusive, the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Chronic homelessness” refers to the definition established by the U.S. Department of Housing and Urban Development of a disabled individual who has been continuously homeless on the streets or in an emergency shelter or safe haven for 12 months or longer, or has had 4 or more episodes of homelessness on the streets, or in an emergency shelter or safe haven over a 3-year period where the combined episodes total at least 12 months; provided, that episodes must be separated by a break of at least 7 nights; provided, further, that stays in an institution of fewer than 90 days shall not constitute a break. 

“Community Support Program” or “CSP”, services delivered by community-based, mobile paraprofessional staff, supported by a clinical supervisor, to individuals with mental health or substance use disorder diagnoses or to individuals whose psychiatric or substance use disorder diagnoses interfere with their ability to access essential medical services.

“Community Support Program for Chronically Homeless Individuals” or “CSP-CHI”, specialized services aimed at supporting chronically homeless individuals delivered by community-based, mobile, paraprofessional staff, supported by a clinical supervisor, to individuals with mental health or substance use disorder diagnoses, or to individuals whose psychiatric or substance use disorder diagnoses interfere with their ability to access essential medical services.

“Congregate shelter”, any sheltering approach of mass dormitory-style bed space in which individuals are not each sheltered in an individual bedroom demarcated by walls on all sides and a door.

“Disabled”, (i) a person who has a physical or mental impairment, including substance use disorders, which substantially limits 1 or more major life activities, has a record of such an impairment, or is regarded as having such an impairment or (ii) a person who has a diagnosable substance use disorder, serious mental illness, developmental disability, post-traumatic stress disorder, cognitive impairment resulting from a brain injury or chronic physical illness or disability, including the co-occurrence of 2 or more of those conditions.

“Flexible housing pool”, public-private partnerships creating and leveraging health and housing services for housing medically complex persons experiencing homelessness.

“Functional zero”, housing capacity sufficient to meet the ongoing placement needs of those persons experiencing homelessness.

“Medically complex person experiencing homelessness”, a disabled individual experiencing homelessness who needs extra care due to complex medical issues and social determinants of health that are often compounded by the social, economic, environmental and behavioral factors resulting from their experience of homelessness. 

“Non-congregate shelter”, a setting where a person experiencing homelessness is sheltered within an individual bedroom with walls on all sides and a door.

“Permanent supportive housing” or “PSH”, a model of housing that combines ongoing subsidized housing matched with flexible health, behavioral health, social and other support services.

Section 32. (a) The department shall incrementally reduce and end all mass congregate dormitory-style shelter within 5 years of the effective date of this section and replace it with a regional emergency non-congregate shelter system. Future procurement of shelters for unaccompanied adults experiencing homelessness shall be solely for the funding of non-congregate shelter. 

(b) The department shall conduct an objective and predictive study of future shelter demand to determine the number of non-congregate units necessary in order to achieve functional zero or available shelter to meet demand 1 year following the effective date of this section. This plan shall determine non-congregate shelter capacity in a regional calculation based on the ratio of the number of units to the overall population in order to ensure adequate capacity statewide.

(c) The department shall create an inventory of existing mass congregate shelters, the cost to the commonwealth of this existing mass congregate shelter and conduct a feasibility study as to the extent these current resources can be converted to non-congregate shelter within 1 year following the effective date of this section.

(d) The department, in partnership with the Massachusetts emergency management agency, shall promulgate, without impeding the goal of achieving functional zero or adequate capacity for those unaccompanied persons experiencing homelessness, regulations outlining the conditions which may require congregate mass shelter including, but not limited to, response to economic, social or natural conditions, including natural disasters, that have created an emergency situation; provided, however, that specifications of such shelter shall be consistent with the recommendations of the Centers for Disease Control; provided, further, that the department shall establish length of stay guidelines and requirements for rapid re-housing and relocation of impacted individuals in order to avoid the condition of long-term homelessness.

Section 33. The commonwealth shall develop housing resources across a spectrum of need, but shall prioritize those elderly, disabled and medically complex persons experiencing homelessness who are currently inefficiently served by costly emergency approaches throughout all systems of care.

(a) The department shall develop and provide a specific plan for unique housing responses specifically targeted to unaccompanied adult persons experiencing homelessness, including, but not limited to, long-term vouchers, shallow subsidy pools, rapid re-housing resources and permanent supportive housing;  

(b) The department shall develop or secure predictive models for determination of housing need for medically complex persons experiencing homelessness based upon a comparison of statewide homeless management information system data and MassHealth Medicaid claims data in order to determine the need for permanent supportive housing units for disabled medically complex persons experiencing homelessness for the next 5 years. Such a report will be delivered to the chairs of the joint committee on housing no later than 1 year following the effective date of this section;

(c) The department, in partnership with the executive office of health and human services, shall either reduce the regulatory barriers of the Massachusetts rental voucher program, comparable to what the Department of Housing and Urban Development has done with its homeless assistance funding, or develop an appropriate flexible project-based and sponsor-based subsidy within 1 year of the effective date of this section, suitable for the utilization in the leasing and development of permanent supportive housing; and

(d) The department shall review and consider alternative construction models including, but not limited to, modular construction, micro-units, repurposed hotels or other alternatives capable of bringing homeless housing initiatives to an affordable scale necessary to end the homelessness of chronic and medically complex persons experiencing homelessness. The department shall submit a plan for developing such housing to the chairs of the joint committee on housing no later than 1 year following the effective date of this section.     

SECTION 3. The executive office of health and human services and its agencies and the department of housing and community development shall explore alternative organizational models and utilization of public-private innovative financing to achieve the transformation of individual assistance to those experiencing homelessness and report their findings to the chairs of the joint committee on housing no later than 1 year following the passage of this act.

SECTION 4. The secretary of administration and finance shall, in consultation with Harvard Kennedy School social impact bond lab, explore various forms of social innovation financing as a way of reforming the current emergency system of care for individuals experiencing homelessness as well as promoting additional permanent supportive housing within Massachusetts. 

SECTION 5. The secretary of administration and finance, with the assistance of the department of housing and community development, shall evaluate the effectiveness of structures formed in Massachusetts pay for success program to address chronic homelessness in: (i) delivering, measuring and evaluating outcomes externally; (ii) raising private capital for social purposes through broad collaborations; (iii) developing service delivery networks and shared social objectives through a common intermediary; and (iv) lessons learned around the inability to convert cost avoidance and savings into budget savings. The secretary shall report their findings to the chairs of the joint committee on housing no later than 1 year from the effective date of this act. 

SECTION 6. The  executive office of administration and finance, the executive office of health and human services, the division of medical assistance and the department of housing and community development shall explore the feasibility of the creation of a flexible housing pool within the department of housing and community development for the purpose of making grants available to applicants for eligible activities including, but not limited to: (i) rental assistance; (ii) operating subsidies in new and existing affordable or supportive housing units; and (iv) specified supportive services. Such an exploration shall include input from such entities as the Corporation for Supportive Housing, the Massachusetts Housing and Shelter Alliance, Inc., the Massachusetts Alliance for Supportive Housing LLC, Boston Medical Center Corporation, and the United Way of Massachusetts Bay, Inc. and any other entity known to be familiar with this innovative practice. The department of housing and community development shall file a report of its findings regarding the feasibility of the creation of a flexible housing pool with the chairs of the joint committee on housing.