Section 811 Project Rental Assistance Program Phase II Evaluation
A recent research report from HUD’s Office of Policy Development and Research provides new insight into outcomes associated with HUD’s Section 811 Project Rental Assistance (PRA) Program, which provides rental assistance to extremely low-income nonelderly persons with disabilities. The Phase II evaluation of the Section 811 PRA Program examines the program’s early impact on residents across several dimensions, including housing tenancy, the use of community-based services, the characteristics of the properties and neighborhoods where assisted residents live, and residents’ healthcare diagnosis and utilization. The evaluation compared short-term outcomes of the program against outcomes for similar residents with disabilities in the Section 811 Capital Advance/Project Rental Assistance Contract (PRAC) program, in other HUD rental assistance programs, and receiving Medicaid but not assisted by HUD.
The Section 811 PRA Program is a joint effort of HUD and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services. The goal of PRA is to expand access to high-quality, affordable housing and voluntary, community-based services to allow eligible low-income nonelderly persons with disabilities to live in more integrated housing settings/ in the community. The program fosters the collaboration between state housing and health agencies to coordinate the provision of housing assistance with long-term services and supports. PRA differs from PRAC and other HUD programs that assist similar populations in several ways, including how the program identifies eligible housing, the type of rental assistance offered, the program cost structure, and the ways in which the program provides coordinated access to services.
The Phase II evaluation assessed the implementation of PRA and the program’s outcomes and effectiveness in six states: California, Delaware, Louisiana, Maryland, Minnesota, and Washington. The evaluation uses administrative data on the individuals included in the study, data on use of healthcare, interviews of PRA program administrators and other program partners, surveys of PRA and PRAC residents, and program documents. The evaluation was designed to answer the following questions:
- How do the short-term impacts of the Section 811 PRA Program compare with the outcomes for comparison groups of similar people living in other settings?
- What is the relationship between PRA features and strategies and program results?
- What are the costs of PRA, and how do they compare with costs for other HUD programs serving similar populations?
To estimate PRA program impacts, the researchers constructed the following four statistically matched comparison groups composed of similar nonelderly persons with disabilities from the six states:
- Persons receiving assistance through PRAC, which provides capital grants to develop housing exclusively for persons with disabilities and project rental assistance for operational costs. PRAC owners, like PRA owners, must ensure that residents have access to services.
- Persons receiving assistance through HUD’s Non-Elderly Disabled (NED) voucher program, which provides tenant-based rental assistance to nonelderly persons with disabilities to lease units of their choice that meet HUD’s requirements.
- Persons receiving assistance through other HUD programs, including the Housing Choice Voucher program, public housing, and multifamily assisted housing programs that serve eligible low-income people with and without disabilities.
- Medicaid recipients who do not live in HUD-assisted housing.
The analysis generated several key findings related to the Section 811 PRA Program in the six study states, ranging from the characteristics of program residents to the quality of the properties. On average, PRA residents tended to have lower incomes than similar residents in other HUD programs, which is consistent with the PRA program design of targeting lower income households. The PRA program targets a population that has more healthcare needs than the population in any other HUD program. The prevalence of chronic and disabling conditions was higher than in comparison groups and, prior to housing assistance, PRA residents used healthcare services more often and were more likely to have had long-term stays in inpatient settings than nonelderly persons with disabilities in any other HUD program.
The researchers identified differences in the quality of properties and neighborhoods of units where PRA residents live compared to units in PRAC and other HUD-assisted programs. On average, PRA residents reported liking their buildings and neighborhoods and feeling safe where they live, but not to the same extent that PRAC residents do. PRA residents tend to live in neighborhoods with higher residential density that are more walkable and have better access to public transit, but with higher poverty rates and lower levels of education than similar residents in other HUD programs.
The study found that PRA and PRAC residents report high levels of autonomy and independence. Most PRA residents report knowing other people in their building, but not to the same extent as PRAC residents do. Most PRA residents report they could be alone, eat, and see family and friends when they wanted to, but PRAC residents are more likely to report they could see their friends and family when they wanted to.
Overall, both PRA and PRAC residents reported that the tenancy supports and other services that they receive meet their needs. PRA residents were significantly more likely than PRAC residents to report receiving help with their lease application and move into the unit. Both groups were satisfied with the quality of their supportive services, although gaps were reported in some areas, such as help with taking medication. Although most PRA and PRAC residents rate their quality of life as “okay,” PRAC residents were more likely than PRA residents to report that their quality of life was “good.” PRA and PRAC residents have similar rates of exists of about 20 percent a year, but PRA residents are more likely to leave for non-payment of rent than PRAC residents do.
The study did not find statistically significant differences in healthcare outcomes between PRA residents and individuals in the comparison groups, with one exception. Compared to similar Medicaid beneficiaries not assisted by HUD, PRA residents were more likely to use case management services and less likely to use long-term inpatient care less than one year after entering the program. These results should be viewed with caution due to the small sample size and short follow-up period, but they suggest that housing assistance could help persons with disabilities remain in community-based housing.
The study tentatively concludes that the PRA program is as cost-effective as the PRAC program, but at a considerable administrative cost. Average PRA rental subsidies were $586 per unit, per month, which is $69 per month higher than the average PRAC rental subsidy and lower than monthly subsidies in NED and other HUD housing assistance programs. Total rental plus capital subsidies average $11,810 annually for each PRA unit, compared to $12,052 for each PRAC unit. Housing subsidies in the PRA program rely on the LIHTC program for capital subsidies, with HUD funds providing, on average, almost 60 percent of the total annual housing subsidy. In contrast, HUD funds provide more than 90 percent of the housing subsidies in the PRAC program.
Policy Implications and Future Research
Based on the results of the study, the researchers believe that the PRA program is achieving its goal of integrating eligible households in community-based supportive housing with positive early outcomes. Moving forward, the researchers believe that HUD and state grantees should continue to monitor tenancy outcomes, unmet service needs, and reasons for program exits over time. The study recommends that HUD exercise flexibility setting rent limits to attract high-quality properties and neighborhoods to the program. Finally, while the short period of observation limits the researchers ability to draw definite policy implications, the findings on healthcare utilization of PRA residents compared to similar individuals without HUD assistance suggests that home and community-based services combined with housing supports could help low-income nonelderly persons with disabilities to live independently and promote more cost-effective use of healthcare services.