Chronic Homelessness

11th June
2012
written by Lisa Stand

Leaders and innovators in supportive housing convened in Chicago last week for a multi-faceted look at integrating housing and health care. The Leadership Forum, sponsored by the Corporation for Supportive Housing, was also the occasion for the release of a “business case” for states to tap Medicaid to pay for key services in permanent supportive housing. The presenters at the day-long conference and the paper on the business case speak to recent innovations with health care and supportive housing — demonstrating what’s possible under the Affordable Care Act, and what’s actually happening in communities where state government and homeless providers are proactive.

Two stand-out ACA provisions enable homeless advocates to persuade state policymakers that supportive housing is a worthwhile Medicaid investment.

 

  • First, the “health home” benefit can be a good vehicle for funding care management and service coordination, services that make supportive housing viable as a strategy to end chronic homelessness. As the Forum audience heard, a Medicaid health home is a unique concept that has to be understood in a health policy context. But once that context is understood, it is easier to bring relevant data and analysis to Medicaid decision-makers. The business case illustrates that if Medicaid pays appropriately for care management via this new benefit, states can expand their service capacity in supportive housing. That’s because Medicaid allows the state to access federal funding to pay a portion of what the state would otherwise have to pay all by itself for a given number of supportive housing units.
  • Second, when Medicaid expands in 2014, states will have new responsibilities to care for very vulnerable people who currently lack coverage and tend to incur very high public costs, especially in hospital emergency rooms. They tend to have severe behavioral and physical health conditions, often co-occurring. And they tend to have unstable housing histories. This is not news to homeless advocates. However, the expanded Medicaid role creates an opportunity to talk to state decision-makers about the value of Housing First for clinical outcomes and managing health care costs.

This is all promising for systems of care addressing chronic homelessness. Safety net systems may always be somewhat fragmented financially, but in any case they need to be integrated and high-performing for the vulnerable people who rely on them. Of course, more needs to be done to finish the job of ending chronic homelessness, and Medicaid in supportive housing is not the answer by itself. As the business case also points out, new strategies should also consider “new processes and/or technologies to identify high-cost, chronically ill clients who could most benefit from supportive housing.” Those who are now experiencing chronic homelessness should be a priority.

The Medicaid proposition for ending chronic homelessness requires advocates to be active in statewide arenas – with Medicaid administrators, of course; but also with their partners – such as mental health directors, hospital systems, and even managed care organizations that deliver on Medicaid contracts. Advocating statewide is the theme of an Alliance pre-conference session on July 16, immediately preceding the start of the National Conference on Ending Homelessness. “Opening Medicaid Doors: State Strategies to Support Homeless Assistance for Vulnerable Populations” is co-sponsored by the U.S. Interagency Council on Homelessness. The half-day program will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless. Space is limited and pre-registration is highly recommended. RSVP at healthcare@naeh.org.

Image courtesy of donbuciak.

14th May
2012
written by Lisa Stand

“States vary” –  a top research finding in virtually every field studied inside the Beltway. When it comes to understanding how Medicaid is relevant to ending chronic homelessness, we would like to be more helpful. True, Medicaid’s relevance to ending chronic homelessness in your community depends greatly on the profile of your state. Still, success in another state is worth looking at, along with assessing what can be borrowed effectively. A pre-conference session for early arrivals at the Alliance’s summer conference will offer an opportunity to do just that.  The half-day mini-conference is co-sponsored by the U.S. Interagency Council on Homelessness. We will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless.

  • Homeless Advocates at the Table. One facet is effective engagement at the right time in state health policymaking. How do homeless advocates get the ear of state health care officials before they make decisions that have implications for addressing chronic homelessness in a person-centered way? New York has an inspiring story of supportive housing stakeholders at the table of statewide Medicaid reform — with results that bolster community-based strategies to end homelessness. In Louisiana, supportive housing is now viewed as a core element in Medicaid’s plans for managing care of behavioral health enrollees. In short, policy gaps have been successfully bridged with stakeholder input at high levels.
  • Benefits and Payment Policy. Another facet is how a state defines Medicaid benefits and payment policies. Do these policies promote housing solutions in a plan of care for homeless people with significant behavioral and other health needs? As federal authorities roll out approved benefits and demonstrations, we are seeing how states embrace new community-based services allowed by the Affordable Care Act (ACA). States like Oregon and New York are doing this with a clear view of supportive housing in the domain of health care, at least for those as vulnerable as chronically homeless people. It may be too soon to know how these approaches succeed, but the state policy pieces are evident and intentional.
  • Federal Policy Implementation. A third facet is coordination at the federal level, such as initiatives led by the Department of Housing and Urban Development (HUD) and various subdivisions of the Department of Health and Human Services (HHS). Which new federal policies and regulatory decisions will have the most impact on ending chronic homelessness by 2015, as the federal strategic plan envisions? Federal Medicaid rules are more favorable to the concept of permanent supportive housing, and HUD is looking for ways to promote access to Medicaid in housing for people with disabilities. Federal policy will continue to drive state and local responses.

These topics will be covered by knowledgeable speakers convening for “Opening Medicaid Doors: State Strategies to Support Homeless Assistance,” on Monday, July 16, in Washington, DC. The half-day session immediately precedes the opening of the National Conference on Ending Homelessness, which takes places July 16-18. Both events are at the Renaissance Washington Hotel. For more information about Opening Medicaid Doors, contact healthcare@naeh.org. Space limited and pre-registration is highly recommended.

27th March
2012
written by Lisa Stand

On Tuesdays in March, the Alliance has been blogging about the Affordable Care Act (ACA), which was enacted two years ago and is today (literally, today) the center of attention in the U.S. Supreme Court. As we and our partners have pointed out, the ACA is already helping very vulnerable people, including people experiencing homelessness – for instance, through a limited amount of new funding for community health centers. Other changes are coming on-line this year, such as Medicaid health homes, a state option that can help communities do a better job of coordinating health care and homeless assistance.

Still bigger changes are yet to come. If the key Medicaid expansion is upheld as constitutional, chronically homeless and at-risk adults who do not qualify now will have access to Medicaid benefits, starting in 2014. Even then, the promises of the ACA can fall short, if those benefits are not sufficient for people who need housing stability to recover and improve their health status. It is important for homeless advocates to have a voice in designing Medicaid benefits that make that link with concrete solutions when housing is necessary to complete an effective, person-centered care plan.

There is much work to be done. The ACA offers resources and innovative policies. Whatever the outcome in the Supreme Court, homeless advocates will continue to strive for community networks that seamlessly provide supportive housing, primary care and behavioral health services. We know this approach is necessary to end chronic homelessness.

In closing out this month of blogs on the ACA and ending homelessness, let’s give due notice to how the ACA could touch people experiencing homelessness who fit other typologies besides chronic. Two examples come to mind:

  • At-risk young people – Research shows that children who age out of foster care frequently have significant health care needs, especially compared to other young adults. Under the ACA, states are now required to consider access to health care as part of the transition plan for young adults exiting foster care. Starting in 2014, states will have the further requirement of extending Medicaid coverage to these individuals until they reach age 26.   Advocates for homeless youth have a role to play as states implement this new provision. For more information about access to health care for foster youth, a recent blog at Community Catalyst is a place to start.
  • Vulnerable families – The ACA funds the Early Childhood Home Visiting Program, allowing states to target evidence-based programs for children under age 5. These services may be critical to outcomes for children who have experienced homelessness. Homeless service providers are well positioned to help home visiting succeed by informing strategies to target these new resources, and giving valuable feedback about how the program addresses needs of homeless families.

The Alliance will continue to analyze health care reform and its implications for ending homelessness. For more information about homelessness and health, visit our website or contact us at info@naeh.org.

20th March
2012
written by Lisa Stand

It has been two years since passage of the Affordable Care Act. Next week, key parts of the ACA will be debated in Supreme Court oral arguments. The nine Justices will hear from lawyers on both sides – those who are challenging and those who are defending the law. Yet it could be several months (at least) before we know how the highest court in the land decides.

Whatever happens, there is no denying that the ACA has been helping people, as we noted in our March 6 blog. As we also noted, some of the ACA’s greatest promises are still unfolding for the nation’s most vulnerable people who still lack health care coverage. The Medicaid expansion, for instance, will not take effect until January 1, 2014 – assuming this part of the law is upheld by the Supreme Court. Even so, progress is being made.

For this week’s ACA blog, the Alliance asked some of our national partners how they view the impact of the ACA. Here’s what we heard:

From Barbara DiPietro of the National Health Care for the Homeless Council:

“Homelessness is hazardous to your health.  Poor health causes homelessness, and in many cases, the experience of homelessness creates new health care conditions and exacerbates existing ones.  It is very difficult to become stable in employment or housing when there are untreated health care conditions.

Under the ACA, serving the most vulnerable homeless people will require more capacity in community health centers, especially Health Care for the Homeless (HCH) projects, as the graph below indicates. Nationally, there are currently 1,130 health center grantees that saw 20 million patients in 2010.  Of these, 223 are HCH grantees, which saw 805,000 individuals.”

The ACA allocates $11 billion over 5 years to health centers, with a goal of doubling the patients seen by 2015 to 40 million people. Unfortunately, to date, Congressional appropriations have not fulfilled these goals.  For fiscal year 2011, there was no increase.  In fiscal year 2012, there was a $200 million increase.

Using the modest increases to date, HRSA has issued 67 new access point grants that would create new sites for patients to access—16 of these were specifically to HCH grantees.  In total, these new access grants will facilitate service capacity for an estimated 262,000 new patients, most are very low income.

As the ACA is implemented, the need for health center investments intensifies.  If we can’t expand capacity, those with Medicaid cards won’t have a timely and reliable place to call their health care home. The ACA not only helps people access health insurance, but it also facilitates a growth in non-profit, privately administered, community health care services. Health centers directly employ 130,000 people, but there are many, many indirect jobs as well (contractors who clean buildings, provide maintenance, do contractual services, etc.). In this way, the ACA health center investments help further two national goals:  grow health care capacity and increase employment rates at the local level.

From Peggy Bailey at the Corporation for Supportive Housing:

“Years of living on the streets often leave people battling chronic medical conditions. When they find a home in supportive housing, they can need significant health care service–beyond those available in standard medical benefit packages. Health reform gives states the opportunity to provide comprehensive and integrated benefits to their most vulnerable citizens, giving them access to the breadth of services they need. Thanks to the Affordable Care act, hundreds of homeless people who previously had no health insurance are now Medicaid eligible in DC, CT, MN and WA. That’s progress that improves lives while helping service providers lower uncompensated care costs.”

From Andrew Sperling at the National Alliance on Mental Illness (NAMI):

“One of the four issues that the US Supreme Court will consider next week when it takes up the constitutionality of the Affordable Care Act is whether or not it is within Congress’s limited powers to require states to expand Medicaid eligibility up to 138Q% of the federal poverty level.  This expansion of Medicaid eligibility is a critical provision for homeless individuals living with serious mental illness.  Once Medicaid expansion becomes effective in 2014, in most states these individuals will no longer have to meet the very high eligibility standard for Supplemental Security Income (SSI) in order to qualify for Medicaid.”  (NAMI recently signed onto a “Friend of the Court” brief urging the Supreme Court to uphold lower court rulings rejecting challenges to the Medicaid expansion.  You can view this brief online. )

If the Court upholds these rulings and allows Medicaid expansion to go forward in 2014, NAMI, NAEH and our allies will face a new challenge – convincing states to include appropriate benefits in the “benchmark” plans that will be made available to this new “expansion population” in Medicaid.  For example, it will be critical for these plans to include intensive case management services (including assertive community treatment) and services in supportive housing to ensure that the complex needs of single individuals with mental illness and a history of chronic homelessness are met.

Thanks from the Alliance to Barbara, Peggy, and Andrew – for your thoughts on the ACA and for being great partners, with your organizations, in ending homelessness! Please visit their websites and ours to learn more about how health care reform can change the way you work to end homelessness in your community.

 For information about advocating for affordable, high-quality health care in general, you might visit Families USA and Health Care for America Now. To find out about the ACA in your state, check out these resources from the Henry J. Kaiser Family Foundation. 

13th March
2012
written by Lisa Stand

If you spend your day helping people who have experienced chronic homelessness, you know a lot about “person-centered” care. It means organizing services and supports around the specific needs of an individual – a place to live first and foremost, then recovery supports, medical treatment, supported employment, and so on. In a world of service silos and payment mazes, it also often means a headache of coordination – you braid together programs and accounts, keep an eye on staff resources, manage partner relationships, and try to catch whatever falls off the table before it lands on your client. (You’re welcome). Fortunately, the health care system just might be catching up to you.

There is one area of health care reform that doesn’t draw much partisan controversy. It’s the drive to make the system work smarter with the resources dedicated to people who use the most services. We are all aware of the problem. In health care, the highest share of spending is associated with a small percentage of people who have very complicated health and functional profiles. How much of the costs can be managed better by paying more attention to care management and service coordination? Medicaid policymakers think the answer is “a lot,” and they have gotten behind new strategies to prove it. This is welcome news for homeless advocates.

 

The medical home (or health home) is one of the most promising ways to integrate health care with supportive housing interventions. The concept came to the fore first as a health-care-quality initiative, and later as a possible cost-saver. A medical home is a single provider responsible for organizing a person’s care – especially needed if the care involves many disciplines and practitioners. A qualified medical home provider – like a health center or a doctor’s office — can be paid a certain monthly fee for this service.

Starting this year, Medicaid is paying extra federal funds to states that designate health homes for certain high-need, high-cost populations – including people with mental illness. The Centers for Medicaid and Medicare Services (CMS) has approved health homes in at least three states so far – Missouri, New York and Rhode Island. More health home approvals are in the pipeline. The federal guidelines are clear that Medicaid health homes can be broad in the scope of service – using interdisciplinary teams, emphasizing behavioral health, and providing links for covered enrollees to “community and social support services.”

New York state has clearly made the connection between Medicaid health homes and addressing chronic homelessness. Its application for federal approval explicitly mentions “lack of permanent housing” as an issue to be addressed in its health home population. Housing specialists are considered possible members of interdisciplinary teams in New York and in a number of other Medicaid health home models. All three of the early states have responded to the call for integrating behavioral health with Medicaid health homes. Missouri and Rhode Island are building on their existing infrastructures; community mental health centers will serve as health homes for their Medicaid enrollees with severe mental illness.

This could be good news, and something to watch, for advocates working to end chronic homelessness. However, better service coordination does not have to depend on a Medicaid health home designation. In many communities and service networks, leaders in housing and health care are taking stock and creating betters ways of working together to make supportive housing a sustainable solution. Often, the process begins by getting everyone on the same page about recent changes in policies and programs. Have you had a conversation with your community partners about what’s new in your state? There may be ways to leverage new resources together, to improve how vulnerable homeless people experience their systems of care.

The Alliance is on the lookout for best practices in integrating housing solutions with changes in the health care system. Let us know what’s happening in your community. We are also keeping track of new and improved policy approaches, as the Affordable Care Act is implemented. If you want more information on health homes and related Medicaid strategies, check out the Integrated Care Resource Center and the Safety Net Medical Home Initiative. Take another step: Advocate! Make sure your leaders in state health policy are using this important information as well.

 

15th December
2011
written by Lisa Stand

Last week, we re-ran an earlier blog post about how expanding Medicaid through the Affordable Care Act (ACA) is critical to ending chronic homelessness. Starting in 2014, the vast majority of vulnerable adults not already on Medicaid will have the opportunity to enroll in a health benefits plan.  We talked about what this means for individuals and their access to care, and what it means for communities, given new opportunities to access Medicaid funding.

Today, we look deeper into the crystal ball to explore what health care reform might mean for mental health and substance abuse treatment.

Behavioral health services, including treatment for substance use disorders, will be part of new Medicaid benefits. Between now and 2014 – and for a long time after – policy officials and advocates will be talking about what those benefits might look like in any given state. What kinds of services will Medicaid pay for? In what kinds of settings, for how long, and by whom? These are key questions that policymakers will gradually answer as implementation proceeds. No matter what, though, it is clear that the ACA is meant to transform behavioral health care delivery, as it transforms the rest of the health care system.

Consider, for instance, that 61 percent of people served under state substance abuse programs have no insurance. Some 87 percent of those uninsured behavioral health consumers will be eligible for Medicaid. So already we can see that Medicaid will play a much bigger role than it has in the past. Many providers of substance abuse treatment do not accept Medicaid now, and will have to decide how they are going to relate to the program in the future.

We also know that the ACA is driving – or attempting to drive – integration of behavioral and physical health care (what is often called “primary care”). Experts speak of “bi-directional” integration, meaning simply that care is client-centered rather than silo-based. So a person needing medical care and behavioral health treatment will be served in a holistic fashion, wherever they access care. There is a double bottom line here – improved access and quality for the consumer; and cost effectiveness in the programs that serve them. To make this work, Medicaid is encouraging the “medical home” concept to coordinate services for people with complex needs like severe mental illness and co-occurring substance or medical conditions.

What does all of this mean when homelessness is in the picture?

- First, it means that Medicaid is moving closer to housing solutions that are proven to be effective. Medicaid does not pay for housing, but it will offer more ways to meet people clinically where they are – for instance, in supportive housing – with more of the services they need.

- Second, communities have an important window of opportunity to make their homelessness assistance programs more effective and realign their funding priorities. Now is the time to build service networks that emphasize service integration, client-centered strategies, and financing that follows the changes in health care financing.

At the Alliance, we are excited to see communities respond to these promising changes that can really improve the lives of vulnerable people who are homeless or at-risk of homelessness. We are studying models and best practices to share in the broader advocacy community. For instance, the Alliance will host a webinar in early January that will highlight the practical aspects of integrating health care with supportive housing. (Register here.)

For a more thorough look at the ACA and behavioral health, check out these materials from the Substance Abuse and Mental Health Services Administration or check out our website.

7th December
2011
written by Lisa Stand

Today’s post is a re-run about the impact that Medicaid (and health care reform) can have on ending chronic homelessness. For more about Medicaid, check out our blog archive and our website.

HUD Secretary Shaun Donovan recently called Medicaid “our greatest chance to make the biggest difference for the most people to move the needle on all of homelessness.”

Why? Perhaps because Medicaid is getting ready to sign up millions more low-income people. Because of the Affordable Care Act, all uninsured citizens with incomes under $15,000 per year will be eligible for Medicaid starting in 2014. That means vulnerable people who have been experiencing homelessness without access to health care will have one less barrier to housing stability.

And what a big barrier lack of coverage can be! Studies show that chronically homeless people tend to be physically burdened by conditions like cardiovascular disease, HIV/AIDS, diabetes, and untreated injuries. These illnesses often compound mental illness and substance use disorders, which are themselves made worse by homelessness.

Access to health care – including behavioral health care – can make an enormous difference for someone living on the street, or even a person barely hanging on with health-related burdens in subsidized or market housing. The most basic medical benefits pay for physicians, prescription drugs, lab tests, mental health services, and much more. Uninsured poor people who now line up for such services in busy emergency rooms will finally be able to get this treatment in community settings on a regular basis.  For people with very high health care needs, better access to care and improved health status can make permanent supportive housing a more realistic goal, or make losing one’s home less of a threat to begin with.

The Affordable Care Act will definitely help vulnerable homeless individuals who now lack the access to services that health insurance provides. Community-based systems of care will benefit in turn. By one national estimate, Medicaid funding will increase by 27 percent in the first years of the expansion. This means new revenues in every state and every local system now receiving Medicaid funds. Strategic use of these new resources could lead to expanded capacity to solve chronic homelessness.

Of course, there is a long way to go before these promises of health care reform reach the front door of homelessness assistance programs. Federal administrators and state policymakers have yet to define key elements — such as basic benefits – or create programs to guarantee access for the hard-to-find and hard-to-serve.

More worrisome are the recurring moments when the powers-that-be in Washington think about drastic cuts to entitlements like Medicaid. Medicaid already helps millions of low-income people. It is already the foundation of critical safety net systems in every state. Cutting services now will increase vulnerability to homelessness. Delaying the expansion, which is absolutely critical to ending chronic homelessness, would be a serious setback for housing policy as well.

To learn more about Medicaid and homelessness, check out the Alliance’s web resources, and to get involved in our efforts to protect benefits like Medicaid, sign up for the Alliance Advocacy Alerts.

31st October
2011
written by Anna Blasco

According to the Pew Center on the States, between 1973 and 2009, the nation’s prison population grew by 705 percent, resulting in more than 1 in 100 adults behind bars. When this growing population exits the corrections system, they are frequently at risk for homelessness, which can in turn increase the likelihood of another imprisonment. People leaving incarceration tend to have low incomes, and, often due to their criminal history, lack the ability to obtain housing through the channels that are open to other low-income people.

Recently, the Baltimore-based organization Health Care for the Homeless released a report on the link between incarceration and homelessness. This study focused on the situation in the Baltimore region, which has a particularly large population of people in jails and prisons. According to the report, among the cities with the largest jails, Baltimore has the highest percentage of its population in jail, more than three times that of New York City or Los Angeles County.

This report draws a very direct line between housing and homelessness. For example, 74 percent those surveyed who reported experiencing homelessness before their incarceration reported that stable housing would have prevented their incarceration. In Baltimore City, people experiencing homelessness spend an average of 35 days in jail annually.

It is important to point out that the connection goes both ways – incarceration often leads to homelessness, and homelessness can result in incarceration. This report found that the number of people who lacked stable housing after being released from incarceration almost doubled, from 35 percent having unstable housing prior to their most recent incarceration to 63 percent 6 months after being released.

Investing in housing solutions may be the answer to Baltimore’s predicament. When you take into consideration that incarceration costs $2,200 per person per month in Maryland, housing certainly starts to look like a good answer. On our website, we have looked at some successful models for addressing this, including re-entry housing and stabilizing families. Among the report’s recommended courses of action for Baltimore is to expand Housing First models of permanent supportive housing.

13th October
2011
written by Catherine An

Last week, we told you about the Super-Committee and why we need to ask them to protect homeless assistance programs.  Last month, we told you what the Super-Committee needs to know about ending homelessness. Today (and tomorrow), we need you to pass that message along to the members of the Super-Committee.

Specifically, we’re talking about Medicaid. The Medicaid Coalition, led by Families USA, will be having call-in days today, Thursday, October 13 and tomorrow, Friday, October 14. We’re asking you to call the Members on the Super-Committee and urge them to reject any cuts to Medicaid. Medicaid is a critically important part of the social safety net that protects homeless and other vulnerable people.

Why tomorrow? Because tomorrow is the deadline for congressional committees that work on Medicaid to relay their expert recommendations to the Super-Committee. All committees that work on Medicaid – on both the House and Senate sides – have the opportunity to send the Super-Committee their thoughts on how the Super-Committee should approach Medicaid tomorrow.

This is another great chance to contact your Members of Congress, build upon your emerging relationship with lawmakers, and make a difference in the lives of those suffering most in this economic climate. Reaching out to your Members on this issue is an important step in letting congressional leadership know that homelessness programs like Medicaid, TANF, the McKinney-Vento Homeless Assistance Grants and other low-income housing and homelessness programs are key to stabilizing millions of families across America.

The Coalition has offered their toll-free number for the Capitol Switchboard which can connect you to your Member’s office:  1-866-922-4970

In addition, Families USA has made talking points and other fact sheets available through the following links:

Medicaid, Deficit Reduction and the “Super Committee”
Cutting and Restructuring Medicaid Should Not Be Part of Deficit Reduction
Medicaid’s Impact in the States: Helping People with Serious Health Care Needs

The Alliance has talking points specifically tailored to strategies for ending chronic homelessness through Medicaid and the need for the Super-Committee to preserve this key program.

16th September
2011
written by Lisa Stand

This post is part of a series of blogs from the Alliance staff. Each day a different expert is taking the reins of our blog, Facebook and twitter accounts to share with you their perspectives and knowledge on ending homelessness. For more information, see this introductory post. Today’s post comes from Lisa Stand, Senior Health Policy Analyst.

HUD Secretary Shaun Donovan recently called Medicaid “our greatest chance to make the biggest difference for the most people to move the needle on all of homelessness.”

Why? Perhaps because Medicaid is getting ready to sign up millions more low-income people. Because of the Affordable Care Act, all uninsured citizens with incomes under $15,000 per year will be eligible for Medicaid starting in 2014. That means vulnerable people who have been experiencing homelessness without access to health care will have one less barrier to housing stability.

And what a big barrier lack of coverage can be! Studies show that chronically homeless people tend to be physically burdened by conditions like cardiovascular disease, HIV/AIDS, diabetes, and untreated injuries. These illnesses often compound mental illness and substance use disorders, which are themselves made worse by homelessness.

Access to health care – including behavioral health care – can make an enormous difference for someone living on the street, or even a person barely hanging on with health-related burdens in subsidized or market housing. The most basic medical benefits pay for physicians, prescription drugs, lab tests, mental health services, and much more. Uninsured poor people who now line up for such services in busy emergency rooms will finally be able to get this treatment in community settings on a regular basis.  For people with very high health care needs, better access to care and improved health status can make permanent supportive housing a more realistic goal, or make losing one’s home less of a threat to begin with.

The Affordable Care Act will definitely help vulnerable homeless individuals who now lack the access to services that health insurance provides. Community-based systems of care will benefit in turn. By one national estimate, Medicaid funding will increase by 27 percent in the first years of the expansion. This means new revenues in every state and every local system now receiving Medicaid funds. Strategic use of these new resources could lead to expanded capacity to solve chronic homelessness.

Of course, there is a long way to go before these promises of health care reform reach the front door of homelessness assistance programs. Federal administrators and state policymakers have yet to define key elements — such as basic benefits – or create programs to guarantee access for the hard-to-find and hard-to-serve.

More worrisome are the recurring moments when the powers-that-be in Washington think about drastic cuts to entitlements like Medicaid. Medicaid already helps millions of low-income people. It is already the foundation of critical safety net systems in every state. Cutting services now will increase vulnerability to homelessness. Delaying the expansion, which is absolutely critical to ending chronic homelessness, would be a serious setback for housing policy as well.

To learn more about Medicaid and homelessness, check out the Alliance’s web resources, and to get involved in our efforts to protect benefits like Medicaid, sign up for the Alliance Advocacy Alerts.

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