Integrating housing development into its broader health care operations has allowed CCH to focus more holistically on patient health and stability. While they have routinized many aspects of financing and development, it is clear that their expertise grew and matured over time and is continuing to evolve as their reputation for high-quality projects expands. HCH programs (and others) interested in developing housing should partner with developers in their local community who have this experience. Start with smaller projects and determine how to grow further once the partnerships and learning curve progresses. Involving board members, staff, clients, and community partners in all phases of housing development (from concept to ribbon-cutting) will establish credibility and buy-in from key stakeholders and serve as a platform to grow further. This policy brief outlines how CCH became a national leader integrating health and housing, but their model can be replicated elsewhere with strong leadership and vision.

The development costs for the housing and service projects are funded using a combination of Federal Low Income Housing Tax Credits (LIHTCs), Private Activity Bond (PAB) Tax Credits, New Market Tax Credits, federal, state and local grants and loans, foundations grants, and occasionally CCH fundraising. Operational costs are provided through tenant rents (set at 30% of adjusted gross income for those with rental assistance) and federal, state, and local housing vouchers. CCH generally does not utilize (or only carries minimal) permanent debt on any project. Each building is controlled by CCH via subsidiary corporations and limited partnerships and maintained by CCH/RHDC. Colorado does not currently have a housing trust fund that reserves funding for affordable housing. Instead, various agencies solicit proposals for projects, including Colorado Housing Financing Authority (CHFA – tax credits and a variety of loan sources), Colorado Division of Housing (DOH – Federal pass-through and State funding), and local municipal programs (Federal pass-through and dedicated housing grant funds).