Area of Expertise: Justice and Reentry Systems

Twenty years ago, CSH developed the FUSE (Frequently Used Systems Engagement) model to deliver a transformative solution that aligns housing, health, and justice systems to provide supportive housing and coordinated care. With a proven track record of success, FUSE has become a national model for cross-sector collaboration and data-driven intervention.

For 20 years, CSH has partnered with communities across the country to identify people with complex needs who frequently cycle through emergency systems—such as shelters, hospitals, and jails—and connect them to the housing and services they need to break the cycle, achieve stability, and thrive.

This brief highlights 4 communities that have successfully implemented FUSE. Partners share their lessons learned and the lasting impact that FUSE has had on systems, residents, and communities.

People who return to the community after experiencing incarceration face many challenges in reorienting to life in their communities. Addressing basic needs like food, clothing, and shelter is likely their priority, as many of them do not have a home where they can return upon discharge. Even for those who receive family support, it is challenging to navigate the process of obtaining and maintaining the services, including healthcare, that they need to thrive in the community.

States looking to improve health, improve public safety, and decrease costs are providing Medicaid insurance coverage to this population in new and innovative ways. Various states have been approved by the federal Centers for Medicare & Medicaid Services (CMS) to use 1115 research and demonstration waivers to facilitate the enrollment of Medicaid for justice-involved persons, primarily 90 days before release.

This resource highlights the requests and approvals of Reentry Demonstrations by states. The below table summarizes state programs that are focused on the justice-involved population based on research conducted by CSH.

This resource is intended to support health centers in identifying some important components to effective programming for HIV+ individuals leaving carceral settings to ensure smooth linkage to care and housing following discharge.

The New York City Frequent Users System Engagement program (FUSE) was part of the CSH’s Returning Home Initiative, a multi-year effort of public, inter-agency collaboration and investment that provided supportive housing for people cycling between incarceration and homelessness. NYC FUSE targeted persons with recurring homelessness and incarceration, most of whom challenged also by health, mental health, and/or substance use issues.

Columbia University researchers evaluated FUSE by comparing program participants with a closely matched comparison group of “frequent users.” This evaluation found that supportive housing significantly reduced participants’ (re)admissions to and time spent in jail and homeless shelters and their use of crisis healthcare services. These reductions resulted in significantly lower costs for publicly supported services, offsetting housing and other program costs. Results have inspired jurisdictions throughout the US to launch similar efforts.

Now, 10 years later, the FUSE Long Term Study presents a unique opportunity to examine stable housing as a critical component of successful community reentry, not simply in the short term but over people’s lives.

This data brief guides system providers on how to better coordinate data and services for families involved with systems, such as child welfare, homelessness response, behavioral health, education and justice.

The Frequent User Services Enhancement (FUSE) initiative is a supportive housing program developed by CSH with support from various government agencies that provided housing and support services to individuals who were frequently cycling in and out of jails, homeless shelters, and hospital emergency rooms in 2008. A two-year follow up evaluation by Columbia University Mailman School of Public Policy found that FUSE participants spent significantly fewer days in jails and shelters and engaged in less cycling between public systems. These service use reductions resulted in significant cost savings to the government and tax payers. Download our two-page snapshot for the report highlights.