By Barbara Poppe, Executive Director of the US Interagency Council on Homelessness

October 1st was an important day as the first day of open enrollment in private insurance through the health insurance marketplaces and in Medicaid in the states that are expanding. But it's also important to remember that this is only the beginning, not the end, of the road to health care transformation. The Affordable Care Act won't bring about changes to our nation's approach to health care overnight, nor will it fix everything in our nation's approach to health care. But it's an important first step. 

These changes won't happen by themselves either. The Affordable Care Act is a tool, but a tool is only as good as its user. It will take our collective efforts to help implement the law and fully leverage it to end homelessness. 

So how can we make the best use of the Affordable Care Act to solve homelessness? I share five questions for your consideration in my blog. 

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As much as a flexible "do whatever it takes" approach to case management and supportive services is essential to permanent supportive housing's success for people experiencing chronic homelessness, it is also very difficult to finance. Providers have often had to patch together multiple streams of public and private funds-each with different eligibility and coverage rules-in order to provide the "support" in supportive housing. Funding these services often feels like solving a complex mathematical equation, where providers have to solve for multiple variables at once. 

Through changes under the Affordable Care Act, providers may finally have found a solution to that equation: Medicaid.  With states having the choice to expand Medicaid eligibility, more people experiencing chronic homelessness may be eligible for Medicaid. At the same time, the Affordable Care Act is shifting the focus of Medicaid to "whole person" health needs rather than just medical and physical health needs. This means that states will have incentives to pay for things like case management and behavioral health services under Medicaid, alongside hospital stays, doctor's visits, and prescription drugs. 

So what can providers of permanent supportive housing do to tap Medicaid as a way to pay for the services in permanent supportive housing?  Four emerging and exciting trends offer some ideas. 

How Medicaid Expansion Will Help People Experiencing Homelessness 

But the benefits don't stop there. State budgets, hospitals, health care providers, and Americans in general also stand to gain from Medicaid expansion.  

The U.S. Department of Labor announced nearly $24 million in Workforce Innovation Fund grants to pilot the Pay for Success program, a new model of financing social service programs to help federal, state and local governments ensure that public funds only go to programs that achieve positive, measurable outcomes. Under this model, independent investors provide the financial capital to cover the operating costs for the programs, and the Department of Labor disperses funds when and if those programs demonstrate that they have achieved the targeted outcomes. 

Two grants were awarded: one to the New York Department of Labor in the amount of $12,000,000 and the other to the Massachusetts Executive Office of Labor and Workforce Development in the amount of $11,670,000. These grants will support programming that aims to increase employment and reduce recidivism among formerly incarcerated individuals.

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The unprecedented changes now unfolding in the health care marketplace present supportive housing providers with opportunities to strengthen linkages with health care payers. 

The expansion of Medicaid coverage under the Affordable Care Act (ACA) will mean that millions of currently uninsured adults will be eligible for coverage, including many formerly homeless individuals residing in supportive housing.

Likewise, the ACA encourages new models of health care delivery focusing on the "Triple Aim" of improving health outcomes, improving the patient care experience, and reducing health care costs.

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