CSH is circulating the following sign-on letter to convince the new Administration and Congress to embrace supportive housing and ensure that health coverage for the lowest income Medicaid beneficiaries continues even if the Affordable Care Act is altered or repealed.
President Donald J. Trump
Honorable Senator Mitch McConnell, United States Senate
Honorable Speaker Paul Ryan, United States House of Representatives
As the 115th Congress convenes and the focus turns to national healthcare policy, we strongly recommend that you recognize the proven role supportive housing plays in reducing healthcare costs while improving outcomes for individuals with complex health conditions and housing instability – instability that, without a cost-effective intervention, leads to a need for far more expensive health care services.
Every day doctors in America provide treatment to some of our sickest patients who live on the streets, in shelters, institutional settings or unsafe, tenuous housing. Despite heroic efforts by our nation’s health care professionals, they often do not have the right tools and resources to treat many of the most pressing needs of these individuals. These patients often lack access to basic needs like housing, transportation, preventative care, and social supports. Medicine and medical interventions alone will never resolve the complexity of issues they face. Most will return to the clinic or hospital emergency department again and again, with more serious and expensive problems.
Institutional care is not a cost-effective alternative to this scenario. The costs of keeping individuals institutionalized in hospitals, nursing homes or other segregated settings are exorbitant and proving to be significant burdens on federal, state and local budgets. There is a notable subset of individuals residing in nursing homes not because they have medical needs requiring this level care but because they lack a home to go to and are too ill or frail to recover on the streets or in a shelter.
There is a growing consensus among health care professionals and policymakers that in order to break this cycle of crisis system utilization, increase cost-efficiency, and improve health, our country must shift attention and dollars toward systematically addressing social determinants of health that create cost-effective, longer-term impacts on the health of a community. Based on mounting research, it is clear that underlying, contributing factors of health impact the needs and behavior of generations.
Supportive Housing is the Solution
Access to safe, quality, affordable housing and the supports necessary to remain in that housing is the essence of supportive housing, and constitutes one of the most fundamental and powerful social determinants of health. (See studies cited below.) Yet supportive housing, a proven model producing measurable results, remains woefully under capacity in our country, due to ineffective structures in government that result in a lack of alignment between healthcare and housing policies for a subset of the population.
As you consider reforms impacting healthcare, we hope you will take actions that will expand the positive impact supportive housing has on individuals and families. Specifically, we urge you to:
- Ensure that health coverage for the lowest income Medicaid beneficiaries continues even if the Affordable Care Act is altered or repealed.
- Encourage and increase access to housing resources to pair with the healthcare system, a proven model for reducing public costs while serving as a platform for improved health and economic sufficiency.
- Encourage more states to incorporate supportive housing pre-tenancy and tenancy sustaining services in their Medicaid Plans.
- Provide states with new resources and authority to increase Medicaid beneficiaries’ use of Home and Community-Based Services (HCBS), responding to the individual’s preferences to live at home or in home-like settings. By substituting for more expensive institutional services, increasing the use of HCBS has the potential to further reduce costs and expand access to long-term supports in states with waiting lists for services.
Brief Summary of the Evidence Base for Supportive Housing
A study from the Kansas-Oklahoma region found that among baseline drug users who became residents of supportive housing, the use of crack cocaine, cocaine, and marijuana decreased by 28–50% after they were housed with access to treatments. Total quarterly health cost estimates declined by 50%, from $6,832 to $3,376.
In Indiana, an evaluation concludes significant public cost savings are realized from supportive housing compared to traditional means of treating chronic homelessness, even when considering the extra costs associated with providing housing. The results suggest a net saving of $1,149 per person (9.7%), by allocating resources to supportive housing.
In Houston, Texas, CSH partnered the local Homeless Services System with the local Managed Care Organization to prioritize housing and services for the most vulnerable members of that community. Houston was able to house 3,120 individuals, end Veteran’s Homelessness and decrease chronic homelessness by 76%. Only with the flexible supports of the state Medicaid program, was this possible.
A compilation of 16 evaluations from across the country shows supportive housing has a significant impact on emergency department visits with an average reduction of 46% from baseline to the end of the first year of housing, and a 52% reduction by the end of the second year (for studies that include second year data). Similar conclusions document that hospital bed stays per person decline following entry into supportive housing – in some cases as much as 84 percent!
A Kaiser Family Foundation report showed that nursing facility care costs an average of $62,750 per person per year whereas community-based care cost about half that figure per year.
As we move forward, the most fitting question is not how will we afford to pay for social determinants of health such as supportive housing, but whether we can afford not to pay for this proven intervention. This intervention improves our quality of health and the efficiency of the healthcare system. We look forward to working with you and Members of Congress to improve efficiency in the US Health Care systems while also improving health outcomes for U.S. citizens with the most significant healthcare and housing needs.
Advance Housing, Inc., New Jersey
AIDS Foundation of Chicago Center for Housing & Health
Arizona Coalition to End Homelessness
Behavioral Health Services and Homeless Services Divisions
Blue Water Safe Horizons
California Institute for Behavioral Health Solutions
Capital Area Coalition on Homelessness
Catholic Charities of Chemung/Shuyler Counties NY
Center for the Study of Social Policy (CSSP)
Central City Concern
Chinatown Community Development Center
Chrysalis Center, Inc.
CitySquare, Dallas, Texas
CLUSTER Community Services
Columbus House, Inc.
Community Housing Network
Community Housing Partnership
The Connection, Inc.
CURE IL, Illinois
Deborah’s Place, Chicago
Delivering Innovation in Supportive Housing (DISH)
Downtown Emergency Service Center (DESC)
Downtown YMCA of Columbus, Ohio
East House Corporation
Ecker Center for Mental Health
Episcopal Community Services
Funders Together to End Homelessness
Goodwill Industries of Northern Michigan
Glide Community Housing
Hands On Hartford
Heartland Alliance for Human Needs & Human Rights
Hesed House, Illinois
Housing Action Illinois
Housing Alliance of PA
Housing Authority of Cook County
Housing Authority of the County of DeKalb, Illinois
Housing Development Consortium of Seattle-King County
Housing and Services, Inc.
Housing for Independent People (HIP)
Huskey & Associates
Illinois Collaboration on Youth
Illinois Council on Developmental Disabilities
Illinois Parents of Adults with Developmental Disabilities Unite
Jewish Family Service of Atlantic & Cape May Counties, NJ
La Maestra Community Health Centers
Lakeview Health Services, Inc.
Larkin Street Youth Services
Los Angeles Regional Reentry Partnership
Lutheran Social Services
Mary & Elizabeth Inn
Massachusetts Housing and Shelter Alliance
Mental Health America
Mental Health Connections
Mercy Haven, Inc.
Mercy Housing and Shelter Corporation
Milwaukee Center for Independence
Mission Economic Development Agency
Mission First Housing Group
Monarch Housing Associates
Montgomery County Coalition for the Homeless
National Alliance on Mental Illness (NAMI)
National Alliance on Mental Illness (NAMI) Barrington Area
National Alliance on Mental Illness (NAMI) Connecticut
National Alliance on Mental Illness South Suburbs of Chicago
National Alliance to End Homelessness (NAEH)
National Association of Social Workers (CT)
National Council for Behavioral Health
National Health Care for the Homeless Council
New Reach, Inc.
New Jersey Association on Correction
New Jersey Association of Mental Health & Addiction Agencies, Inc.
North/Northwest Suburban Task Force on Supportive Housing for Individuals with Mental Illness
Partnership for Strong Communities
Pathways to Housing PA
Pennsylvania Council of Churches
THE PEOPLE CONCERN | OPCC & LAMP COMMUNITY UNITED
Plymouth Housing Group, Seattle, Washington
Project HOME, Philadelphia
Redevelopment Authority of the City of Harrisburg
Rockford Housing Authority, Illinois
Rosecrance Health Network
San Francisco Housing Development Agency
Sargent Shriver National Center on Poverty Law
Seattle/King County Coalition on Homelessness
Shelter Partnership, Inc.
Skid Row Housing Trust
Southern California Association of NonProfit Housing (SCANPH)
Supportive Housing Association of New Jersey
Supportive Housing Providers Network (San Francisco)
Swords to Plowshares
Tenderloin Housing Clinic
Tenderloin Neighborhood Development Corporation
Texas Homeless Network
Transitional Services Association, Inc.
Trilogy Behavioral Healthcare
United Way of King County, WA
United Way of Massachusetts and Merrimack Valley
Unity House of Troy, Inc.
University Consultation and Treatment Center for Mental Hygiene, Inc.
Volunteers of America
Volunteers of America Delaware Valley
Windham & Windsor Housing Trust
YWCA of Quincy, Illinois
INDIVIDUALS WHO ASKED TO BE LISTED
James M. Hill, VP Government Relations & Housing, Milwaukee Center for Independence
Michael Mcmanus, Esquire, Colorado
Anthony M. Zipple, SC.D, MBA, President & CEO, Centerstone-Kentucky
Christopher Burke, CEO, Unity House of Troy, Inc.