Guest Blog by: Ehren Dohler Coordinator, Housing Special Projects, Center on Budget and Policy Priorities
Advocates and practitioners have known for years that supportive housing is highly effective at reducing homelessness among people who struggle with mental illness, substance use, and other serious issues. Yet only a small share of people who need it actually receive it, and it’s still relatively unknown outside the homeless service system. A recent CBPP paper evaluates the research on supportive housing and outlines four ways to increase its availability.
As CSH has long recognized, research plays an essential role in efforts to help more people through supportive housing. Supportive housing is costly and resources are scarce, so establishing that it’s worth the investment is important. Yet clarity about the limitations of the evidence is also important so that projects establish achievable outcomes and further study is directed where it’s most needed.
Research also builds support for supportive housing beyond homelessness advocates and practitioners. Studies show, for example, that supportive housing can reduce the use of costly health and corrections services, help seniors who wish to stay in the community as they age, and help families keep their children out of foster care (the focus of CSH’s Keeping Families Together initiative).
Research also informs policy proposals to create more supportive housing. Policymakers can create more supportive housing by:
Providing additional rental assistance and other housing resources. Rental assistance — most of which is federally funded — ensures that rents are affordable even to the poorest households. Case management alone is much less effective at helping people with disabilities maintain stable housing in the community. Yet only one in four eligible low-income households receives rental assistance due to funding limitations. Expanding the availability of rental assistance is essential to meeting the need for supportive housing.
Reinvesting savings generated by supportive housing to provide more rental assistance. Supportive housing reduces some people’s use of other expensive services, such as emergency rooms, inpatient hospital stays, nursing homes, and prisons or jails. Research indicates that targeting the costliest users of health care and corrections for supportive housing would produce sufficient savings to merit reinvestment. For less costly groups of people who may still need supportive housing, in contrast, supportive housing may appropriately raise health care costs by providing them with care for previously untreated conditions. Communities seeking to use cost savings to expand supportive housing should use data to target the costliest users of public systems.
Making greater use of Medicaid for supportive housing. Providing more supportive housing can have positive effects on health. For instance, supportive housing reduces the risk of death among people with HIV/AIDS, and may also lessen the amount of the virus in their bloodstream. While more research is needed on supportive housing’s impact on other health outcomes such as blood pressure, diabetes, or heart disease, the research shows that supportive housing can help people receive more appropriate community-based health care, like outpatient visits, and reduce the use of unnecessary emergency health services.
Unfortunately most federal grant programs that fund supportive services are time-limited and receive too little funding to meet the need. Medicaid is available to anyone who qualifies, so it provides a much larger, more predictable source of health and supportive services funding for supportive housing. But it’s underutilized for this purpose
Providing more services for supportive housing through Medicaid could increase the impact and efficiency of the program. States can take multiple steps to expand the availability of services for supportive housing through Medicaid. For example, more states should take advantage of their flexibility under Medicaid to provide services that help people stay in their homes, such as personal care services in homes, behavioral health care services, and housing-specific supports like help search for housing and working with landlords, if these services are necessary for someone to maintain their health and keep them out of expensive institutional care. States could also institute a process for supportive housing providers to secure Medicaid reimbursement where appropriate.
Targeting supportive housing on those who need it. Most people, even those with disabilities, remain stably housed without supportive housing’s intensive services. To best use available resources, supportive housing providers should concentrate on those who can’t succeed with less intensive care. In addition, providers need options for transitioning people — without disrupting their lives — from supportive housing to less intensive supports, though they likely will continue to need long-term rental assistance to afford housing in the community. CSH will publish a toolkit later this month highlighting promising examples from around the country that help people move on from supportive housing.
There’s no one assessment tool to differentiate between people who need supportive housing and those who don’t, so more research is needed to develop better assessment tools to use supportive housing more efficiently.
The CBPP paper is a publication of our new Connecting the Dots: Bridging Systems for Better Health project, which advances policies to improve health care delivery and other services for people with significant physical, mental, and substance use conditions, including those reentering the community from the criminal justice system.
CBPP is a Washington, DC-based non-partisan research and policy institute that pursues federal and state policies to reduce poverty in a fiscally responsible way. CBPP has published other resources — including data and analysis of housing and health care funding and policy — on the effectiveness of federal and state policies and programs that help low-income and other vulnerable people.