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Deborah De Santis

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Can Health Reform Help End Chronic Homelessness?

Posted: 03/27/2012 6:26 pm

Over the past several years, those of us in the business of solving homelessness have seen a troubling trend: Progress seems to be plateauing when it comes to ending chronic homelessness. This despite the increasing national inventory of supportive housing, which is the proven solution for men and women who are chronically homeless.

This is admittedly discouraging, but CSH remains committed both to the goal of ending chronic homelessness and to our belief that supportive housing is the most effective vehicle for achieving this goal. After all, we have long known that just creating more supportive housing units is itself not enough to end chronic homelessness. To be sure that we're actually serving the high-need people who are chronically homeless, these homes must be in the right communities AND they must work as part of a coordinated targeting initiative. To date, neither has been consistently true.

In addition, for supportive housing to effectively end chronic homelessness, the hardest part of the supportive housing puzzle must be soundly in place: the services. Chronically homeless people often battle multiple, complex health conditions that require coordinated health services over a long period of time. That means they need long-term sources of services funding. But increasing investment in supportive housing is a difficult consideration in the current economic and political climate.

We believe that, rather than looking to traditional homeless assistance funding, there is vast potential in engaging mainstream services systems. To that end, health care reform offers a variety of solutions.

There are three key ways that CSH thinks health reform can help end chronic homelessness.

1. Health reform provides states OPTIONS (not expensive mandates) to expand coordinated health services that will ultimately save money and improve health outcomes.

2. Health reform brings insurance coverage to all homeless populations and opens up the opportunity to develop services benefit packages that meets their complex needs over time.

3. Health reform offers incentives for hospitals to discharge patients into housing, reducing the cost of ongoing expensive hospital services.

As Medicaid and managed care organizations struggle to control costs among high-cost beneficiaries, there is a tremendous opportunity in using supportive housing to control costs and improve outcomes for the most-costly, chronically homeless men and women.

We're seeing good progress so far. States like Connecticut, Minnesota and Washington have expanded Medicaid eligibility, as has the District of Columbia. Louisiana has an approved 1915i Home and Community Based Services State Plan Option to target services in supportive housing. And many other states are looking at health home options to comprehensively serve chronically ill patients.

CSH is committed to helping more states use health reform as a springboard for these kinds of positive steps. We're confident that we can finally push through the last barriers and end chronic homelessness once and for all, while also helping states and counties curb public costs among their highest-cost Medicaid beneficiaries.