"I am too old and sick to be back out there on the streets. It kind of takes a toll on a person."
These words, spoken to Kaiser Health News by a gentleman once facing homelessness and now in supportive housing, say it all. That's why several states are looking to use dollars traditionally set aside for healthcare programs to cover housing costs too.
As CSH and others have shown, supportive housing is a social determinant of health. Very simply: if you are stably housed in a solution such as supportive housing, you are more likely to be able to care for yourself and access appropriate healthcare.
Because study after study has demonstrated the nexus between housing and health outcomes, California is asking the federal government for permission to use Medicaid funds contributed by Uncle Sam to pay for rental assistance for the most medically fragile and vulnerable people facing homelessness. California isn't the first state to make this request. New York pitched the idea before, but the feds said no and so the State decided to go it alone and use its own share of Medicaid to house chronically ill patients experiencing homelessness. New York was given permission by Washington to use federal Medicaid dollars for services. And other states too, such as Massachusetts, use their own and federal Medicaid monies not for rental assistance but for the services so critical to making supportive housing work.
CSH is active in California, New York and Massachusetts, and our own analyses in these states underscores the fact that supportive housing reduces care costs and produces better health outcomes for residents. The main reasons -- there are stark reductions in emergency department use, hospital admissions, length of hospital stays, and even days in nursing homes when formerly homeless people are housed and access to preventive and regular healthcare services is part of the mix.
Research by our partners in Los Angeles produced similar conclusions. In a report two years ago, the Economic Roundtable found total health care costs for the most medically fragile homeless patients in supportive housing were 72 percent lower per person than for those still mired in homelessness.
California's proposed blueprint is one of the most sweeping to date, providing incentives for Medicaid not only to cover a broad number of vulnerable people on a consistent basis, but also to collaborate with counties, housing authorities, and health and housing providers to coordinate resources.
In a recent statement to Kaiser, Mari Cantwell, deputy director of the State of California Health Care Services Department, said healthcare and housing are too often treated as two distinct areas, never really coordinating, collaborating or sharing information or resources. "We are really trying to look at the whole person," she said. "And our belief is that this (California's proposal to the feds) will improve health care and reduce costs."
Cantwell is right and the federal government should recognize her wisdom and the mounting evidence, and say yes to California's plan as soon as possible.
When a person is taken out of homelessness and finds the stability that comes with housing, they can focus on other needs such as healthcare. That benefits all of us because we save money and see better outcomes.