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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.
A message from Matthew Doherty, USICH Executive Director
On behalf of the entire team at USICH, the teams at our Federal member agencies, and our many dedicated state and local partners working tirelessly to prevent and end homelessness, I am thrilled to share with you this updated version of Opening Doors, as amended in 2015.
This document is the culmination of a tremendous amount of work by countless individuals who contributed ideas and information through online forums, in meetings, and by analyzing their agencies’ programs and policies, helping to identify best practices and lessons learned from their years of experience. That collective wisdom has shaped and strengthened this amendment and its focus on objectives and strategies informed by data, research, and results.
The release of this amendment could not be more timely. We have made great strides toward the goals established in Opening Doors, but there remains a large amount of work to be done. Today, on the anniversary of the original publication, we reaffirm our commitment to achieving an end to homelessness in America, with even greater confidence in our collective ability to solve this problem.
Together, we are proving that homelessness does not have to appear in the pages of American history as a permanent fixture, but as a problem the American people overcame. It is my hope that the release of this amendment to Opening Doors will help move us closer to the lasting solutions that we can and must implement.
This blog was originally published on the Bill and Melinda Gates Foundation blog, Impatient Optimists.
By David Wertheimer
Twenty-five years ago, in the earlier years of the AIDS epidemic, health care and housing providers figured out that without housing, the health of people living with AIDS deteriorated far more rapidly than for those who had stable homes. AIDS Housing of Washington, now Building Changes, helped coin a critically important phrase that became a game changer in the fight against AIDS: “Housing is healthcare.”
A quarter century later the phrase still rings true, and has expanded meaning in the challenging work of ending homelessness for all people, including families, single adults, youth, and veterans.
The Bill & Melinda Gates Foundation recently hosted more than 100 state and local leaders in ending family homelessness together with health care leaders responsible for implementing the Affordable Care Act (ACA) and Medicaid expansion here in Washington State. As the health care system changes, the opportunities to integrate and improve the delivery of both housing and health services to families recovering from homelessness have the potential to be transformational.
What might this look like in practice? We can now envision and realize the possibilities, thanks to a 5-year, $65 million competitive federal grant for State Innovations in Medicaid secured by the Washington State Health Care Authority. In part, this grant offers the opportunity to think in new and innovative ways about “social determinants of health,” the broad set of conditions in which we live and work, at home and with our families, including the air we breathe and the water we drink, that play a more important role in promoting long-term health than medical interventions.
Health starts where we live, learn, work and play.
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:
By Martha J. Kegel
Three months ago, after a campaign led by Mayor Mitch Landrieu, New Orleans became the first major city to effectively end Veteran homelessness. During an intense six-month campaign, community partners connected every Veteran living on the street or in emergency shelter who would accept housing with an apartment of his or her own, with supportive services scaled to the Veteran’s needs. Now we actively work every day to maintain a “functional zero” in Veteran homelessness by housing any newly homeless Veteran within an average of 30 days.
I firmly believe that every community can and should end Veteran homelessness.
Yes, New Orleans had some advantages. For one thing, the local VA and its partners had already achieved a significant reduction in Veteran homelessness before we started the final drive in June 2014. At that point, we had already driven down the number of Veterans suffering in homelessness from 660 in the January 2011 Point-in-Time (PIT) count to 193 in the March 2014 count. For another, we have a very strong visionary leader in Mayor Mitch Landrieu, who set the bold goal of ending Veteran homelessness a full year before the federal deadline, convened the key players, and recruited active duty military and Veteran groups to help with outreach.
But in other important ways we were at a distinct disadvantage: As of the 2014 PIT count, New Orleans still had one of the highest per capita rates of Veteran homelessness in the nation as compared to our general population of only 379,000 residents. We were also at a disadvantage in resources: Compared to many other cities, we have precious few ways to pay for housing and services other than federal funds. And when pushing ourselves to get to zero, we were confronting the challenge of housing those whom we had always failed to connect to housing before – those Veterans who tended to have the most complex challenges and who for the most part were not eligible for HUD-Veterans Affairs Supportive Housing (HUD-VASH) program.
By: The 25 Cities Downtown San Diego Design Team
Before he unlocked the door to his studio apartment in September 2014, Ben Jaramillo had been homeless in the downtown area of San Diego for four years. “I was working as a carpenter, and ended up in my van when work fell flat, and then just kind of stayed there out of convenience and convenience turned into necessity and necessity turned into stuck, because of finances,” he said.
Jaramillo described the challenges he experienced while living in his van. “If [my van] breaks down I can’t use it for transportation, and if it gets towed, I’m really jammed up. Then I have to find someplace else to live, which means turning to my friends or a shelter or, push comes to shove, on the street.”
In June, Jaramillo participated in a Vulnerability Index and Service Prioritization Decision Assistance Tool (VI-SPDAT) survey during a 25 Cities Street Outreach week. VI-SPDAT is one tool the San Diego community is using as part of its Coordinated Assessment and Housing Placement (CAHP) System. The following week he was assigned a Housing Navigator, who helped him understand the resources available to him and collect necessary documents for permanent housing. Soon after, he was matched to a Supportive Services for Veteran Families (SSVF) rapid rehousing program through Veterans Community Services, a division of Community Catalysts of California and a partner in the San Diego 25 Cities Effort. The Veterans Community Services SSVF program assisted Ben in finding and staying in permanent housing and provided him with financial assistance to help him pay his rent.
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.
02/25/2015 - Positive Outcomes for Victims of Domestic Violence and Families through Housing First Pilot Program
By Kiley Gosselin
The link between domestic violence and homelessness is well-documented. Regardless of whether survivors seek help through homelessness services, housing assistance, or domestic violence programs, research shows a strong correlation between domestic violence and homelessness. A Department of Justice study found that at least one in four women were homeless as a result of domestic violence and a Massachusetts study found that a staggering 92% of homeless women experienced severe physical or sexual assault at some point in their lives. Often, it is not only the victim, but the children of domestic violence victims that suffer as a result of abuse. Domestic violence is a leading cause of family homelessness in the United States.
The Bill & Melinda Gates Foundation has made ending family homelessness in Washington a focus of their state efforts starting with the launch of the Sound Families Initiative in 2000. The Foundation has helped fund thousands of new housing units for families experiencing homelessness and is investing in approaches that are aligned with the strategies identified by USICH’s Family Connection resource, including coordinated entry and rapid housing.
In 2009, with the financial backing of the Gates Foundation, the Washington State Coalition Against Domestic Violence (WSCADV) launched a five year pilot program testing the success of a survivor-centered, Housing First approach to preventing homelessness for survivors of domestic violence and their families. The pilot worked with 13 existing programs in 13 urban, rural and tribal areas across the state and the findings demonstrate positive outcomes across all sites.