[From the contract between CMH, Community Mental Health, and DCH, Michigan Dept. of Community Health.]

This guideline establishes policy and procedure for ensuring that the provision of mental health services and supports are not affected by where consumers choose to live: their own home, the home of another or in a licensed setting. In those instances when public money helps subsidize a consumer’s living arrangement, the housing unit selected by the consumer shall comply with applicable occupancy standards.

A. Psychiatric hospitals operated by the Michigan Department of Community Health (MDCH).

B. Regional centers for developmental disabilities operated by MDCH.

C. Special facilities operated by MDCH.

D. Residential placement agencies operated by MDCH.

E. Community Mental Health Services Programs (CMHSPs) as specified in their master contract with MDCH.

The Michigan Department of Community Health recognizes housing to be a basic need and affirms the right of all consumers of public mental health services to pursue housing options of their choice. Just as consumers living in licensed dependent settings may require many different types of services and supports, persons living in their own homes or sharing their household with another may have similar service needs. RMHA’s [Responsible Mental Health Agency] shall foster the provision of services and supports independent [regardless] of where the consumer resides.

When requested, RMHAs shall educate consumers about the housing options and supports available, and assist consumers in locating habitable, safe, and affordable housing. The process of locating suitable housing shall be directed by the consumer’s interests, involvement and informed choice. Independent housing arrangements in which the cost of housing is subsidized by the RMHA are to be secured with a lease or deed in the consumer’s name.

This policy is not intended to subvert or prohibit occupancy in or participation with community based treatment settings such as an adult foster care home when needed by an individual recipient.

Affordable: is a condition that exists when an individual’s means or the combined household income of several individuals is sufficient to pay for food, basic clothing, health care, and personal needs and still have enough left to cover all housing related costs including rent/mortgage, utilities, maintenance, repairs, insurance and property taxes. In situations where there are insufficient resources to cover both housing costs and basic living costs, individual housing subsidies may be used to bridge the gap when they are available.

Habitable and safe: means those housing standards established in each community that define and require basic conditions for tenant/resident health, security, and safety.

Housing: refers to dwellings that are typical of those sought out and occupied by members of a community. The choices a consumer of mental health services makes in meeting his or her housing needs are not to be linked in any way to any specific program or support service needs he or she may have.

Responsible Mental Health Agency (RMHA): means the MDCH hospital, center or CMHSP responsible for providing and contracting for mental health services and/or arranging and coordination the provision of other services to meet the consumers’ needs.

RMHAs shall develop policies and create mechanisms that give predominant consideration to consumers’ choice in selecting where and with whom they live. These policies and mechanisms shall also:

A. Ensure that RMHA-supported housing blends into the community. Supported housing units are to be scattered throughout a building, complex, or the community in order to achieve community integration when possible. Use of self-contained campuses or otherwise segregated buildings as service sites is not the preferred mode.

B. Promote and support home ownership, individual choice, and autonomy. The number of people who live together in RMHA-supported housing shall not exceed the community’s norms for comparable living settings.

C. Assure that any housing arranged or subsidized by the RMHA is accessible to the consumer in compliance with applicable state and local standards for occupancy, health, and safety.

D. Be sensitive to the consumer’s cultural and ethnic preferences and give consideration to them.

E. Encourage and support the consumer’s self-sufficiency.

F. Provide for ongoing assessment of the consumer’s housing needs.

G. Provide assistance to consumers in coordinating available resources to meet their basic housing needs. RMHAs may give consideration to the use of housing subsidies when consumers have a need for housing that cannot be met by the other resources which are available to them.

MCL 330.1116(j).

Federal Housing Subsidy Quality Standards based on 24 CFR § 882.10.

Housing occupied by a consumer of the Supported Community Living Program must meet the following minimum environmental standards as interpreted by MDCH based on 24 CFR § 882.10 [Housing Quality Standards]. Such housing standards shall serve as an example of standards that should be considered when seeking federally subsidized housing.

Every unit must have at least a living room, kitchen and bath. A one-room efficiency with a kitchen may be utilized provided there is a private bath.

The ceilings, walls and floors of each room should be in good condition; cracks, bulges, holes, and floor coverings that might cause someone to trip are unacceptable as is lead paint.

Each room must have at least one window that opens to the outside except for the bath where a working exhaust fan may substitute for a window. All windows designed to be operable and should open easily. All operable windows and doors that can be reached from the outside, a common public hallway, a fire escape, porch or other outside place that can be reached from the ground, must have a working lock.

The living room should have at least two wall mounted electrical outlets, or one outlet and one permanent overhead light fixture. The kitchen should have at least one electrical outlet and one permanent light fixture; the bath at least one permanent overhead or wall light fixture. Both the kitchen and bath electrical outlets must have ground fault interrupters. Table, floor and ceiling lamps plugged into sockets and extension cords do not count; they are not permanent. Broken or frayed wiring, fixtures hanging from wires with no other firm support (such as a chain), missing cover plates on switches or outlets and badly cracked outlets are not acceptable.

Both the kitchen and bath must have hot and cold running water. A bathroom sink may not be used in place of a kitchen sink and vice versa. The bathroom should have a tub or shower with hot and cold running water and a toilet that works.

Single units must have at least two unobstructed means of egress. Units in apartment complexes should have an entrance from the outside or from a public hall so that it is not necessary to go through anyone else’s living space to get into the unit.

There shall be an operating smoke detector adjacent to each sleeping area with appropriate maintenance procedures in place to keep each detector continuously operational.

If the unit is in an apartment building with elevators or stairwells, the former should be safe and work properly and the latter well lit and have railings. Any length of stairs (e.g., generally more than four steps), and porches, balconies or decks more than 30 inches above ground should have secure handrails attached.

The building foundation should have no serious leaks and the plumbing and sewage systems must be served by an approved public or private water supply system. The roof should not leak and the gutters and downspouts, if present, should be securely attached to the building. Roof leaks can usually be detected by checking for stains on the ceiling inside the building. The chimney should not lean or have big cracks or missing bricks, the water pipes should be in good condition with no leaks and no serious rust that causes the water to be discolored, the water heater should be equipped and installed in a safe manner, and the heating equipment should be adequate to provide sufficient heat to keep the unit warm during cold months. Spacer heaters (or room heaters) that burn oil or gas and are not vented to a chimney are not acceptable. Space heaters that are vented are acceptable if they provide sufficient heat.

If the service site is a mobile home, it must be placed on the site in a stable manner so as to be free from hazards such as sliding or wind damage, and there must be at least one operating smoke detector in the home with appropriate maintenance procedures in place to keep it continuously operational.

[For general information about how to get what you need from CMH, click on HOW.]

Go back to the Index to the Best Practice Guidelines, click on BPG.

Go to the Medicaid Manual, Chapter III, click on MANUAL.