Geography: National

Practical steps for states, advocates, and housing providers to prevent coverage loss 

By Marcella Maguire, Ph.D., Director, Health Systems Integration at CSH 

As we outlined in our previous post, H.R.1 (the “One Big Beautiful Bill Act”) makes significant changes to Medicaid that will require states to adapt their programs to stay in compliance.  The bill’s nearly $1 trillion reduction in federal support over 10 years will force states to cut costs, while new eligibility rules and administrative requirements are expected to push many people off Medicaid entirely. 

This article focuses on work requirements, which the federal government refers to as “community engagement.” This change will impact many affordable and supportive housing residents, people actively experiencing homelessness, people who have formerly experienced homelessness, and anyone facing any type of housing instability. 

What “Community Engagement” Means  

The Centers for Medicaid and Medicare Services (CMS), which administers Medicaid, uses “community engagement” to describe activities that will be required to keep a person’s Medicaid coverage active after 12/31/2026. A subset of Medicaid recipients will have to report 80 hours of work or other qualifying community engagement activities in the previous month to maintain coverage.  

States are already designing these systems, and those in the field participating in those discussions now can help reduce barriers that might otherwise disrupt coverage and access to supportive services. We encourage supportive housing, homelessness, and affordable housing advocates to ask their state and health care partners how they are prioritizing continuous coverage for the people they serve.  

What Research and Early State Experience Show 

Current research indicates 92% of people targeted by work requirements are already working.¹ Two states —Arkansas and Georgia —have implemented versions of these policies. Arkansas work requirements program was halted by court order in 2018-19.²  Studies found 18,000 Arkansans lost coverage, primarily because they could not navigate administrative requirements.³ Researchers found that work requirements had no positive impact on employment or health outcomes. Georgia’s program remains active and, similar to Arkansas, shows no measurable impact on work or health outcomes.⁴   

Georgia has not expanded Medicaid under the Accordable Care Act. Because there was no prior coverage pathway for many affected individuals, the state does not report comparable loss of coverage statistics.  

Despite these findings, all states must set up systems to track and ensure “community engagement” (commonly known as work requirements) by December 31, 2026. 

What This Post Covers and How Your Agency Can Prepare 

Below, we outline the critical choices states face in the coming months, who must report, who is exempt, what counts as community engagement, when requirements begin, how states will implement tracking, and concrete steps agencies can take now to help people keep coverage. 

Who Must Report Work?  

States must implement tracking systems for people whose Medicaid eligibility is based solely on low income—often called the expansion population—in states that expanded Medicaid. Non-expansion states are not required to create these systems, although some, such as Georgia, are experimenting with the impact of these programs.⁵⁶ 

This same group will also face more frequent eligibility redeterminations. Proof of work or community engagement will be required at application and at each redetermination. States are required to look back at least one month and up to three months before application within each six-month eligibility period to verify compliance. 

Whose Exempt from Work Requirements? 

States have some flexibility to set exemptions, and federal law requests several. As defined by the law, exemptions must include:⁷ 

1. People under age 19 or 65 and older 

2. American Indians and Alaska Natives 

3. Caregivers for children 13 or younger 

4. Veterans with disabilities 

5. People enrolled in substance use disorder treatment 

6. People deemed medically frail (states must define and operationalize this process).⁸  

7. People facing a short‑term hardship (for example, some states are considering homelessness as a short‑term hardship; Montana has requested this, and as of February 25, 2026, no public decision has been posted).⁹  

8. People living in an area with a Presidential disaster declaration¹⁰ 

9. People in an area with unemployment at or above 1.5 times the national rate 

What Constitutes Work or Community Engagement Under H.R.1? 

H.R.1 (Public Law 119-21) ties continued Medicaid eligibility to completing least 80 hours per month of qualifying work and community engagement activities. States have some discretion to refine categories and set tracking methods. Allowable categories include: 

1. Employment: Any paid job counts toward the 80‑hour requirement 

2. Job training/workforce development: Job skills training, workforce preparation, or structured employment programs qualify 

3. Education: Enrollment at half time or more in an approved program, including adult education, community or technical college, GED coursework, or higher education 

4. Community service: Unpaid service with nonprofits, civic, or community organizations that add up to 80 hours 

CSH launched a new partnership to pilot Clubhouse participation to enhance recovery and advocates for other supported employment opportunities to count as work. In states that fund these services through Medicaid, agencies should be able to track attendance via Medicaid claims, so individuals don’t need to submit extra paperwork.  

States are also modernizing data systems. If eligibility systems for Medicaid and SNAP communicate, compliance documented in one program could automatically satisfy requirements in the other, reducing the burden on individuals. The simpler and more automated the system, the fewer eligible people will lose coverage due to paperwork barriers. 

When Do the Requirements Start? 

States must have systems operational by December 31, 2026, to comply with H.R.1 and we expect states to roll out requirements in fall 2026.  

To meet federal minimums, states must verify at least 80 hours of work or community engagement in the month before a person applies or redetermines coverage. “Redetermination” means the state confirms the person still qualifies for Medicaid, typically every six months for this population. States may choose to check more often, but federal rules don’t require it.  

How Will States Track and Verify? 

States must quickly develop ways to track compliance and exemptions and should prioritize verification that doesn’t burden people. Examples include: 

• Data matching with state wage or tax systems to verify work without extra paperwork. 

• Claims‑based verification for participation in Medicaid‑funded services (e.g., supported employment). 

• Interoperability with SNAP or other programs to reduce duplicate reporting. 

Today, many state databases operate in silos—even within Medicaid (eligibility vs. claims) and across agencies (e.g., tax, workforce). States that already link systems to comply with SNAP work reporting can apply those lessons to Medicaid. 

States must check compliance at least every six months, including at application and each redetermination. Communication channels vary widely: most states accept documents online; a few still require in‑person interviews. Some allow trained assisters or navigators to support people directly in their online accounts. Clear, proactive communication will be essential, so case managers, service coordinators, peer supports, and housing staff can help people maintain coverage. 

What a state will count as proving compliance remains to be determined, and advocates are encouraged to push states to make these systems as easy to navigate as possible.  

How to Maintain Coverage Under the New Rules 

Confirm expansion status. Determine whether you—or your tenant/resident—are in the expansion group (income‑only eligibility). Check state eligibility criteria, contact your Medicaid office, or review enrollment notices and codes that indicate expansion coverage. 

Assess eligibility for traditional Medicaid. If someone may qualify through disability (via the Social Security Administration), consider starting that process now. It can be lengthy, and disability advocacy is often critical to success. 

Check for exemptions. Review the exemption list above. If one applies, gather documentation early and note how the state wants it submitted.  

Plan for compliance if needed. If a person is in the expansion group, does not qualify for traditional Medicaid, and does not meet an exemption, help them identify qualifying activities and straightforward ways to document 80 hours per month. 

Helpful Resources 

CSH’s partner agencies also have released helpful material regarding this issue, including: 

• National Health Law Program, Justice in Aging, and Bazelon Center for Mental Health Law 

• Center on Budget and Policy Priorities 

• National Health Care for the Homeless Council (NHCHC) 

Bottom Line 

Our shared goal is to help people maintain continuous health insurance coverage, so they can access the services necessary to manage health conditions and thrive in their communities. Agencies, staff and advocates should be engaging with state officials now to make the systems as easy to navigate as possible. Providing support as people adjust to these requirements will help them stay connected to essential services and strengthen their ability to remain stably housed.  

A look at how CSH deployed $202 million to advance supportive housing in 2025

In 2025, CSH’s Community Investment team deployed flexible, mission-driven capital to advance supportive housing and community-based health and service solutions nationwide. Through strategic lending and New Markets Tax Credit (NMTC) investments, we partnered with nonprofit and mission-aligned for-profit developers to expand access to affordable housing and essential services for people most impacted by homelessness. 

2025 at a Glance

2025 Project Highlights

Looking Ahead to 2026 

As we move into 2026, CSH remains committed to expanding access to capital for emerging developers, advancing supportive housing solutions, and investing in projects that strengthen housing stability, health, and community well-being nationwide. 

Thank you for your continued partnership and support. 

Media Contact:
Jesse Dean, Director, Strategic Communication
[email protected] | 347-931-0132

New York, NY | January 28, 2026 – The Corporation for Supportive Housing (CSH) announced today an $85 million allocation of New Markets Tax Credit (NMTC) authority from the U.S. Department of the Treasury’s Community Development Financial Institutions (CDFI) Fund. The award is part of the Calendar Year 2024–2025 NMTC allocation round.

This new allocation brings CSH’s total NMTC authority to $570 million across eleven awards, its largest single‑round allocation and a significant milestone for the organization.

“This allocation strengthens our ability to make New Markets Tax Credit investments in ways that are disciplined, strategic, and closely aligned with community needs,” said Ross Clarke, Director, New Markets Tax Credits at CSH. “CSH uses NMTCs to finance projects that expand access to essential services, particularly services connected to deeply affordable housing. These investments help ensure that critical facilities and service providers can better meet the needs of their communities and create lasting jobs.”

Within a highly competitive round, CSH was selected as one of 142 Community Development Entities (CDEs) awarded New Markets Tax Credit allocation authority. CDEs are financial intermediaries certified by the CDFI Fund to make NMTC investments in low‑income communities.

As a national CDE, CSH will use its NMTC allocation to make investments in essential community facilities serving economically distressed areas. These investments build on CSH’s strong NMTC track record. CSH has deployed $467 million in NMTC allocation across 39 projects in 31 cities, supporting facilities such as Federally Qualified Health Centers, PACE centers, behavioral health clinics, medical respite programs, and food security infrastructure. Nearly 70% of these projects are part of developments that include co-located affordable or supportive housing (financed directly with NMTCs or separately with Low Income Housing Tax Credits), totaling more than 2,557 housing units nationwide, including 1,683 supportive housing units.

The award is part of a $10 billion national NMTC allocation round administered by the CDFI Fund. Since the program’s inception, the NMTC Program has delivered more than $81 billion in tax credit authority to support investment in low-income communities nationwide.

“This award reflects CSH’s enduring commitment to investing in impactful, proven solutions that strengthen communities and expand opportunity,” said Deborah De Santis, President and CEO of CSH. “We are deeply grateful to the U.S. Department of the Treasury and the CDFI Fund for recognizing CSH’s capacity to steward this important resource. The New Markets Tax Credit program remains a vital tool for advancing community health, economic stability, and thriving communities and this allocation will help us further our mission nationwide.”

About the Corporation for Supportive Housing

CSH (Corporation for Supportive Housing) advances affordable and accessible housing aligned with services by advocating for effective policies and funding, investing in communities, and strengthening the supportive housing field. Since our founding in 1991, CSH has been the only national nonprofit intermediary focused solely on increasing the availability of supportive housing. Over the course of our work, we have created more than 512,500 units of affordable and supportive housing and invested more than $2.2 billion in communities. Our workforce is central to accomplishing this work. We employ approximately 170 people across 30 states and U.S. Territories. As an intermediary, we do not directly develop or operate housing but center our approach on collaboration with a wide range of people, partners, and sectors. For more information, visit www.csh.org.

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Media Contact: Jesse Dean
347-931-0132
[email protected]

New York, NY – January 26, 2026 – The Corporation for Supportive Housing (CSH) Board of Directors elected three new members, effective January 1, 2026, bringing the leadership body to 18 members. The new members are Rockette Ewell, Vice President, Community Affairs Manager at U.S. Bank; Kevin Goldsmith, Managing Director, Community Development Tax Credits and Intermediaries Lending at J.P. Morgan; and Carmen Heredia, Owner of Sonora Strategy Partners, who previously served as the director of the Arizona Health Care Cost Containment System (AHCCCS), which is Arizona’s Medicaid Program.

“We are thrilled to welcome Rockette, Kevin, and Carmen to the board. Their combined expertise in community reinvestment, Community Development Financial Institution (CDFI) innovation, and health policy reflects the breadth of leadership needed to advance our mission. Each brings a unique perspective that will help us strengthen partnerships and deliver solutions that build thriving communities,” said Michelle Norris, CSH Board Chair.

Rockette Ewell

Rockette Ewell is Vice President, Community Affairs Manager, California Region at U.S. Bank, where she oversees philanthropic giving and community impact initiatives statewide. Her work includes developing strategic partnerships that align with the bank’s corporate social responsibility priorities and support business growth across California. She and her team leverage their expertise in community development, CSR, and stakeholder engagement to create lasting value for the bank and the communities it serves. In addition, she is an active community leader, serving on several nonprofit boards and committees.

Kevin Goldsmith

Kevin Goldsmith is the Managing Director for Community Development Tax Credits (CDTC) and Intermediaries Lending at J.P. Morgan and helps lead the firm’s commitment to community development by investing in affordable housing, historic building preservation and community facilities like charter schools and health clinics. Prior to joining J.P. Morgan, Kevin worked at Grow America (formerly NDC), a national CDFI focused on community and economic investment.

Carmen Heredia

Carmen Heredia is the owner of Sonora Strategy Partners. She is the former director of the Arizona Health Care Cost Containment System (AHCCCS), which is Arizona’s Medicaid Program, Children’s Health Insurance Program (CHIP), and Mental Health Authority, which oversee acute, behavioral health, and long-term care services for more than 2 million Arizonans. She has worked with both Democratic and Republican governors to ensure fair access to quality healthcare and behavioral health services.

“These appointments signal our commitment to tackling housing and services challenges through bold, cross-sector collaboration. Rockette’s community engagement, Kevin’s financial leadership, and Carmen’s health policy experience will guide us in creating integrated strategies that connect housing, health, and opportunity for people with complex barriers to stability, and the communities that support them,” said Deborah De Santis, CSH President and Chief Executive Officer.

About the Corporation for Supportive Housing

CSH (Corporation for Supportive Housing) advances affordable and accessible housing aligned with services by advocating for effective policies and funding, investing in communities, and strengthening the supportive housing field. Since our founding in 1991, CSH has been the only national nonprofit intermediary focused solely on increasing the availability of supportive housing. Over the course of our work, we have created more than 512,500 units of affordable and supportive housing and invested more than $2.2 billion in communities. Our workforce is central to accomplishing this work. We employ approximately 170 people across 30 states and U.S. Territories. As an intermediary, we do not directly develop or operate housing but center our approach on collaboration with a wide range of people, partners, and sectors. For more information, visit www.csh.org.

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Earlier this week, Congress released the fiscal year (FY) 2026 HUD appropriations bill after several months of negotiations. The final agreement provides $77.3 billion for HUD in FY 2026, representing an increase over the yearlong continuing resolution that passed for FY25.

Key Provisions

The bill maintains stable funding across most accounts and includes targeted increases to help programs keep pace with rising rents and operating costs.

Tenant-based Rental Assistance: $38.439 billion, including $34.96 billion for contract renewals, $15 million for Veteran’s Supportive Housing vouchers, and $30 million for Family Unification Program vouchers, with most of the latter set aside for youth exiting foster care.

Emergency Housing Vouchers: While Congress did not provide new funding specifically for Emergency Housing Vouchers (EHVs), the bill increases Tenant Protection Vouchers by $264 million, for a total of $600 million, and allows public housing authorities to transition EHV holders to TPVs and other vouchers to ensure continued assistance.

Project-based Rental Assistance: $18.043 billion, including $1.031 billion for housing for older adults and $287 million for housing for people with disabilities.

Homeless Assistance Grants: $4.417 billion, including $290 million for Emergency Solutions Grants, $107 million for Youth Homeless Demonstration Programs, and $4.010 billion for the Continuum of Care (CoC)—which incorporates $43 million for cost‑of‑living adjustments and $52 million for new rapid re‑housing projects and supportive services for survivors of domestic violence.

Housing and Community Development: $3.3 billion for Community Development Block Grants and $1.250 billion for the HOME Investment Partnerships Program, supporting local efforts to expand affordable housing and strengthen community infrastructure.

Additional Funding

The House has already approved $324 million for the Community Development Financial Institutions (CDFI) Fund as part of the Financial Services appropriations bill. That funding will advance into the final package sent to the Senate. Congress also approved $5 million for supportive housing through the Second Chance Act Pay for Success Fund at the Department of Justice.

What’s Next

The House is expected to bring the FY26 HUD bill to the floor this week as part of a four‑bill minibus. The Senate returns from recess next week and is expected to vote shortly thereafter. As always, CSH will continue to monitor the process closely and provide timely updates as Congress advances its work.

Supportive housing is a proven approach to breaking the cycle of homelessness for people with serious mental illness and other disabilities. Supportive housing is a cost-effective approach that combines affordable housing with voluntary support services, enabling people to live with stability, autonomy, and dignity. While supportive housing is an effective approach for addressing homelessness, residents also need social support to live healthy lives and address loneliness, isolation, and barriers to maintaining their mental health.

Fountain House and CSH are exploring Community-Centered Housing (CCH), an innovative approach that integrates the clubhouse model’s social practice into supportive housing. Pioneered by Fountain House, social practice uses community engagement and social connection to help people recover from mental illness.

This policy brief illuminates early research findings from pilot programs, showing that Community-Centered Housing strengthens social connections, reduces loneliness, and enhances residents’ sense of purpose and wellbeing. To forge a path forward for expanding CCH, the brief recommends bringing the model to additional pilot sites, conducting rigorous evaluation, expanding workforce training, and educating the field about social practice and supportive housing integration.

This approach offers a chance to reimagine what housing can achieve. By embracing this model, we can drive meaningful transformation in the housing sector and create environments that support people living with serious mental illness and promote lasting recovery and stability.

New Community-Centered Housing approach integrates evidence-based approach to reduce isolation and support recovery  

CSH Media Contact: Jesse Dean | [email protected] | 347-931-0132 
Fountain House Media Contact: Witney James | 646-455-7363 | [email protected]  

New York, NY | January 21, 2026 – As communities struggle to address rising homelessness and the needs of people living with serious mental illness, Fountain House and Corporation for Supportive Housing (CSH) today announced a collaborative partnership to advance Community-Centered Housing (CCH). CCH offers an innovative approach that integrates evidence-based social practice with supportive housing to help people living with serious mental illness achieve lasting recovery and stability.

To launch the partnership, the organizations jointly released a policy brief outlining how CCH integrates the Fountain House clubhouse model and its evidence-based therapeutic intervention, called social practice, into supportive housing. Pioneered by Fountain House, social practice has demonstrated strong outcomes in reducing loneliness, fostering belonging, and reducing psychiatric hospitalizations, as well as public and social costs.  Economic modeling suggests clubhouses have an annual cost savings impact of $11,374 per person when accounting for a wide range of health, social, and productivity costs.

“For more than 75 years, Fountain House has helped lead the clubhouse movement to advance long-term recovery for people with serious mental illness,” said Ken Zimmerman, Fountain House CEO. “This partnership embodies our commitment to innovations that allow us to extend supports beyond the walls of the clubhouse to ensure people living with serious mental illness are stably housed and socially connected.”

 “We are excited to partner with Fountain House to demonstrate how integrating their social practice model with supportive housing will result in better outcomes for people living with serious mental illness,” said Deborah De Santis, President and Chief Executive Officer of CSH. “Fountain House has shown that intentional community offers a clear path to recovery, and CSH has long demonstrated that supportive housing is a powerful, cost-effective solution for people facing both homelessness and serious mental illness.”

The partnership addresses a critical gap in current approaches: while supportive housing provides stability, many residents still experience feelings of isolation. Research shows that social isolation among people with serious mental illness significantly increases health risks and premature death. By embedding Fountain House’s proven approach to building belonging through social practice into supportive housing through CCH, the partnership seeks to pilot and evaluate it as a more comprehensive solution that addresses both housing stability and social connections essential for recovery.

In 1948, Fountain House pioneered the clubhouse model which incorporates a nonclinical treatment approach called social practice. Social practice is based on the core insight that intentional creation of community is an evidence-based therapeutic intervention. Clubhouses are social practice in action, providing access to supports such as care management, benefit application assistance, transitional employment and housing opportunities, wellness activities and daily meals.

The partnership will include pilot demonstrations across multiple sites, continued research on Fountain House’s Community Apartment Program serving 100 residents in New York City, and the development of a 235-unit supportive housing building in the Bronx that will integrate a 15,000-square-foot clubhouse. The organizations are seeking additional partners, funders and pilot sites to expand the CCH approach.

“By embracing this approach, we can drive meaningful transformation in the housing sector and advance evidence-driven solutions that build safer, stronger, and thriving communities,” added De Santis.

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This worksheet provides an overview of the most common housing models and interventions, from short-term housing to long-term housing. It is important to provide families with timely access to housing options that meet their unique needs. However, communities often have limited housing resources and mismatches between family needs and available housing options. This worksheet helps community leaders understand the various housing models and identify strengths, gaps, and opportunities within their current family housing resources. By identifying these gaps, communities can develop strategies that keep families stably housed.

Acknowledgements
This resource was made possible in collaboration with:

• Casey Family Programs, whose mission is to provide, improve – and ultimately prevent the need for – foster care.
• Chapin Hall, an independent policy research center dedicated to improving the well-being of children, youth, and families.

For two decades, CSH’s data-driven approach has helped more than 50 communities break the costly cycle of crisis—proving that collaboration works better than silos.

This week, CSH commemorated 20 years of the FUSE (Frequently Used Systems Engagement) initiative—a groundbreaking approach that has helped more than 50 communities build and scale supportive housing interventions for their residents with complex barriers to housing. Since its inception, FUSE has stably housed more than 3,000 individuals who were previously trapped in expensive cycles of crisis services.

Nearly 600 people from around the country joined CSH’s virtual symposium to mark this milestone. The event brought together partners from three communities using FUSE—Mecklenburg County, NC, Bozeman, MT, and Omaha, NE/Council Bluffs, IA—along with a researcher from Urban Institute and a Bozeman supportive housing tenant to share insights, lessons learned, and the lasting impact the program has had on their systems and on the lives helped by FUSE.

The Innovation: When Systems Work Together
The FUSE concept originated more than 20 years ago during an elevator conversation between two New York City commissioners. Martin Horn, then Commissioner of the Department of Corrections, and Linda Gibbs, Commissioner of Homeless Services. Commissioner Horn was tasked by then Mayor Michael Bloomberg to reduce incarceration costs and Commissioner Gibbs was tasked to address a demand for affordable housing while more than 8,000 individuals were residing in the city’s shelters.

In that brief ride, they recognized something profound: each system was independently trying to help the same individuals, consuming enormous resources yet failing to break the cycle. At that moment, they resolved to work together rather than separately to more effectively solve what was the city’s collective challenge.

That insight became the foundation for what CSH would develop into FUSE—a technical assistance framework that helps communities use data to identify people frequently cycling through systems, then coordinate across sectors to provide what evidence shows works: affordable housing paired with support services.

“We have powerful data systems—all of us are collecting enormous amounts of data and trying to create better outcomes for our communities,” Jason Feldhaus, Executive Director of Threshold CoC of Omaha, NE/Council Bluffs, IA, said during the symposium. “But putting those systems together creates an innovative way to identify solutions.”

The Problem FUSE Solves
Across the United States, a small population remains trapped in a cycle of crisis services—shelters, jails, emergency rooms. These frequent system users often have complex needs: chronic homelessness, mental health conditions, substance use disorders, and involvement with the justice/carceral system.

Fragmented responses fail because each system operates independently. A person might be released from jail to a shelter, visit the emergency department for a health crisis, then cycle back through the same systems. Each intervention addresses an immediate crisis but never solves the underlying cause: having no safe, stable home with coordinated support.

“We started [FUSE] to solve jail overcrowding,” Stacy M. Lowry, Director of Community Support Services in Mecklenburg County, NC, explained at the symposium. “We had many individuals stuck in our jails and we needed a new way to work with them. Doing the same old methods of building more jails wasn’t going to solve the issue. We had unmet needs in our mental health systems.” Mecklenburg County is the state’s 2nd most populous county and includes the city of Charlotte.

Lowry described how FUSE enabled a shift in approach: “FUSE allowed us better ownership of our own community. Instead of placing the burden on one system, it allowed us to join together—criminal justice, mental health, homeless provider system. We developed a joint understanding of how we can work together to create better outcomes.”

How CSH Makes FUSE Work
CSH brings more than three decades of expertise in supportive housing development and systems change to help communities implement FUSE. This includes technical assistance in cross-system data matching, stakeholder engagement across health, justice, and housing sectors, and guidance on developing supportive housing interventions tailored to local needs.

The FUSE approach centers on data-driven decision making. Communities identify their highest system users by matching data across homeless services, criminal justice, healthcare, and other crisis systems. This reveals not just who is cycling through systems, but the scale of unmet need and the costs of the current fragmented approach.

“Starting with a data-driven understanding of the people you’re intending to serve” was critical in Denver’s Social Impact Bond Initiative that brought FUSE to scale, according to Sarah Gillespie, Associate Vice President at Urban Institute, who presented evaluation findings at the symposium. “There was a population that was frequently experiencing homelessness. Once this list came to life based on data, they saw there was a much larger population that needed supportive housing.”

Gillespie noted that this data-driven approach helped reframe supportive housing beyond just a housing solution: “Supportive housing came to be seen not as a housing solution, but came to be one of the city’s criminal justice solutions and healthcare solutions.”

Evidence: FUSE Delivers Results
Twenty years of implementation across diverse communities—urban and rural, across all regions—has generated compelling evidence that FUSE works.

Urban Institute’s evaluation of Denver’s Social Impact Bond Initiative found that 86% of participants remained in stable housing after one year, with most maintaining stability even after three years. These outcomes were achieved among people with the highest previously unmet needs.

The impact extended well beyond housing stability. Speaking at this week’s event, Gillespie shared: “We found really significant outcomes across criminal justice and health care systems. We found a 40% reduction in arrests and a 30% reduction in jail stays. This is meaningfully breaking that homelessness-jail cycle.” The evaluation also found a 40% decrease in emergency department visits, while community-based healthcare visits increased by 155%, which was evidence that people were accessing appropriate and preventative care rather than using emergency services for routine needs.

“About half of the total cost of the supportive housing program was offset by these other outcomes,” Gillespie noted.

In Mecklenburg County, the evidence was similarly powerful. “We saw housing stability increase and it broke the cycle of recidivism and homelessness,” Lowry said during the panel discussion. “The success of MeckFUSE provided the county with the evidence to further invest in this area of need.”

Housing First Village in Bozeman, Montana, demonstrates FUSE’s impact in rural communities. Greg Overman, Supportive Housing Manager at HRDC, shared at the symposium: “Over four years, we’ve had zero evictions. There are three individuals here who have lived here for four years—if you look at their histories, it totals 70 to 80 years of homelessness.”

The Human Impact
Behind the data are individuals whose lives have fundamentally changed. Cori Wilson, a tenant at Housing First Village who joined the symposium, described her transformation: “The people that live there, we are a community. We can be social and feel like a normal person. I get help with substance abuse treatment. They help me get to therapy. Now I have a stable environment for my daughter.”

Wilson shared that with support, she has been able to maintain sobriety, secure stable housing for two years, and reunite with her child. “You have to have the programs to have people succeed in life,” she said.

Overman shared another resident’s perspective during the panel: “We have a resident here that lives in Unit F and she likes to say ‘F is for Forever.’ Her barriers that led to her being on the FUSE list aren’t magically going away. But she celebrated four years of housing stability after almost 30 years of homelessness.”

Reflecting on participant feedback from Mecklenburg County, Lowry noted that connection to community emerged as a top priority for FUSE participants. “We heard over and over—the connection to community. Being able to foster connections with parents, children, was high on people’s list for what they were able to accomplish in their first year of housing. Fostering those relationships were one of the things they were most proud of.”

Why FUSE Matters Now
As communities across the country face pressure to address homelessness and rising costs across health, justice, and social service systems, at the same time that the federal government shifts funding away from affordable housing and services, FUSE offers a proven path forward. The approach demonstrates that coordinated, data-driven intervention is more effective and more cost-efficient than fragmented crisis response.

“FUSE continues to be the strategy that allows us to address our most vulnerable populations,” Feldhaus reflected at the symposium. “We see FUSE really target our ability to work for fiscal sustainability and deliver quality services. This targets the neediest individuals in a way that makes sense for the future with a strategy that’s long term and proven.”

The evidence is clear: communities can reduce public spending, alleviate pressure on health and justice systems, and create pathways to stability for those most in need. Investment in supportive housing is not just compassionate—it’s sound fiscal policy.

“FUSE is replicable—you can do it in urban areas, rural areas, red states, purple states, blue states,” Lowry emphasized. “FUSE works.”

Resources and Next Steps
CSH released a FUSE 20th Anniversary Brief showcasing two decades of impact through case studies from four communities that successfully implemented FUSE. The brief highlights transformative outcomes across healthcare, justice, and housing systems, demonstrating how FUSE moves people from crisis to stability.

Learn more about how FUSE can work in your community. View a recording from CSH’s FUSE 20th Anniversary Symposium, visit CSH’s FUSE resources or contact us to explore bringing this proven approach to your region.

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.