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Promise Comprehensive Services

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                             SERVICES AND ELIGIBILITY

 

                                                      SERVICES AND ELIGIBILITY


As our agency’s name suggests, we provide many services all of which are geared towards assisting the people we serve to either move back to suitable and stable housing in the community if they are living in institutions or help them to maintain their community living if they are at risk of being institutionalized or at risk of loosing their housing. We then help connect them with medical, social, financial, educational, legal, safety and many other services and resources that will ensure their safety, independence, health and an overall improved quality of life. Eligibility for our services is contingent on having an active Medical Assistance (MA) and (for some of our services) also being on a waiver.

Below are the services we provide described in greater details.



             1.                            RELOCATION SERVICE COORDINATION


Relocation Service Coordination-Targeted Case Management (RSC-TCM) is a six months Medicaid-funded service that assists people who have an active Medical Assistance and who are living in qualified institutions like nursing facilities, hospitals, some Mental Health Treatment facilities and ICF/MR homes, to move back to suitable housing in the community and connect them to needed services and resources that will help them live safely and with greater independence once back in the community. When we find a suitable and stable housing for the people we serve, we arrange for them to have the services they will need in the community before we move them. If you or a loved one is living in any of the above institutions and you want to move back to the community or want your loved one to move back to the community and would like us to help with that, please do one of the following:

  • Call us at 651-739-6933. Or email us at: rihrehali@promisetransition.com
  • Fill out our referral form on this website and click send or submit.
  • Contact your facility social worker and let him or her know that you would like to move back to the community and would like our agency to help you find a suitable housing setting in the community.
  • If you are in an institution in Hennepin County, contact your county case manager who usually visits the facility you live at and tell him or her that you want to move back to the community and would like our agency to help you do that.
  • Call your county case worker and tell him or her you are in an institution and would like our agency to help you find suitable housing in the community.

Once we receive your call or email, we will immediately take the necessary steps to get services started for you. If you contacted your facility social worker, he or she will contact your county case manager or your county intake or contact us and the necessary steps will be put in place to get services started.

Suitable placement differs depending on the person’s needs. Someone might need a group home, an adult foster care, a customized living, an assisted living or independent housing with or without services. For those who are moving to their own Apt, we also help them get basic furniture, security deposit, moving services and basic household supplies through Transitional Services if they have a waiver. For those who do not have a waiver, we can help them get furniture and other household supplies through Bridging.



2.                 MOVING HOME MINNESOTA TRANSITION COORDINATION


Like Relocation Service Coordination, Moving Home Minnesota (MHM) is a six-months Medicaid (MA) funded service that helps people living in qualified institutions and who want to move back to the community.

The difference between RSC and MHM is that in addition to having an active MA at the time service begins, someone must have also lived at least 90 consecutive days in a qualified institution or institutions in order to qualify for the service. The person must also sign an Informed Consent Form after he or she has been briefed about the service and if he or she wants to proceed.

Someone who uses MHM to move to an independent housing or an assisted living setting where he or she has his/her own Apt, the person is eligible for Transitional Services through MHM. These include basic furniture, basic household supplies, security deposit and moving services. If the person has a waiver, he or she will get Transitional Services through their waiver. Those who do not move with a waiver will also have MHM Case Management for 12 months to help them maintain heir housing and succeed after they move back to the community. They may also benefit from other MHM services like Comprehensive Community Support Services (CCSS), Overnight Assist, Emergency Alert System and many more.

If you have lived in a nursing home or another institution for 90 consecutive days and would like us to help you find housing in the community through MHM please inform your floor social worker at the nursing home and tell him or her you need help finding housing in the community and that you would like our agency to help you.

You can also contact us directly through one of the following:

Call us at 651-739-6933. Or email us at: rihrehali@promisetransition.com. 

 Fill out our referral form on this website and click send or submit


  

3.                                          HOUSING ACCESS COORDINATION


Housing Access Coordination (HAC) is a home and community-based service that assists people 18 and over on a waiver, who are facing housing instability or who are at risk of being institutionalized in finding stable and independent housing that is not owned or operated by a service provider. Anyone on a qualified waiver (CADI, EW, TBI, DD, CAC) living in the community with family or friends, in an assisted living, in a customized living, in a group home or adult foster or living independently but at risk of losing their housing or who just want to move to another housing or to a different location is eligible for HAC. The type of housing someone on HAC is moving to must be an independent housing that is not owned or operated by a service provider. That means housing with on-site services are not eligible for HAC. However, after moving to their independent housing the HAC beneficiary can have visiting services like PCA, ILS, Nurse visits, Homemaker Services, and other needed but outside services covered through their waiver or MA. During the search for a suitable independent housing, the HAC staff works closely with the person, his/her case manager, and his/her support team.

When a suitable housing has been found, the HAC worker will help the person served with all leasing formalities and help explain the leasing terms very clearly to the person. The HAC worker then assists the person with packing, moving, and unpacking.

HAC clients are also eligible for Transitional Services through their waiver. That means their waiver can help pay security deposit, provide basic furniture, basic household supplies, and moving services.

After the move, the HAC staff does a follow-up time to make sure the person fully settles at the new home and everything is going well.

If you are 18 and over and, on a waiver, and need help finding an independent housing and would like our agency to help you, please talk to your case manager.

You can also contact us directly through one of the following:


Call us at 651-739-6933. Or email us at: rihrehali@promisetransition.com

Fill out our referral form on this website and click send or submit.             



4.                       COMPREHENSIVE COMMUNITY SUPPORT SERVICES


Comprehensive Community Support Services (CCSS) is one of the Moving Home Minnesota services that accompany someone who has just used MHM to move back in the community to an independent housing. Irrespective of whether the person is on a waiver or not, he or she can benefit from CCSS so long as MHM transition coordination was used to move from an institution back to the community. The referral for CCSS can be made by the MHM case manager or by the county case manager if the person has a waiver. Among others, the following are areas the Community Support Specialist focuses on:

  • Independent Living
  • Learning
  • Working
  • Socializing
  • Recreation


Sometimes clients face challenges that aren’t exactly clinical. They often need help acquiring certain life skills or accessing community resources. CCSS steps in to fill this gap. A Community Support Worker (CSW) supports individuals and families with the services and resources to help promote recovery, rehabilitation, and resiliency.

Interacting face-to-face and on behalf of the client in community locations, a Community Support Worker utilizes a variety of interventions to address any barriers that impede the client’s development toward independent functioning in the community.

If you are a MHM Case Manager or a waiver Case Manager working with someone who has recently used MHM to move out of an institution to the community and you think he or she will benefit from Comprehensive Community Support Services please contact us through one of the following:

- Call us at 651-739-6933. Or email us at: rihrehali@promisetransition.com.

- Fill out our referral form on this website and click send or submit




5.                                                     TRANSITIONAL SERVICES


Most of the time, after RSC, MHM or HAC has helped a person find housing and the client is all excited about moving home to his or her new Apt and becoming more independent, he/she is faced with the problem of security deposit, furniture, household supplies, and moving services to transport their belongings from storage or a family or friend’s home to the new home. Transitional Services is a program that helps in such situations for those who are eligible either through their waiver or through Moving Home Minnesota. Transitional Services helps with security deposit, moving services, basic furniture and basic household supplies for those eligible so long as they are moving to their own home or Apt.


If you are a Relocation Coordinator, Moving Home Minnesota Transition Coordinator, Housing Access Coordinator or Case Manager who needs to provide Transitional Services for your eligible clients please contact us through one of the following:




6. HOUSING STABILIZATION SERVICES : TRANSITION & SUSTAINING

Housing Stabilization Services is yet another new program introduced by the Minnesota DHS in 2018 with the goal of reducing homelessness and preventing homelessness through helping qualified individuals in need of housing to find one and helping those who were at risk of losing their housing to maintain it.  The program effectively started in August 2020.

To be eligible for Housing Stabilization Services, you must meet some of the following criteria:

  • Be on Medical Assistance (MA)
  • Be 18 years old or older
  • Have a documented disability or disabling condition, defined as one of the following:
  • A person who is aged, blind or has a disability as described under Title II of the Social Security Act.
  • A person with an injury or illness that is expected to cause extended or long-term incapacitation.
  • A person with a developmental disability (or related condition) or mental illness.
  •  A person with a mental health condition, substance use disorder or physical injury that required a residential level of care and who is now in the process of transitioning to the community.
  • A person who is determined to have a learning disability according to policy adopted by Department of Human Services (DHS); or
  •  A person with a substance use disorder and is enrolled in a treatment program or is on a waiting list for a treatment program.
  • Be assessed to require assistance with at least one of the following areas resulting from the presence of a disability or a long-term or indefinite condition:
  • Communication
  • Mobility
  • Decision-making; or
  • Managing challenging behaviors
  • Be experiencing housing instability, evidenced by one of the following risk factors:
  • Homeless. An individual or family is considered homeless when they lack a fixed, adequate nighttime residence; or
  • Currently transitioning, or has recently transitioned, from an institution or licensed or registered setting (registered housing with services facility, board and lodge, boarding care, adult foster care or community residential setting, hospital, Intermediate Care Facility for persons with Developmental Disabilities (ICF-DD), intensive residential treatment services, the Minnesota Security Hospital, nursing facility, regional treatment center); or
  • At risk of homelessness. An individual or family is at risk of homelessness when
  • a) the individual or family is faced with a situation or set of circumstances likely to cause the household to become homeless, including but not limited to: doubled-up living arrangements where the individual’s name is not on a lease, living in a condemned building without a place to move, having arrears in rent or utility payments, receiving an eviction notice without a place to move or living in temporary or transitional housing that carries time limits; or
  • b) the person, previously homeless, will be discharged from a correctional, medical, mental health or substance use disorder treatment center and lacks sufficient resources to pay for housing, and does not have a permanent place to live; would be at risk of homelessness if housing services were removed
  • At risk of institutionalization – meets an instutional level of care/eligible for the following waivers:• Brain Injury (BI)
  • - Community Access for Disability Inclusion (CADI)
  • - Community Alternative Care (CAC)
  • - Developmental Disability (DD)
  • - Elderly Waiver (EW)

  • If you or someone you know needs help finding housing or need help maintaining their housing and meets the eligibility criteria above please contact us by phone at 651-739-6933 or email us at rihrehali@promisetransition.com 

    You can also contact us by completing the "Contact Us" form on this website and click send.  



    7. COMPREHENSIVE HOME CARE


    8. HOME AND COMMUNITY BASED WAIVER SERVICES

    a. Homemaker Services: ADL Assistance, Home Management, Basic Cleaning

    b. Adult Companion Services (EW, AC)

    c. Individual Community Living Support (ICLS) EW, AC

    d. Night Supervision (CADI, BI, CAC, DD)

    e. Community Living Assistance (ESC only)