Department of Health and Human Services Archive
To accompany the release of Opening Doors, as amended in 2015, we will be taking a closer look at each of the four key updates to the document this week. We’ll be sharing comments from partners, community members, and the USICH staff on how the updates are impacting their daily work, helping to prevent and end homelessness across America, as well as highlight the key changes around the updated topic.
Spotlight on Medicaid
"When launched in 2010, Opening Doors was more than a blueprint for effective Federal, state and local partnerships to end homelessness, it motivated all of us - inside and outside of government - to work harder, together, to address the needs of our most vulnerable people. Five years later, it is just as impactful; a platform on which proven solutions such as supportive housing can expand, and an affirmation that services through Medicaid, coordinated assessment and access, and cooperation among systems must grow too if we are to succeed and tackle homelessness once and for all." –Deb DeSantis, President/CEO, Corporation for Supportive Housing
The Affordable Care Act creates new opportunities to leverage Medicaid to end homelessness, specifically by financing services that can help people obtain and maintain housing as well as achieve health and well-being. All states now have the opportunity to expand Medicaid eligibility to nearly all individuals under the age of 65 with incomes up to 133 percent of the Federal poverty level. As of May 2015, 30 states including the District of Columbia have acted to expand Medicaid programs, and provide health coverage to millions of adults without dependent children for the first time. More than 16 million Americans have gained health coverage, bringing the number of people without insurance down to historic lows. Included in the newly insured are approximately six million of the lowest income Americans, who have gained access to public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). And while the data is limited on the specific number of people experiencing homelessness who have gained coverage, we have numerous reports that enrollment in Medicaid and other types of health insurance among people experiencing homelessness has grown significantly.
By Richard Cho
Five years since the passage of the Affordable Care Act, many of the major objectives of the law are being met; more than 16 million Americans have gained health coverage, bringing the number of people without insurance down to historic lows. Included in the newly insured are approximately six million of the lowest income Americans, who have gained access to public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). And while the data is limited on the specific number of people experiencing homelessness who have gained coverage, we have numerous reports that enrollment in Medicaid and other types of health insurance among people experiencing homelessness has grown significantly. With so many people now able to access health care coverage, the results are in: the Affordable Care Act is working.
Of course, increasing access to health coverage is only one objective of the law. The other major objective is to shift the focus of health care away from procedures and treatments and towards the overall quality of care and people’s health outcomes. For people who experience homelessness, we know that having stable housing is essential to health. Stable housing not only has direct benefits on health—reducing exposure to high-risk behaviors and the negative effects of life on the streets—but it also creates a platform for better care. Thus, for people experiencing homelessness, the ultimate measure of whether or not the Affordable Care Act is working may be the degree to which it can incentivize the health care system to address housing needs as a foundation for better health.
05/07/2015 - Medicaid is a Game-Changer for Ending Chronic Homelessness, But to Win, We Have to Play
By Richard Cho
It has been proven time and time again that for people experiencing chronic homelessness and suffering from chronic health conditions, the path to improved health begins with stable housing, namely through supportive housing. Supportive housing (also known as ‘permanent supportive housing’) has been shown to improve physical and behavioral health outcomes for people experiencing chronic homelessness, while simultaneously lowering health care costs by decreasing emergency room visits and hospitalizations. In most communities today however, the services that make supportive housing so effective are still funded by a patchwork of public and private sources, or in some cases, are severely under-funded. Fortunately, thanks to the Affordable Care Act we now have the potential to create a more systematic and sustainable way to finance services in supportive housing -- through Medicaid.
The truth is, this isn’t all new. Medicaid has covered these types of supportive housing services for a long time. After all, one of Medicaid’s first authorities allowed states to cover primary care case management. What is new is the Affordable Care Act, which by increasing the coverage of people experiencing homelessness under Medicaid and by shifting the focus of health care on value rather than volume, creates new opportunities to increase the role of Medicaid in covering services in supportive housing. At the same time, Medicaid is a Federal and state program and the decision to cover these services under Medicaid rests with the states. Whether states do so will depend on the degree to which they are made aware of the cost-benefit of helping people access and obtain housing as opposed to cycle in and out of emergency rooms, inpatient hospital beds, shelters, and the streets.
We all have the responsibility of educating states about the cost-effectiveness of supportive housing and the opportunity to cover services in supportive housing under Medicaid. Here are four things you can do to ensure your state includes these services:
04/23/2015 - Federal Partners Move Forward on HMIS Alignment & Integration, Announce MOU on Roles & Responsibilities
The U.S. Department of Housing and Urban Development’s Office of Community Planning and Development, the U.S. Department of Health and Human Services’ Administration for Children and Families and the Substance Abuse and Mental Health Services Administration, and U.S. Department of Veteran Affairs’ Veteran Health Administration have recently announced a Memorandum of Understanding (MOU) that sets forth shared understanding of each agency’s respective roles and responsibilities regarding the use of Homeless Management Information Systems (HMIS).
We know that using data to make smart decisions drives improvement in results. The more effectively we can collect, analyze, share, and coordinate around a common set of data, the more effectively we can inform action to end homelessness. For most communities, Homeless Management Information Systems (HMIS) are the primary data systems to capture information about families, youth, and individuals experiencing homelessness as well as information about the provision of housing and services to homeless individuals and families and persons at risk of homelessness.
HMIS helps us not only understand the impact our programs are having, it helps us better understand who our programs are engaging and how effective that engagement is. Action is underway now at the Federal level to integrate and align HMIS across Federal programs, which will help break down silos between services and programs and improve the effectiveness of our services and programs.
This blog was originally published on the Administration for Children & Families website.
By Marsha Basloe, Senior Advisor for Early Childhood Development
When my son was little, he had a favorite stuffed animal called “elephant.” Elephant went everywhere Benjy went! One of my favorite memories is standing in his bedroom doorway and watching him sleep in his “new big bed” with his arm wrapped around elephant under the covers. This memory was important to me last week as I attended the National Alliance to End Homelessness Family and Youth Conference to present on the Administration for Children and Families’ early childhood efforts to support young children experiencing homelessness.
There were multiple workshops sharing the amazing efforts of programs and communities across the country. Secretary Julian Castro spoke to a large audience about the Department of Housing and Urban Development’s work and HUD’s linking with partners including the Veterans Administration and the Department of Health and Human Services. He said that people need more than just housing; families don’t live in silos and it’s why the collaboration and coordination between HUD, VA and HHS is so important – from the federal level to the local level.
By Peter Nicewicz
We often say at USICH that to end homelessness nationally, we must end homelessness locally. To help communities optimize their current resources to accelerate progress towards ending Veteran homelessness, we have identified ten essential strategies for communities to increase leadership, collaboration and coordination among programs serving Veterans experiencing homelessness, and promote rapid access to permanent housing for all Veterans. Each strategy is accompanied by resources to help community leaders and stakeholders understand how to implement these strategies more effectively.
Meanwhile, we have been working on the Federal level to assist communities as they work to reduce the number of Veterans experiencing homelessness and build the systems to prevent its recurrence. Below is a highlight of some of the Federal efforts aimed at helping communities develop and optimize their systems of connecting Veterans experiencing homelessness to permanent housing and the appropriate services and resources Veterans need to have a safe and stable place to call home.
A message from USICH Interim Executive Director Matthew Doherty
This week, President Obama put forward a 2016 Budget that again demonstrates his Administration’s deep commitment to ending homelessness. As Interim Executive Director of the U.S. Interagency Council on Homelessness, I am pleased to share that this Budget calls for the investments needed to end chronic homelessness in 2017, make significant progress toward ending homelessness among families, children and youth in 2020, and sustain efforts to end Veteran homelessness in 2015. In his Budget, the President calls for nearly $5.5 billion in targeted homelessness assistance. In addition to targeted homelessness assistance, the Budget also includes key investments to mainstream programs needed to end homelessness, such as 67,000 new Housing Choice Vouchers to support low-income households, including families experiencing homelessness; survivors of domestic and dating violence; families with children in foster care; youth aging out of foster care; and Veterans experiencing homelessness, regardless of their discharge status.
By Diane Kean
Over the past two weeks, communities across the country have organized thousands of volunteers to conduct the 2015 Point-In-Time (PIT) Count, an opportunity to measure our progress as well as identify people in need—including Veterans—and connect them with a path to permanent housing. As always, Federal partners were on hand to help, including Labor Secretary Thomas Perez, HUD Secretary Julián Castro, OMB Director Shawn Donovan, VA Secretary Robert McDonald and White House Chief of Staff Denis McDonough. The Administration has come out in full force to demonstrate our deep partnership with communities and our unwavering commitment to ending homelessness.
We have compiled just some of the photos, blogs, news articles and captions from PIT Count volunteers at the Departments of Housing and Urban Development, Health and Human Services, Veterans Affairs, and Labor, and USICH and we would like to see more! Share your PIT Count experiences with us using Twitter with the hashtag #PITCount.
By Liz Osborn
For communities across the country, 2014 has been another year of continued progress in the effort to end homelessness. From the 2014 Point in Time (PIT) count data showing a 10 percent decline in overall homelessness since 2010, to 351 mayors, governors, and local officials joining the Mayors Challenge to End Veteran Homelessness, we have gained incredible momentum over the past year. Here are just a few of the events that helped to drive progress in 2014.
By Matthew Doherty, Kelly King Horne and Libby Boyce
All across the country, communities are developing coordinated entry systems to streamline and facilitate access to appropriate housing and services for families and individuals experiencing homelessness. In the Greater Richmond area of Virginia and in Los Angeles County, California—like in other places—efforts to bring these systems online are in full swing.
Let’s hear from Richmond and Los Angeles County, who presented at the December 2014 full Council meeting regarding their local efforts to implement coordinated assessment, their successes, their lessons learned, and the challenges that they continue to tackle.
October is Domestic Violence Awareness Month and this year is the 30th anniversary of the Family Violence Prevention and Services Act. Over the past several months, there have been a number of high profile cases involving domestic violence that have garnered significant media attention. The spotlight on these specific experiences has helped to bring a larger discussion to the public arena about domestic violence, including perceptions about perpetrators and survivors, as well as the supports that are an essential part of the network of emergency shelters and supportive services in responding to domestic violence.
By Jay Melder
Reallocations will help communities make the system changes needed to end homelessness, and in this year’s Continuum of Care NOFA, there is once again a strong emphasis on reallocations. As in FY 2013, HUD is allowing reallocations of funds to new permanent supportive housing for people experiencing chronic homelessness and rapid re-housing for families with children. HUD and USICH encourage CoCs to take full advantage of reallocations, shifting funds away from underperforming or less cost-effective programs and toward evidence-informed models.
by William H. Bentley and Laura Green Zeilinger
Forty years ago, the U.S. government took the bold step of making the landmark Runaway and Homeless Youth Act, or RHYA, the law of the land. RHYA is the only Federal law that highlights the need for and funds critical services for youth experiencing homelessness. In July 2014, Congress introduced the Runaway and Homeless Youth and Trafficking Prevention Act (S.2646), new legislation that, if enacted, would reauthorize and strengthen RHYA. With continued funding for street outreach, basic center and transitional living programs, RYHA provides critical services and support to runaway and homeless youth and plays an important role in the effort end youth homelessness by 2020, a goal set in Opening Doors: Federal Strategic Plan to Prevent and End Homelessness.
By Liz Osborn
Homelessness has many faces. People experiencing homelessness can be old or young, male or female, and can come from any ethnic background. But when one thinks of a person experiencing homelessness in this country, few people picture the face of a child. The fact is, nearly one-quarter of all people experiencing homelessness at a point in time are children, and most of them are very young. In one 2013 Abt Associates study on family homelessness, almost a third of the participating children were two years old or younger, and more than half were under the age of five.
By Debbie Thiele and Katy Miller
This week CSH, in partnership with the Washington Low Income Housing Alliance, published Creating a Medicaid Supportive Housing Services Benefit. In the white paper CSH lays out an easy-to-follow framework for states that want to create a Medicaid benefit to pay for the services in supportive housing. The framework consists of five action steps: 1) Determine benefit eligibility criteria; 2) Define the package of services to be delivered; 3) Align the state Medicaid plan; 4) Establish a financing and reinvestment strategy; and 5) Operationalize the benefit.
Without housing options, people often are forced to rely on culverts, public parks, streets, and abandoned buildings as places to sleep and carry out daily activities that most reserve for the privacy of their own home. As communities recognize and struggle with the fact that people without homes often live in public spaces, multiple strategies arise. Unfortunately, many of these strategies include policies that criminalize homelessness. In a new report, In the Public Eye, author Lucy Adams, of Australia’s Justice Connect and guest blogger at USICH elevates the conversation.
by Danielle Ferrier and Beatriz McConnie Zapater
There are nearly 6,000 unaccompanied youth in Massachusetts. Experiencing homelessness often prevents motivated, hard-working youth from graduating high school and achieving success. A Journal of Emotional and Behavioral Disorders article shows that without intervention, only about 27 percent of them will graduate high school. Opening Doors, the federal strategic plan to prevent and end homelessness, sets a goal of ending youth homelessness by 2020 by ensuring communities can connect youth with stable housing, permanent connections, education, and employment all while improving youths’ social and emotional well-being.
by Eric Grumdahl, USICH Policy Director
Ending youth homelessness means putting a system in place to do so in every community. Here, having a common purpose is a key ingredient. Luckily, at the interface of the child welfare system and the homeless response system, we should agree on a common purpose. The child welfare system wants to see successful transitions to adulthood, which includes all of the outcomes of the framework to end youth homelessness, including stable housing. The homeless response system is certainly eager to close what has been called a pipeline from child welfare to shelter, and to see youth in stable housing instead of outside a shelter door. We should not have to debate our shared purpose.
Where it seems to me that our efforts get stuck is...
by Laura Green Zeilinger, USICH Executive Director
Yesterday marked the fourth Anniversary of the launch of Opening Doors, the first-ever Federal Strategic Plan to Prevent and End Homelessness. In four years, we have changed the trajectory of homelessness in America. In just the first three years of implementation, Opening Doors led to significant reductions in homelessness, including an eight percent reduction in homelessness among families, a 16 percent reduction in chronic homelessness, and a 24 percent reduction in homelessness among Veterans. And we are hopeful that we will be able announce even greater reductions when the 2014 Point-In-Time Count data are available later this year.
The progress we are making across the nation has proven that Opening Doors is the right plan with the right set of strategies. Opening Doors also provides a foundation and scaffolding upon which we can continue to innovate and refine the solutions that will end homelessness in this country.
This year, we’re considering amending the plan again to include more of what we’ve learned from our progress.
by Richard Cho, USICH Senior Policy Director
I must make a confession. When I first came to Washington to work for USICH, I was a bit skeptical about how sold the Federal government was on Housing First. I knew that Housing First was mentioned in Opening Doors, but did the Federal government truly embrace it? After all, it was not so long ago that terms like "harm reduction" were considered four-letter words by the Federal government.
So imagine my happy surprise when I discovered that I was flat-out wrong. In the first, of what I learned would be many, interagency meetings on chronic homelessness, Housing First adoption was discussed as a primary strategy for accelerating progress. And one of the very first tasks I was given was to help provide a clear, operational definition of Housing First. The result of that work is USICH's Housing First Checklist, a tool that communities can use to adopt Housing First across their programs and overall community response. Not only does this Administration fully believe in Housing First, but it is working to make Housing First the underlying approach behind every community's response to homelessness.
Yesterday, more than 600 providers and stakeholders from across the country joined us for a great discussion about what ending homelessness among families means and what achieving it will require. We were joined by Laura Zeilinger, USICH Executive Director; Ann Oliva, Acting Deputy Assistant Secretary for Special Needs and Director of the Office of Special Needs Assistance Programs at the Department of Housing and Urban Development (HUD CPD/SNAPS); Ali Sutton, Policy Advisor at the Department of Health and Human Services Administration for Children and Families (HHS ACF); and Debra Rog, Associate Director at Westat.
At the end of our discussion, we received a lot of really great questions, many of which we didn’t have time to answer. In this post, we provide responses to two of these questions and will be responding to more of these questions over the next few weeks.
05/05/2014 - The Chance to Grow Up to Be Whatever You Want: Expanding Access to Services for Children and Families
By Brock Grosso, HHS, Administration for Children and Families
Recently, I got to experience the intersection of policy and field work first hand when I took a trip to Baltimore with ACF staff members to see the great work being done in Baltimore by Health Care for the Homeless (HCH), an HHS funded health care grantee. HCH is doing everything it can to make sure that every young child who experiences homelessness has the chance to grow up to be whatever they want.
By Eric Grumdahl, USICH Policy Director
Today, the Department of Housing and Urban Development (HUD), the Department of Health and Human Services (HHS), and the Department of Veterans Affairs (VA) released the 2014 HMIS Data Dictionary and HMIS Data Manual, with an effective date of October 1, 2014. This joint release demonstrates the significant collaboration between the three agencies to support data collection on homelessness across their programs and systems.
By Lindsay Knotts, USICH Management and Program Analyst
Our partners at the Departments of Health and Human Services and Education just launched Birth to 5: Watch Me Thrive! – a coordinated, Federal effort to encourage healthy child development, universal developmental and behavioral screening for children, and support for the families and providers who care for them.
10/21/2013 - Leveraging the Affordable Care Act to Solve Homelessness: A Message to CoCs and Ten-Year Plan Leaders
How can we make the best use of the Affordable Care Act to solve homelessness? USICH Executive Director Barbara Poppe poses five questions for communities to consider.
The expansion of Medicaid coverage under the Affordable Care Act (ACA) will mean that millions of currently uninsured adults will be eligible for coverage, including many formerly homeless individuals residing in supportive housing.
Many states are still opting out or remain undecided about whether to participate in Medicaid expansion. One factor these states might consider in evaluating or re-evaluating their decision to participate is the impact of Medicaid expansion on homelessness in their state. But the benefits don’t stop there. State budgets, hospitals, health care providers, and Americans in general also stand to gain from Medicaid expansion.
07/16/2013 - Ending Family Homelessness: A Message to Continuum of Care & Ten-Year Plan Leaders from Barbara Poppe
Recently, I wrote about the urgency to increase our efforts to end chronic homelessness, suggesting key questions Continuums of Care and Ten Year Plan leaders should ask. Today I want to pose similar questions related to how we address family homelessness. People in families make up nearly 40 percent of the homeless population nationwide. To reach our goal of ending family and child homelessness by the year 2020, we must realign our programs and systems now. As a mother, this quote from Marian Wright Edelman tugs at me: “The future which we hold in trust for our own children will be shaped by our fairness to other people's children.” Shaping better community responses to family homelessness is about shaping our collective future. Thank you for stepping up to the challenge..
11/20/2012 - Keeping the Momentum for Ending Youth Homelessness: Reflections from Indianapolis and Beyond
Last week, the Family Youth Services Bureau of HHS’s Administration on Children, Youth, and Families hosted two days of training and workshops on addressing youth homelessness at the National Runaway and Homeless Youth Grantee Conference. More than 550 participants from around the country met in Indianapolis to share knowledge and learn from others as we work together to end youth homelessness by 2020.
The Runaway and Homeless Youth (RHY) provider community has thoroughly embraced the Opening Doors goal to end youth homelessness by 2020. The goal was mentioned throughout conference workshops, it was written in conference materials, and in the hallways of the hotel I heard this goal in discussions among providers, administrators, and policy professionals. It is inspiring to see the resounding commitment and enthusiasm for this ambitious goal has spread outside of Washington, DC and into communities throughout the country.
Given the momentum we have gained from Opening Doors and the USICH Framework to End Youth Homelessness, the RHY conference was ripe with opportunity to build more commitment and enthusiasm for the work ahead. The USICH Framework to End Youth Homelessness held a prominent spot on the conference agenda at a luncheon keynote session. Jennifer Ho provided an energetic keynote address about ending youth homelessness. She discussed two complementary strategies—getting better data on youth and building service capacity—included in the Youth Framework and explained why these strategies are important to our goal of ending youth homelessness.
What We're Talking About is a new weekly column from USICH Communications on the topics and issues in the news and on our minds. Topics range from international and national conferences, news from around the country, innovative work to highlight, and more. We look forward to catching you up news you may have missed and connect you to articles and resources.
This week the International AIDS Conference was in Washington, DC for the first time in 22 years, shining a spotlight on HIV/AIDS both in America and around the world. For us at USICH, this conference also pointed to the topic of housing instability and homelessness among those with HIV/AIDS in America. There are more than 1 million people in the United States currently living with HIV/AIDS, and for those with low incomes or experiencing homelessness, managing the disease is complicated and expensive...
When USICH released Opening Doors in June 2010, the Affordable Care Act had passed in March, just three months earlier. The second anniversary of Opening Doors occurred the same time that the Supreme Court delivered its ruling on the Affordable Care Act (ACA). Since the law was largely upheld, many of the provisions that will help us prevent and end homelessness are still in place. The provision giving states greater choice around Medicaid expansion, however, means that some of the original promise of the ACA in the fight against homelessness will be, in some parts of the country, up in the air, at least for a while.
Remaining provisions of the law that will prove helpful for populations experiencing homelessness are the expansion of affordable insurance coverage through state health insurance exchanges and the expansion of community health centers. Better access to affordable insurance that covers people with pre-existing conditions and does not limit coverage when you get sick can act as homelessness prevention for many.