Housing
Everyone Deserves a Place
to Call Home
There are over 6,000 people with serious mental illness on housing waitlists in Arizona. Many families are housing their loved ones themselves — with no plan for what happens when they can no longer provide that care. We need a better system. Now.
The Crisis
Housing Is the Foundation — And It's Crumbling
Without stable housing, nothing else works — not medication management, not therapy, not community integration. Yet Arizona's housing system for people with serious mental illness is broken at every level.
Over 6,000 individuals with SMI are waiting for permanent supportive housing in Arizona. The waitlist grows every year.
The majority of individuals with SMI also have a co-occurring substance use disorder, requiring integrated treatment — not just a roof.
Arizona has zero comprehensive campus-style housing programs designed specifically for the SMI population with multiple levels of care.
Many families are housing their loved ones right now. When parents age or pass away, there is no safety net. No transition plan. Nothing.
The Federal Barrier
The IMD Exclusion: A 1965 Law Still Blocking Care
The Institutions for Mental Diseases (IMD) Exclusion is a federal Medicaid rule dating back to 1965 that prohibits Medicaid payments for care in residential facilities with more than 16 beds that primarily treat mental illness.
This means the very campus-style housing models that work best for people with serious mental illness — facilities with 100+ beds, multiple levels of care, on-site clinics, and 24/7 staffing — cannot be funded through Medicaid under current federal law.
How the IMD Exclusion Hurts Arizona Families
- ✕Limits residential facilities to 16 beds to qualify for Medicaid — far too small for the campus models our families need
- ✕Forces states to choose between comprehensive care and federal funding
- ✕Creates a patchwork of small, disconnected group homes instead of integrated communities
- ✕Does not apply to nursing homes, prisons, or hospitals — only to mental illness facilities
The IMD Exclusion is one of the most discriminatory policies in American healthcare. It treats serious mental illness differently than every other medical condition. Arizona Mad Moms supports federal efforts to repeal or reform this exclusion — and in the meantime, we are fighting for state-level solutions like SB 1630 (ALTCS-SMI) to work around it.
The Legislative Fight
SB 1630: ALTCS-SMI Could Change Everything
Arizona's ALTCS program already provides attendant care, supervised living, and medication administration for people with Alzheimer's and other physical conditions. But people with serious mental illness? They get none of it.
SB 1630 would create an ALTCS-SMI program — bringing the same home and community-based services to individuals with serious mental illness. This is the funding mechanism that could make campus-style housing a reality in Arizona.
Services ALTCS-SMI Would Fund
Why This Matters for Housing
The IMD Exclusion blocks Medicaid from funding large residential facilities for mental illness. But ALTCS-SMI takes a different approach — it funds services delivered to individuals, not facilities. This means:
- →On-site medication management and nursing care could be funded through ALTCS-SMI regardless of facility size
- →Supervised community living and attendant care could support the campus model our families envision
- →Blended funding (Medicaid, Medicare, private, corrections) becomes possible when ALTCS covers the service layer
Our Vision
The Campus Model: What Our Families Need
Through strategic planning workshops with families, caregivers, and housing experts, Arizona Mad Moms has developed a comprehensive vision for what permanent supportive housing should look like for the SMI community. Not a group home. Not a shelter. A community.
Inspired by models like Psynergy's SLO Vista Campus in California, the Dementia Village in Amsterdam, First Place for neurodivergent individuals, and Rainbow Acres — we envision a multi-level campus where individuals can live permanently, with dignity, in a community designed around their needs.
Living & Design
- •Individual and shared units based on personal preference
- •Multiple levels of care on one campus — residents move across levels as needs change
- •Trauma-informed, therapeutic design throughout
- •Secure perimeter with voluntary exit protocols for psychosis-level care
Clinical & Medical
- •On-site psychiatrists, nurses, and behavioral health staff
- •Medication administration — including clozapine monitoring
- •24/7 crisis response without calling 911
- •Integrated substance use disorder treatment
Community & Enrichment
- •Vocational programs and meaningful daily activities
- •Social spaces, gardens, art, and recreation
- •Peer support and mentoring within the campus community
- •Gradual supported integration into the broader community for those ready
Family & Support
- •Family visitation and family education center on campus
- •Respite care for caregivers
- •Transparent communication with families — no HIPAA stonewalling
- •Long-term residential option — permanent for those who need it
The Guiding Principle
“70% hospitality, 30% services. Long-term sustainable housing with a slow migration out to the community — for those who are ready. Permanent for those who need it.”
Making It Real
Funding & Accountability
A campus model of this scale requires creative, blended funding — and real accountability. California passed a billion-dollar bond to fund similar programs. Arizona needs its own path forward.
Blended Funding Model
No single funding source can cover a campus of this scope. We are building a model that layers multiple streams together — making the whole sustainable without depending on any one source.
- →
ALTCS-SMI (SB 1630)
Service-layer funding — attendant care, nursing, medication administration
- →
Medicaid HCBS Waivers
Home and community-based services for eligible individuals
- →
Medicare
Eligible residents' clinical and medical services
- →
State General Fund
Capital investment in housing infrastructure
- →
Criminal Justice Reinvestment
Redirect costs saved by reducing incarceration and ER use
- →
Private Philanthropy & Bonds
Arizona-specific housing bond modeled on California's Proposition 1
Accountability We Demand
Arizona's behavioral health system has a fraud and neglect problem. Any new housing model must be built with oversight structures that prevent the failures we've seen in BHRFs — from day one.
- ✓Independent oversight board with mandatory family representation
- ✓Regular facility inspections with publicly posted results
- ✓Outcome tracking: hospitalization rates, medication compliance, quality of life measures
- ✓RBHA contract accountability — performance tied to funding
- ✓Anti-fraud enforcement with real consequences
- ✓Transparent family grievance and appeal procedures
6,000 People Are Waiting. We Can't Wait With Them.
Every day without safe, permanent housing is another day a family is in crisis. Help us build the housing system Arizona's SMI community deserves.