By Kate Baber, Homelessness Policy & Advocacy Specialist, Washington Low Income Housing Alliance

The Other 1%

In the latest episode of the film series, Homeless in Bellingham, we learn how chronic homelessness affects our community. Healthcare experts, a housing provider, an emergency responder, a corrections official, and an emergency room doctor reveal that there are highly vulnerable people who we manage in a state of homelessness with repeated and very expensive emergency services. We meet Alan, a military veteran with serious medical conditions who cannot escape the trap of homelessness; Fred, who has been unsheltered for more than 10 years and cannot manage his sobriety living on the streets; and Cindy, who is working very hard to improve her life and her health. We discover how stable housing can provide the foundation for improved physical and mental health.

This episode demonstrates that our community has the tools to reduce homelessness, improve health, and, in the process, save an enormous amount of public expenditures. However, we lack sufficient resources to deliver these cost-effective services at the scale that is needed.
With smart, new investments that more than pay for themselves we can ensure others like Alan, Cindy and Fred are able move into safe, affordable and housing, reach better health, and experience a higher quality of life.

An exciting policy proposal to fund intensive supportive services, similar to the ones featured in the film, is being considered in our state. It would create a new Medicaid benefit to pay for tenancy support and intensive case management services in supportive housing settings. Supportive housing is a nationally recognized service delivery model that combines affordable housing with intensive housing retention services. It’s designed to serve people who are chronically homeless and have a persistent mental, addictive, or chronic health illness, or physical disability. The services and housing are necessary accommodations for people who are highly disabled to retain housing and access health care while living in the community with stability, autonomy, and dignity.

Rigorous evaluations locally and nationally consistently demonstrate that supportive housing keeps people housed, improves health, and reduces costs to public systems, including emergency services, health care, and criminal justice. People who live outside are at risk of illness, injury, violence, trauma, and health complications. These risks mean that people who become chronically homeless have mortality rates that are four to nine times higher than the general population.

In addition to being harmful to your health, chronic homelessness is a significant barrier to accessing regular, uninterrupted health care. This results in high utilization of expensive public services, including frequent and avoidable emergency room visits, inpatient hospitalizations, and high rates of incarceration often due to non-violent offenses related to symptoms of untreated mental health illness. As referenced in the film, the cost of ignoring chronic homelessness is much more expensive than providing people with housing and intensive supportive services.
In 2012, the state’s 2,042 chronically homeless adult Medicaid beneficiaries in the top 10% of annual health care costs consumed health care services at an average cost of $33,459 per person. Supportive housing and intensive services would cost only one third of that cost and result in a significant net savings. Even more so for the 201 homeless individuals that same year who were in the top 1% of costs and who had average annual health care costs of $117,500 per person!

Today in Washington, our communities do not have the resources to provide enough supportive housing to serve all people who need these services. The shortage of permanent supportive housing has an immense human and financial impact in our communities. One factor preventing us from bringing this type of housing to scale is a lack of resources to pay for the intensive services that are necessary for people to be successful in retaining housing and accessing care appropriately. Housing developers must identify long-term sources of funding for services in addition to securing capital and operating funding to build permanent supportive housing developments.

This is where Medicaid enters the picture. Medicaid is a health insurance program jointly funded by the state and federal government for people living on low incomes, and it can pay for medically necessary services. For people experiencing chronic homelessness, housing and intensive supportive services are the first steps to recovery and better health. Thus, a strong case can be made that a number of supportive housing services are medically necessary and ought to be paid for by Medicaid.

The Washington Low Income Housing Alliance and our community partners across the state will be forwarding a proposal during the 2015 state legislative session to create a new permanent supportive housing services benefit. We hope this benefit will help more people like Cindy access the housing and services they need to reach stability, recovery, and join Cindy in saying “I love my life.”

Interested in joining the advocacy effort to expand permanent supportive housing? Sign up for the Washington Low Income Housing Alliance’s email list to receive updates and action alerts here.