H U D S E C T I O N 8 1 1 P R A Project Rental Assistance Program

Phase II Evaluation

Final Report

Implementation and

Short-Term Outcomes

Executive Summary

U.S. Department of Housing and Urban Development | Office of Policy Development and Research

Executive Summary

or lower than for other HUD programs but that program administrative costs are higher.

The Section 811 Project Rental

Assistance Program

The U.S. Department of Housing and Urban Development (HUD)’s Section 811 Project Rental Assistance (PRA) Authorized by the Frank Melville Supportive Housing Program provides rental housing assistance to non-Investment Act of 2010,1 the PRA program provides elderly people with disabilities. In this second phase project-based rental assistance to extremely low of its evaluation of the PRA program, HUD sought to income, non-elderly people with disabilities. The determine the impact of the program on residents’

program responds to the goals of the Supreme Court’s housing tenancy and use of home and community-based 1999 decision in Olmstead v. L.C.2 to al ow people with services, characteristics of properties and neighborhoods disabilities to live in the least restrictive settings possible where assisted residents live, and residents’ healthcare that meet their needs and preferences. The PRA program diagnoses and utilization. In order to assess the program’s is a joint initiative between HUD and the U.S. Department effectiveness, the study compared short-term outcomes of Health and Human Services’ (HHS) Centers for of the PRA program against outcomes for residents in the Medicare & Medicaid Services (CMS). The goal of the Section 811 Capital Advance/Project Rental Assistance PRA program is to expand access to high-quality, Contract program (referred to as PRAC in this report), affordable housing and voluntary, community-based outcomes for people with disabilities in other HUD rental services to allow eligible people to live successfully assistance programs, and outcomes for a group of similar in the community. To assess the implementation and people who receive Medicaid but are not assisted by HUD

outcomes of the PRA approach, the Melvil e Act required programs.

an independent evaluation.

The evaluation found that the PRA program assists people The PRA program was designed to respond to a number who are different from people with disabilities in HUD’s of policy priorities:

other housing assistance programs in their demographic

• To increase the supply of affordable housing for people characteristics, the types and sizes of properties they live with disabilities in a cost-effective way while continuing in, and the characteristics of the neighborhoods where to serve households with extremely low incomes.

they live. PRA residents have lower incomes, have more chronic and disabling conditions, and are more likely to

• To provide affordable, community-based housing have had long-term stays in inpatient settings. Looking at options for people who might otherwise be, or be early outcomes for a sample of units in just six states, both at risk of becoming, homeless or unnecessarily housing unit and neighborhood quality are lower for PRA institutionalized. PRA residents must meet HUD

units than for PRAC units. PRA units have greater access eligibility requirements for age, income, and disability, to public transportation and are in neighborhoods with and be eligible for Medicaid-funded or other home and greater walkability, but PRA residents do not feel as safe in community-based services (HCBS).

their neighborhoods.

• To offer integrated housing settings where people with PRA residents receive tenancy supports similar to PRAC

disabilities live in multifamily housing for people both residents, and healthcare utilization rates are similar for with and without disabilities.

residents of the two programs. Utilization rates for long-

• To encourage collaborations between state housing term inpatient care are lower for PRA residents than for the and health agencies that result in long-term strategies comparison group that does not receive HUD assistance, for providing permanent, affordable housing options and utilization rates for case management services are for people with disabilities and coordinated access to higher. Rates of healthcare utilization for PRA residents services.

do not differ significantly from rates for residents of other To date, 27 state housing agencies are administering PRA HUD housing assistance programs.

grant programs and expect to provide rental assistance Our assessment of the cost-effectiveness of PRA in for an estimated 6,000 households. The housing agencies relation to other HUD programs that assist people with established interagency partnership agreements with disabilities found that rental subsidy costs are similar state health agencies that administer community-based services funded through Medicaid.

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H U D S e c t i o n 811 P R A P ro g r a m – P h a s e I I E v a l u a t i o n

Executive Summary Evaluating the PRA Program

(PRAC) program, which provides capital grants to develop housing exclusively for people with disabilities The PRA program differs from PRAC and other HUD

and project rental assistance for operational costs.

programs that assist similar populations in a number of Like PRA, PRAC owners must ensure resident access ways—in the way in which the housing is identified and to services.

brought into the program, in the type of rental assistance, in the program’s cost structure, and in whether and

• Receiving assistance through HUD’s Non-Elderly how coordinated access to services is provided. These Disabled (NED) voucher program, which provides differences affect the experience of PRA residents, their tenant-based rental assistance to non-elderly people housing location, access to services, and program costs.

with disabilities who may lease units of their choice that meet HUD’s requirements.

An initial, Phase I Evaluation3 (2014–2016) examined the early implementation of the PRA program in 12

• Receiving assistance through (other HUD) programs states, as state housing agency grantees established available to eligible low-income people with and agreements with property owners to lease units to PRA without disabilities; this category includes Housing residents, determined outreach and eligibility procedures Choice Vouchers, public housing, and multifamily to identify eligible applicants, and began moving people assisted housing.

into housing. Given the complexities of launching the new

• Receiving Medicaid but not living in HUD-assisted program and that many grantees identified most or al housing (non-HUD).

of their PRA units in properties under development, few The Phase II evaluation uses administrative data on applicants had been housed by the end of the Phase I individuals’ demographic characteristics and healthcare evaluation.

utilization patterns, neighborhood characteristics, property This Phase II Evaluation (2016–2019) assessed characteristics for the PRA and PRAC programs, and the ongoing PRA implementation experience as costs associated with the PRA and other HUD programs.

programs matured and the PRA program’s outcomes The study team also compares healthcare utilization for and effectiveness in six states. The selected states—

people in the non-HUD comparison group. Evaluators also California, Delaware, Louisiana, Maryland, Minnesota, reviewed program documents, interviewed PRA program and Washington—were chosen because they had housed administrators and other program partners, and surveyed the largest number of PRA residents by 2017 when the a sample of approximately 400 residents living in PRA and evaluation’s research design was finalized.

PRAC properties.

The Phase II evaluation was designed to answer these Key Findings from the

questions:

• How do short-term impacts of the Section 811 PRA Phase II Evaluation

program compare to outcomes for comparison groups How PRA Residents Differ from Similar made up of similar people living in other settings?

Residents Assisted by Other HUD Programs

• What is the relationship between PRA features and In order to estimate short-term impacts, and to place strategies and program results?

our findings in context, we assessed the characteristics

• What are the costs of the PRA program, and how do of PRA residents relative to people served in other HUD

they compare to costs for other HUD programs serving programs. This analysis uses 2015 Medicaid data within similar populations?

the six selected states.

To estimate PRA program impacts, the study team

• On average, PRA residents are younger and have lower constructed four statistical y matched comparison groups incomes than non-elderly people with disabilities in comprising people similar to PRA residents based on other HUD programs.

their demographic characteristics, chronic and disabling

• PRA residents are less likely to live in single-person conditions, and healthcare utilization patterns prior to PRA households than PRAC residents, but more likely than program implementation. The comparison groups are residents in NED and the other HUD programs.

drawn from non-elderly people with disabilities from the six study states in the fol owing categories:

• A larger share of PRA residents is African-American, and a smal er share is non-Hispanic white or Hispanic

• Receiving assistance through HUD’s Section 811

than residents in the comparison groups.

Capital Advance/Project Rental Assistance Contract 3

https://www.huduser.gov/portal/section-811-process-evaluation.html

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Executive Summary

• Based on 2015 Medicaid data, the prevalence of feeling safe where they live, but not to the same extent as chronic and disabling conditions tended to be higher PRAC residents do.

for PRA residents than for those in the comparison Key findings are:

groups.

• Units under contract for PRA (but not necessarily

• Likewise, before being assisted by PRA, PRA residents occupied by PRA residents yet) are heavily tended to utilize healthcare services such as inpatient concentrated in larger, newer properties with more hospital services, emergency department services, than 50 units, in either walk-up or elevator buildings.

and medical transportation more often than people in Most properties with PRA units under contract (85

the comparison groups. They were also more likely to percent) were built or rehabilitated since 2000. By have a long-term stay in an institutional setting, such comparison (and as limited by statute), nearly all PRAC

as a nursing facility, acute care hospital, or inpatient residents live in smal er properties, general y with rehabilitation facility, than al comparison groups prior fewer than 25 units, and with a smal er share of newer to receiving PRA assistance. This was expected, given properties (60 percent built since 2000).

that states often target PRA units to people leaving institutions.4

• On average, PRA units make up 10 percent of total units in properties with units under contract, wel How Short-Term Outcomes of the PRA below the 25 percent cap. While units set aside under Program Differ from Outcomes of the other state or local programs count towards the cap, Study’s Comparison Groups

information on these units was not available to the These descriptive findings informed the statistical study team. Units occupied by, but not set aside for, construction of the four comparison groups comprising people with disabilities are not included in the cap.

people living in other settings who are similar in Anecdotal y, we heard that some properties would demographics and health characteristics to those assisted exceed the cap if all of these units are included.

in the PRA program in the six study states. Constructing

• Significantly more PRAC residents reported feeling such comparison groups al ows us to attribute outcomes safe in their buildings, 92 percent, compared to 77

for PRA residents to the PRA program, rather than to percent of PRA residents. Slightly higher shares of differences in the populations served.

PRAC residents (80 percent) report they like where they live than PRA residents (76 percent), but this Quality of Properties and Neighborhoods difference is not statistical y significant.

PRA units must be located in affordable housing

• Significantly fewer PRA residents (70 percent) reported developments built with other sources of capital funding, their units are in excel ent or good condition compared with no more than 25 percent of total units set aside to PRAC residents (83 percent).

for people with disabilities. The PRA program also has incentives for grantees to assist more households by

• We measured whether residents feel integrated in subsidizing rents lower than HUD’s Fair Market Rent their community by asking whether they know other (FMR) that is the basis for determining subsidy payments people in their buildings and in the neighborhood.

in the Housing Choice Voucher (HCV) and some other PRA residents were significantly less likely than PRAC

HUD programs. These requirements underscore the residents to report knowing people in their buildings program’s goals of housing people in mixed population (81 percent vs 93 percent) or in their neighborhoods properties, where both those with and without disabilities (38 percent vs 65 percent).

live, in a cost-effective, person-centered way.

We found a number of statistical y significant differences We analyzed administrative data on PRA and PRAC

between the neighborhoods where properties with properties and our survey of a sample of PRA and PRAC

PRA units are located and those where comparison residents to determine if PRA units meet program goals group members live. On average, PRA residents live in and residents’ needs and preferences. We found that neighborhoods with higher residential density (that is, PRA residents live in neighborhoods with higher poverty buildings with 50 or more units) and lower rates of single-rates and lower levels of education and higher residential family owner-occupancy than the comparison groups.

densities than similar people in other HUD programs PRA residents live in neighborhoods with greater access (PRAC, NED, and other HUD). On average, PRA residents to public transit and higher rates of “walkability” than the reported liking their buildings and neighborhoods and comparison groups, factors that could contribute to their quality of life and potential y to improved health.

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Executive Summary

• Relative to the comparison groups, census data Access and Use of Community-Based indicate PRA residents also live in neighborhoods Services and Tenancy Supports

where a significantly higher share of non-elderly adults The PRA program requires residents be eligible for (age 35 to 64) self-report a disability, lower shares Medicaid-funded HCBS or similar state plan services to of all adults have an Associate degree or higher, and ensure that residents will have the supports they need more households have incomes below the poverty to live successful y in the community. Medicaid can line. Further, PRA residents live in neighborhoods with fund certain tenancy support services to help Medicaid statistical y significant higher exposure to harmful beneficiaries find, apply for, move to, and remain stably environmental toxins, according to federal data from housed in community-based housing, although the exact the Environmental Protection Agency (EPA).

mix of services varies by state. It can also pay for other

• PRA residents are significantly less likely to report community-based services that ensure beneficiaries’

feeling safe in their neighborhoods (68 percent) health and wel -being, such as personal care assistance, compared to PRAC residents (87 percent).

home healthcare, or transportation assistance. These However, despite some potential chal enges to their services are intended to support residents’ health status neighborhood environments, the majority (73 percent) and successful community living experience. Community-of PRA residents report they like their neighborhoods.

based services are available under Medicaid waiver This percentage is less than the share of PRAC

programs, state plan services, and community-funded residents (84 percent) who express satisfaction providers. Not all PRA residents are necessarily eligible to with their neighborhoods, but this difference is not receive all services available in their communities.

statistical y significant. (The study did not conduct We surveyed PRA residents in the six study states surveys of residents in other HUD programs, so their about their use of and experience with the services they perception of their neighborhood is unknown.) receive in their homes and their perceived quality of life The analyses of property administrative data and of and health status. We also surveyed similar residents in resident survey responses are not representative of al PRAC properties to see whether their experiences properties and neighborhoods where PRA residents differed from PRA residents. In PRAC, the nonprofit will eventual y live. The analyses represent only a subset sponsors that developed and operate PRAC housing are of the units and households that will eventual y be responsible for ensuring residents have the services and assisted by PRA. The properties represent less than community supports they need to remain in their homes.

half of the estimated PRA units the six study states plan Services in both programs are voluntary for residents.

to assist with their PRA programs.5 Likewise, the resident Results showed:

survey responses represent the experience of a subset

• The majority of PRA and PRAC residents report that of PRA residents at an early point of their tenancy, and the tenancy supports and other services they receive do not reflect the experience of all residents being meet their needs. Significantly more PRA residents assisted by PRA at the time or who will be assisted by reported receiving help with their lease application to PRA in the future.6

move into their apartment.

In addition, the evaluation’s results only apply to the six

• Overal , both PRA and PRAC residents rated the states participating in the study and are not representative quality of their services wel , but some residents in of the PRA program in all of the states that have PRA both groups report gaps in services. Notably, among programs. The states were selected based on the the one-quarter of each group who reported needing implementation status of their programs after two years help with medications, 65 percent of PRA residents of grant funding, based on the number of PRA units reported they had gone without medication because leased in FY17. In many cases, the states that were able there was no one to help them, compared to 15

to implement their programs more quickly than others had percent of PRAC residents, a statistical y significant prior experience with supportive housing programs or had difference.

previous state-level agency partnerships.

• PRA and PRAC residents report no statistical y significant differences in healthcare services received, amount of care provided by friends and family, or quality of care received from caregivers.

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Executive Summary

• Most PRA and PRAC residents rate their quality of life post-acute care services, hospice care, and prescription and overall health as at least okay, but significantly drugs among dual-enrol ed individuals. Medicaid only more PRAC residents rate their quality of life and pays for specific services not covered by Medicare and overall health as good or excel ent than PRA residents.

sometimes covers the cost of premiums, deductibles,

• PRA and PRAC residents have similar rates of exits co-pays, or co-insurance (benefits vary across states).

(about 20 percent a year), but PRA residents are more We cannot be certain that we captured services that likely to leave for non-payment of rent than PRAC

were entirely paid by Medicare. Thus, it is likely we have residents do.

underestimated healthcare utilization by PRA residents and the comparison groups. Moreover, PRA residents Healthcare Utilization of PRA Residents were less likely than the PRAC, NED, and other-HUD

We found that, in less than one year after PRA residents groups to be dual-enrol ed, so we may have overestimated moved into PRA units,

the impact of PRA on healthcare utilization during tenancy to some degree.

• PRA residents tended to use inpatient hospital, emergency department, medical transportation, and Costs of PRA and Comparison to Other HUD

long-term inpatient services at lower rates than similar Programs Serving Similar Populations individuals in the comparison groups, but few of the The PRA program leverages rental assistance in differences were statistical y significant.

multifamily developments built with other capital funding

• We did find statistical y significant differences in sources such as the Low-Income Housing Tax Credit healthcare utilization after receiving housing assistance (LIHTC) program. To promote cost-effectiveness, the between PRA residents and people not receiving program seeks to maximize the number of units assisted HUD assistance: lower use of long-term inpatient at the lowest feasible per unit subsidy cost, while care services and greater use of case management maintaining the long-term affordability requirements of services. The absence of statistical y significant the units. Additional y, PRA residents must have access differences among the HUD programs in utilization of to Medicaid-funded or state plan services that help them health care services suggests that housing subsidies transition to and remain stably housed in community-to help people with disabilities remain in community-based housing and ideal y reduce use of costly long-term based housing may matter more than the type of care and emergency department services.

housing assistance. Because of small sample sizes To assess the PRA program’s cost-effectiveness relative and the short fol ow-up period, this inference should to other programs, we col ected program documents and be viewed with caution, however.

analyzed available administrative data on program costs

• PRA residents were more likely to use personal for the PRA program and the comparison group programs care assistance or case management services, that are assisted by HUD (PRAC, NED, other HUD

the study’s proxies for Medicaid-funded HCBS.

programs). Specifically, we analyzed capital costs, rental These differences may reflect greater access to or subsidy costs, healthcare and disability-related services coordination of services, or a history of unmet (paid or unpaid), and program administrative costs.

needs prior to PRA tenancy.

The cost structures across programs are very different, This analysis provides early evidence that the PRA the PRA program is still in the relatively early stages program might have a substantive long-term impact on of implementation, and the cost data available to the healthcare utilization in a population with many unmet study team are not complete across all the comparison healthcare needs. There are caveats to drawing definitive groups, for all cost categories. The study also found that conclusions, however. The PRA tenancy period in this PRA residents in the study states had higher prevalence evaluation was one year or less, and it is likely too short of chronic and disabling conditions and tended to use a period to detect or attribute significant changes in healthcare services at higher rates than individuals in the patterns of healthcare utilization to the PRA program, comparison groups.

particularly in rare outcomes like transitions to long-term Given these caveats, our preliminary findings are: care institutions.

• Rental subsidy costs for PRA residents are higher than Additional y, while we estimate that between 20 and 40

for PRAC residents, but lower than for NED and the percent of PRA residents and members of our comparison other HUD-assisted housing programs. Per unit annual group are dual-enrol ed in Medicaid and Medicare, rental subsidies range from $6,841 for PRA units to we had access only to Medicaid data. Medicare is the $7,872 for NED vouchers.

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H U D S e c t i o n 811 P R A P ro g r a m – P h a s e I I E v a l u a t i o n

Executive Summary

• Estimated total housing costs (capital and rental Securing PRA Units under Contract subsidies) are $11,800 per unit, per year for PRA units, As of September 2018, national y PRA grantees and their compared to between $12,000 and $13,000 per unit partners have secured contracts for approximately 2,200

per year for PRAC units. The estimated annual cost of of the 6,000 units the program is expected to assist. The rental assistance in the PRA program is $6,941 while PRA program has successful y attracted owners wil ing capital subsidy costs are estimated at $4,969 annual y.

to enter long-term rental assistance contracts, general y (Capital subsidies are either unknown or not applicable at rents below the program’s limit set at HUD’s Fair for the other comparison groups.) In the PRA program, Market Rents. Roughly one-third of units committed to many capital costs are incurred by non-HUD programs the program are under lease, although most residents such as the Low-Income Housing Tax Credit.

had been housed less than one year at the time of this

• Program administrative costs are much higher for the evaluation.

PRA program ($5,780 per unit, annual y) compared to The majority of PRA residents report that they like where the comparison group costs of less than $1,000 per they live and feel safe in their neighborhoods, but a unit annual y. Grantee costs represent just less than quarter of residents report concerns with property quality half (43 percent) of the administrative costs, state and safety. A fifth of PRA residents report unresolved agency partner costs represent about 50 percent, maintenance issues. PRA residents are less likely to and the cost to HUD represents about 7 percent.

report that they feel safe in their building or neighborhood PRA costs may go down as the program matures compared to PRAC residents. While PRA units are and more residents are housed, potential y driving located in neighborhoods with higher rates of walkability down per-unit costs.

and access to public transportation than most of the

• In al , total annual program costs are $17,577 per PRA comparison groups, PRA units are located in census unit compared to almost $14,000 for PRAC units.

tracts with higher concentrations of poverty, lower

• The annual estimated cost of healthcare and disability levels of education, and lower levels of owner-occupied services for PRA residents is $51,179, slightly higher housing. PRA residents also live in neighborhoods with than for PRAC ($50,321), and substantial y lower higher exposure to harmful environmental toxins. Several than for NED ($56,025). For residents of other HUD

grantees have sought waivers to increase targeted rents, programs, the annual estimated healthcare and given the challenges of attracting units with modest disability costs were much lower, $34,204.

rents. If granted, higher rents may attract more owner interest and give PRA residents more choices of units and Strategies to Address

neighborhoods.

Implementation Challenges

Identifying and Selecting the PRA Target Populations PRA grantees and their partners are successful y housing Identifying the Right Unit for the Right Person, the vulnerable groups that grantees target. In the six study at the Right Time, Continues to be the Central Challenge of the PRA Approach

states, about half of the 1,459 planned units are occupied.

Almost half of PRA residents were previously living in As documented by Phase I of the evaluation, the PRA institutions (27 percent) or experiencing homelessness (20

program is challenging to implement. The program’s percent) before moving to a PRA unit. PRA residents to administration and cost structure differ in a number date have histories of high rates of chronic and disabling of ways from HUD’s other rental subsidy programs.

conditions and higher rates of healthcare utilization than In addition, grantees primarily target populations with people in HUD’s other assistance programs that serve extensive needs—those who have been living in or are at non-elderly people with disabilities.

risk of admission to institutions, and those experiencing or at risk of homelessness. Finding and engaging While the PRA program is reaching and engaging eligible PRA applicants and matching them to available, applicants, ineligibility continues to be an issue. Many appropriate units that meet their needs and preferences—

applicants do not meet PRA program requirements for where and when they are ready to move—is very income or Medicaid eligibility. Even those who do may challenging. States are working to meet these challenges not meet the leasing requirements (for example, credit in multiple ways.

and criminal records checks) at the property where they wish to live. Grantees have greater success reaching these populations and clarifying eligibility when outreach strategies are tailored to the needs and current 6

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Executive Summary (pre-PRA) living situations of each group. Finding effective, needs, and reasons for program exits. Grantees and efficient ways to manage eligibility determination and their state partners may also want to monitor differences waiting lists also facilitates timelier housing placement, in tenancy outcomes by target population to see if as do strategies to work with property owners to mitigate some populations are more successfully maintaining concerns about poor credit or criminal histories.

community-based housing than others. Results after less than one year in housing appear promising but may Achieving Stable Housing and Access to Community-based Services

not be definitive. The ongoing study is challenging, given how complicated and costly it is to acquire and match PRA residents should have access to the community-HUD and Medicaid data. We encourage HUD and CMS

based services they need to ensure they can remain in to pursue opportunities to streamline data sharing in their homes as long as they like and to promote positive ways that protect individual privacy and support rigorous health outcomes. Given the short tenure of most PRA research. In addition to pursuing opportunities to share residents, we cannot say definitively that these goals are data among federal agencies, HUD and CMS should being reached, but early evidence indicates that PRA explore similar opportunities to share data with state residents use fewer high-cost healthcare services after housing or Medicaid agencies. Such partnerships could they are housed than they did in the pre-occupancy period include technical assistance for state agencies in linking or relative to similar populations living in other housing and interpreting data.

settings. This provides early evidence that positive outcomes may be observed in the future.

It is not clear that PRA grantees will be able to continue securing high-quality units at rents below FMR, especially Sustaining PRA Partnerships to Ensure Effective Ongoing in high-cost areas. Overall PRA residents report a positive Implementation of the PRA Program experience with their housing and neighborhoods but The ultimate goal of the PRA program is to create not to the same degree as PRAC residents. HUD should institutional knowledge and capacity within states to exercise flexibility in working with grantees who further expand the availability of supportive housing seek waivers to increase rents to FMR. This strategy for people with disabilities. At the core of this effort are potential y has dual benefits. It should help attract owners sustainable partnerships between health and housing with high-quality housing and provide more housing agencies that can bring together their respective choices to PRA applicants. It will have cost implications resources and expertise. These partnerships grow over however, as average per-unit costs may increase.

time, and many have their antecedents in previous state or Incentives in future PRA grant Notices of Funding CMS initiatives.

Availability (NOFAs) that promote locating units in higher quality neighborhoods, rather than incentives for setting The grantees we evaluated see their partnerships as contract rents lower than the maximum al owed, could successful and offer insight into strategies to forming and be another tool to attract PRA units in neighborhoods deepening them. These include regular meetings and PRA residents perceive as safe. As could strengthening communication, recognizing and valuing the expertise inspections requirements for units placed under contract of each partner, and automating or documenting key for PRA.

knowledge and functions so they are not lost when individual staff move on. As documented in the cost PRA partnerships between state housing and health analysis for this study, however, the intensity of this effort agencies have the potential to help break down silos contributes to relatively high PRA program administrative across systems that have traditional y not been wel -

costs compared to other HUD programs.

coordinated, but program administrators report that they are time-consuming and costly. Costs may go down in Policy Implications for State

the longer term, but HUD and CMS should continue to and Federal Stakeholders

support technical assistance to grantees and their Based on the results of this study, we see early evidence partners to build capacity, share information and tools that the PRA program is achieving its aims. Grantees are across grantees, and institutionalize knowledge so that moving eligible households to community-based housing, staff turnover is less disruptive.

and early outcomes appear promising. The research HUD should explore how the PRA cap of 25 percent raises several policy implications and suggestions for units set aside for people with disabilities interacts further inquiry.

with state incentives and property owner experience.

Going forward, HUD should continue to monitor PRA grantee reporting indicates that PRA units total tenancy outcomes in program tenure, unmet support just 10 percent of all units in developments with units 7

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Executive Summary under contract, well below the 25-percent limit. However, While the short observation period for PRA-supported some state affordable housing strategies (notably residency limits our ability to draw definitive policy through states’ Low-Income Housing Tax Credit program implications regarding healthcare impacts, we did observe al ocation processes) provide incentives for higher set-some differences in service utilization over the short asides of housing for people with disabilities that may term that could translate into long-term trends. People conflict with the PRA cap. Further, anecdotal y we heard with disabilities in our study groups who were receiving that some developments have additional people with housing assistance through HUD had lower rates of disabilities living in their properties who are not in set-institutional care than those not supported by HUD

aside units.

programs. Community-based supports such as use of What the “right” set-aside level should be to ensure personal care attendants, are on average less costly than community-integrated housing is difficult to assess. If institutional care and can contribute to improved health states reduce incentives in other programs to set aside status and reduction in unplanned and emergency care.

units for people with disabilities to align with the PRA CMS should continue to work with states to support program’s caps, it may reduce the overall expansion of provision of HCBS, through Medicaid or other state the supply of units for this population. HUD should work funding sources, coupled with housing supports, to with states to explore how their incentive structures affect assist people with disabilities to live independently the shared federal-state goals of expanding housing and promote more cost-effective utilization of opportunities for people with disabilities while permitting healthcare services.

them to live in integrated settings.

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U.S. Department of Housing and Urban Development Office of Policy Development and Research Washington, DC 20410-6000

February 2020

Document Outline

Executive Summary

The Section 811 Project RentalAssistance Program

Evaluating the PRA Program

Key Findings from thePhase II Evaluation

Strategies to AddressImplementation Challenges

Table of Contents

Executive Summary

The Section 811 Project RentalAssistance Program

Evaluating the PRA Program

Key Findings from thePhase II Evaluation

Strategies to AddressImplementation Challenges