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Massachusetts Pay-For-Success Homeless Housing Initiative Exceeds Outcome Targets

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By OPEN MINDS Circle

The Massachusetts Alliance for Supportive Housing (MASH) Pay for Success (PFS) initiative designed to reduce chronic and long-term homelessness among adults significantly exceeded its performance target. MASH PFS began in 2015 with the goal to house 500 to 800 individuals over six years (from 2015 through 2021). However, the program has now successfully placed over 1,055 high-need individuals into stable, supportive housing. About 85% are still in the housing or had a “positive exit” to other permanent housing or more appropriate care.

The MASH PFS initiative focuses on providing permanent, low-threshold supportive housing to people who would otherwise rely on emergency resources, including homeless shelters and emergency health care. MASH is a partnership of the Massachusetts Housing & Shelter Alliance (MHSA), United Way of Massachusetts Bay and Merrimack Valley and Corporation for Supportive Housing (CSH). MASH PFS has led to systemic changes such as:

  1. Expansion of supportive services through Medicaid (MassHealth): MassHealth funding for supportive services to sustain people in housing can provide a flexible funding stream for providers to underwrite staffing and coordinated care. As a result of the MASH PFS partnership, this funding is now available to all eligible individuals experiencing chronic homelessness who are insured through MassHealth.
  2. Broadened service eligibility: Participants were selected based on criteria such as past use of acute care services and medical diagnoses instead of eligibility requirements involving a strict “chronic homelessness” definition. This allowed providers to house the individuals who would benefit most from MASH PFS housing and coordinated services.
  3. Increase in low-threshold vouchers: The Commonwealth of Massachusetts made 145 low-threshold housing vouchers available to the MASH PFS partnership for individuals who may struggle to meet eligibility requirements for traditional rental assistance programs.
  4. Demonstrate the power of collaboration: The MASH PFS partnership effectively demonstrated the value of cross-sector collaboration in solving complex problems. MASH brought the public, non-profit and corporate sectors to the table and will continue to advocate for the expansion of permanent supportive housing for individuals, families, youth, and young adults experiencing chronic and long-term homelessness.

The MASH PFS initiative leveraged a mix of philanthropic contributions and private investor capital from Santander Bank, CSH and United Way to provide upfront funding for housing and supportive services. Under this innovative financing model, if the original goals of the MASH PFS initiative were met, the state government would compensate investors for undertaking the investment risk. If the goals were not met, the state government was not obligated to repay investors. An independent evaluator, Root Cause, was engaged to determine whether the MASH PFS initiative achieved its goals. Performance-based payments to provider agencies were also issued and paid out at every milestone.

In the six months prior to securing supportive housing, the individuals now housed through MASH PFS had accumulated, in total: 78,260 nights in emergency shelters, 4,713 days in the hospital, 1,881 emergency room visits, 1,395 nights in drug detoxification, and 880 ambulance calls. MASH PFS has generated average savings of $5,267 in health care costs per tenant per year. This was accompanied by a significant shift from emergency and acute care to outpatient care. Medicaid coverage has also expanded to cover tenant support services for individuals with a history of chronic homelessness to help them obtain and maintain permanent housing.

These outcomes were reported in “Massachusetts Alliance for Supportive Housing Pay for Success Program Report, November 2021” by MASH. In addition to MASH’s reporting, the Blue Cross Blue Shield of Massachusetts Foundation funded an analysis of healthcare financial data, housing statistics, and Medicaid claims data. The goal was to determine the overall results of the MASH PFS program.

For more information, contact:

  • Brigid Boyd, Senior Vice President, Communications, United Way of Massachusetts Bay and Merrimack Valley, 9 Channel Center Street, Suite 500, Boston, Massachusetts 02210; 617-624-8252; Email: bboyd@supportunitedway.org; Website: https://unitedwaymassbay.org/
  • Joyce Tavon, Senior Director, Policy and Programs, Massachusetts Housing & Shelter Alliance, Post Office Box 8638, Boston, Massachusetts 02114; Email: jtavon@mhsa.net; Website: https://mhsa.net/
  • Audrey Shelto, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts Foundation, 101 Huntington Avenue, Suite 1300, Boston, Massachusetts 02199-7611; 617-246-6783; Fax: 617-246-3992; Email: audrey.shelto@bcbsma.com; Website: https://www.bluecrossmafoundation.org/