Evaluation of the Louisiana Permanent Supportive Housing Initiative

Innovating to meet the housing and service needs of seniors and people with disabilities

In the aftermath of hurricanes Katrina and Rita, Louisiana launched an innovative cross-disability Permanent Supportive Housing (PSH) initiative that was coordinated at the state level and designed to maximize community integration. Working with our partner the Technical Assistance Collaborative, we evaluated the effectiveness of the initiative and the sustainability of the model.


Our evaluation, conducted with our project partner TAC, demonstrated the effectiveness of the nation’s first large-scale cross-disability housing initiative (serving the needs of people with mental illnesses, substance use disorders, developmental disabilities and chronic health conditions, as well as frail elders and youth aging out of foster care) to include sustainable funding for both housing and supportive services.

The positive stable housing outcomes, combined with the 24% reduction in cost, helped create the sustainable model in place today and now being replicated in other locales. 

  • Evaluation
  • Quality Improvement
  • Systems Design
  • Technical Assistance and Training
  • Implementation Analysis

A coordinated, systems-level response

PSH is an evidence-based, cost-effective approach that combines permanent affordable rental housing with voluntary, flexible and individualized services aimed at assisting people with disabilities to live in the community. Louisiana’s PSH program, modeled after a program created in North Carolina, was a critical part of the state’s Road Home hurricane recovery plan following hurricanes Katrina and Rita in 2005. To address the increased number of individuals with disabilities experiencing homelessness or at risk of homelessness following the hurricanes, many state agencies, officials, and advocacy organizations came together for a coordinated, state-level response:

  • Louisiana Department of Health and Hospitals (DHH)
  • Louisiana Department of Children and Family Services (DCFS)
  • Louisiana Office of Community Development (OCD)
  • Louisiana Housing Finance Agency (LHFA)
  • Homeless and disability advocacy organizations
  • Local service partners

The resulting PSH program was unique in many ways:

  • Coordinated at the state level rather than the provider level, it systematized access to a pipeline of affordable housing units and opened up opportunities to leverage Medicaid funding and disaster recovery funds
  • It focused on integrated housing, earmarking a certain percentage of units in rental properties financed with Low Income Housing Tax Credits (LIHTCs) that mainly assisted residents without disabilities
  • It relied on local infrastructure for outreach, referral, and service coordination

The results

In Louisiana, Medicaid and disability services program leaders successfully learned how to develop a sustainable statewide community integrated PSH model. The state took careful steps to create a cross-disability management approach, and to implement a housing targeting policy that ensures that individuals exiting institutions, such as hospitals, jails and nursing homes, or who are homeless get priority access to housing and services to live successfully in the community and in their own home. All of this was accomplished while the state was re-balancing Medicaid and other federal funds to assure PSH program sustainability.

Our formative and summative evaluation was crucial to the mid-course corrections on the model and the sustainability of the PSH model.

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According to our research, the program was serving families with complex and multiple conditions. (**Louisiana had only recently instituted a substance use benefit in its Medicaid program, so the number with a primary SA diagnosis was likely underrepresented in our data.) Our analysis revealed a 24% reduction in average monthly Medicaid costs per person served in PSH households; this was largely attributable to reductions in institutional costs for people who were previously in long-term care or developmental disability facilities or who were receiving inpatient mental health care.

The Louisiana Department of Health & Hospitals

The Louisiana Office of Community Development

The Robert Wood Johnson Foundation

Project Partner(s):

Technical Assistance Collaborative

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