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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.
By Diane Kean
The National Conference on Ending Family and Youth Homelessness is underway. We've captured some of the coversations, key moments, and insights. Here are some of the highlights!
By Diane Kean
Tomorrow, the National Alliance to End Homelessness kicks off the National Conference on Ending Family and Youth Homelessness in San Diego, California. The conference provides a forum of learning and sharing for hundreds of policymakers, practitioners, and federal, local and private partners, all working to end family and youth homelessness. Workshops will focus around three learning tracks on Rapid Re-Housing, Youth, and Systems, and cover topics including family intervention, crisis response systems and coordinated entry process. Keynote speakers include Nan Roman, President and CEO of the National Alliance to End Homelessness, Toni Atkins, Speaker of the Assembly, California State Assembly, and Secretary Julián Castro, U.S. Department of Housing and Urban Development.
USICH is looking forward to attending and participating in the conference. Below is a list of the workshops where USICH staff will be presenting or moderating sessions during the conference.
By Jasmine Hayes
In September 2014, William H. Bentley, Associate Commissioner of the Family & Youth Services Bureau and former USICH Executive Director Laura Zeilinger, highlighted the impact of Runaway and Homeless Youth Act-funded programs for youth experiencing homelessness. These services – street outreach, basic center and transitional living (including maternity group homes) programs – are critical to meet the immediate needs of some of our most vulnerable young people.
We know there are different ways that information is captured across Federal programs about the extent and scope of youth at risk of or experiencing homelessness. We also know that youth can experience homelessness in many ways including being unsheltered or living on the street, doubled-up or couch surfing, and this is impacted by complicated issues including poverty, abuse, violence, trauma, and discrimination based on gender identity and sexual orientation. As communities increase their capacity to capture information on youth, our understanding of the prevalence and characteristics of youth homelessness is improving and helping to shape strategies that respond to the diverse needs of young people.
By Jill Fox, Virginia Coalition to End Homelessness & Matt Leslie, Department of Veterans Services
Most great stories have a beginning, middle, and end. When it comes to the story of Virginia’s efforts to end Veteran homelessness, we started with the end in mind – a vision of a Virginia where Veteran homelessness, when it does occur, is rare, brief, and non-recurring.
The Beginning – Defining the Challenge, Getting Organized!
In the summer of 2013, the Virginia Department of Veteran Services and Virginia Coalition to End Homelessness partnered with the VA VISN Network Coordinator, Jeff Doyle, and local leaders in communities to hold a statewide Veteran homeless summit. This event marked the beginning of increased collaborations among federal, state and community partners. We believed that ending Veteran homelessness in Virginia was not an impossible task.
The goal of our effort was supported by the Governor’s Coordinating Council on Homelessness, which includes representatives across state agencies that play a role in addressing homelessness as well as local providers, nonprofits, and other community leaders. Our focus was to unify mainstream and Veteran specific housing and services while continuing to shift to housing first statewide. The success of this endeavor relied on leveraging existing partnerships with the US Department of Veterans Affairs (VA) and the Department of Housing And Urban Development (HUD) that the Virginia Department of Veteran Services (DVS) had nurtured. Along with federal agencies, DVS built on partnerships with VA Medical Centers (VAMCs), SSVF providers, and the VASH programs. Also paramount were the relationships that the Virginia Coalition to End Homelessness (VCEH) has with local Continuums of Care (CoCs), including nonprofit housing and homeless providers, local jurisdictions, and other mainstream providers involved with local homelessness planning.