Ending Homelessness Today — Health Care Reform
Why Homeless Advocates Should be Optimistic about 2014
January 27, 2014
Judging by early developments in 2014, those of us who are working to end chronic homelessness have reason to be optimistic. In addition to Medicaid eligibility expanding in about half the states, which will give vulnerable people access to health care and bring more safety net resources to communities, the new year ushered in a pair of promising news items.
First, a targeted homeless program in New York City released early results of its studies showing how Permanent Supportive Housing (PSH) can reduce public costs of caring for chronically homeless people with severe mental illness, substance use disorders, and other disabling conditions.
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Homelessness and Mental Health: Moving Past Stereotypes
October 10, 2013
Many people automatically associate homelessness with mental illness, based on stereotypes of men and women on city streets, disheveled and talking to themselves. In fact, certain groups of people experiencing homelessness do live with severe mental health conditions, though this is not true of all homeless people. With October 6 through 12 being Mental Illness Awareness Week, we thought it would be a good idea to revisit this post on the connection between homelessness and mental illness. It originally ran on May 6, 2013.
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5 Ways Nonprofits Can Help Enroll People for Health Care
September 26, 2013
On October 1, the large-scale health insurance expansion established by the Affordable Care Act (ACA) will begin. Already, local health centers to national celebrities have begun efforts to encourage and help uninsured individuals enroll. The enrollment process begins in just five days, and if you're with a nonprofit affordable housing provider you can help enroll people too. Here are five things your organization can do.
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Homeless Advocates Keep Eye on Big Picture, as ACA Benefits Roll Out
September 16, 2013
It seems like everyone who works or volunteers in community services is talking about enrollment in health care plans under the Affordable Care Act (ACA). The Alliance has been joining in. Surely the ACA has enormous potential to help people experiencing homelessness, and homeless advocates can help unlock that potential. That’s why we blogged in August about 5 Things You Can Do Now to be a part of what’s happening as enrollment begins October 1.
Today, we want to focus on two questions that will stay front and center, going forward into 2014 when new ACA benefits take effect.
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ACA Enrollment: Five Things You Can Do Now
August 26, 2013
Advocates for the homeless see the potential of the Affordable Care Act (ACA) in their communities. The Alliance has blogged about the topic since the ACA passed in 2010, and reported on key implementation issues. By now, we know that the ACA opens up Medicaid to a new group – all adults with incomes under $15,000. We also know that next year 24 states will extend Medicaid to the new eligibility group. (For a map showing where your state stands on Medicaid, click here.)
With changes in Medicaid, thousands of vulnerable homeless people could have better access to medical services, behavioral health treatment and long-term supports. And communities could have more flexibility in funding safety net services, with opportunities to re-think the ways they pay for supportive housing.
But these possibilities cannot be realized unless people are actually enrolled in Medicaid and have the best coverage possible. People experiencing homelessness will need help getting started. As ACA enrollment gets under way this fall, homeless advocates should be a part of efforts to sign people up. Here are five things you can do right now.
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States Can Help End Homelessness
August 19, 2013
One of the Alliance’s most popular blog items last year was a guest post by Paul GionFriddo. He shared how our mental health system failed his son, who struggles with mental illness and chronic homelessness. The blogger has written eloquently about his family’s experience, with the added insights of a former state legislator who voted, in the past, on policies that he would later see were missing the mark.
“Many years ago, we emptied our state psychiatric institutions for good reasons. They were monuments to neglect or abuse. But when we emptied them, we failed to put in place the community-based service delivery system we needed.”
Appropriate housing options, a critical part of the service system, are often lacking. This and other flaws in the system persist, holding communities back from ending homelessness -- with dire consequences for the most vulnerable people who face the greatest risks.
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Hope for Homeless Individuals with Addictions Under the ACA
August 05, 2013
For too long, homeless individuals have suffered at the hand of individual and systemic stigma. Often blamed for their circumstances, they are forced into the shadows of our communities. Federal and state policies to support the homeless population have been inadequate and often punitive; leaving a murky path to sustainable housing. This situation is only compounded by chronic illnesses like addictions, resulting in further isolation from societal resources.
The data regarding this population is staggering: according to the Substance Abuse and Mental Health Service Administration, 64 percent of homeless individuals have an addiction disorder. Addictions have a tangled relationship with homelessness, and are sometimes a precursor for homelessness and at other times a coping mechanism.
Recent federal policy changes provide better coverage for homeless individuals with addictions. The Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 states that if a health plan covers physical health and mental health/addictions, it must cover all equally.
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Leaders to Discuss How Health Care Reform Can Help Homeless
June 27, 2013
Health care reform offers real help to many people experiencing homelessness, especially in states that take full advantage of the Affordable Care Act (ACA). Those we call chronically homeless – with disabilities and long histories of instability – have perhaps the most to gain.
That’s why the Alliance will be holding a half-day pre-conference session exploring how health care reform is taking shape in in Chicago, Cleveland, Minneapolis, Philadelphia, and Portland on Monday, July 22, the first day of our 2013 National Conference on Ending Homelessness. We’re calling the session, “Changing the Terms: How Communities are Leveraging Health Care for PSH Capacity.”
Sponsored by the Alliance, the U.S. Interagency Council on Homelessness, and 100,000 Homes, the pre-conference will be offered at no additional charge. However, pre-registration is recommended. For more information, please contact us at email@example.com.
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Substance Abuse, a Factor and a Consequence of Homelessness
June 10, 2013
One in five people who experienced homeless on a given night in 2012 also struggled with chronic substance use problems – 131,000 people altogether.
Clearly, responding to drug and alcohol addiction is an essential part of ending homelessness. One does not need to look far to find connections between behavioral health and risks of homelessness. Substance abuse disorders are commonly found among chronically homeless people and within homeless families. Anyone who has dealt with chemical dependence, or knows someone who has, understands well the connection with homelessness. Job and income loss, family estrangement, issues with landlords, drug-offense convictions – these often go hand in hand with untreated substance use problems – at the cost of housing stability.
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Homelessness and Mental Health: Moving Past Stereotypes
May 06, 2013
Many people automatically associate homelessness with mental illness, based on stereotypes of men and women on city streets, disheveled and talking to themselves. In fact, certain groups of people experiencing homelessness do live with severe mental health conditions, though this is not true of all homeless people. With May being Mental Health Awareness Month, this is a good time to take a look at the connection between homelessness and mental illness.
Of the 633,800 people who were homeless on any given night in 2012, about 99,900 people (or 18 percent) could be described as severely mentally ill. Many are chronically homeless, meaning they have been without homes for a long time or have experienced multiple episodes of homelessness. Their mental conditions make it impossible for them to remain stably housed for long without intensive help. The consensus in the homeless assistance field is that best way to help them is by providing permanent supportive housing.
That’s not the entire story, however.
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How Medicaid Can Help Homeless and At-Risk Individuals
April 29, 2013
At least three vulnerable groups could benefit from the Affordable Care Act (ACA) in ways that could reduce homelessness and risks of homelessness: chronically homeless individuals; young people aging out of foster care; and ex-offenders, also known as homecomers.
Medicaid expansion, which is optional for states, could potentially cover all uninsured men with incomes under $15,000 – meaning most chronically homeless people and homecomers would have better access to medical and behavioral health care. Under the ACA states also must extend coverage to former foster youth until age 26, which will give these young people additional time to receive ongoing treatments and services. And under the ACA signing up for Medicaid will be easier across the country, as states must remove barriers to enrollment.
The ACA will not end homelessness! Housing is the primary intervention to solve homelessness. However, vulnerable people also need supports and services to be stable in housing. Medicaid can help individuals, and covering them will help strained communities by adding resources for services that accompany housing assistance. The proof will be in implementation, starting next year.
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Our 2012 Conference: Some Themes and thoughts
July 20, 2012
We’d like to thank the nearly 1,500 practitioners, public officials and other stakeholders who took time out of their busy schedules to attend our 2012 National Conference on Ending Homelessness. For us in the Alliance, the level of enthusiasm and positivity on display in the plenary sessions and workshops was immensely gratifying. The homeless assistance community has come far, in terms of its overall level of sophistication and focus on implementation in order to get results, and the conference was a great opportunity for people to share what they have learned, as well as for those of us in the community to engage in a discussion about what we still must do to achieve our goals.
In her remarks at the conference’s closing plenary, Alliance CEO Nan Roman touched on a few of the themes that emerged over the course of the three days. I’ll expand on some of those here.
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Is the Obamacare Glass Half Empty or Half Full?
July 10, 2012
What does the Supreme Court decision on the Affordable Care Act mean for communities poised to use new Medicaid funding to bolster their homeless assistance? First and foremost, communities have to engage more intensively with the state policymaking process – this, actually, was true before the ACA ruling came down. And it will be true no matter what the results of elections in November.
Since the decision, we now know that Medicaid will not expand nationally to cover virtually all uninsured people who earn less than $15,000. Therefore, the presumption no longer holds that virtually all people experiencing chronic homelessness will be able to enroll in Medicaid beginning in 2014. But states do have the option to expand in 2014, taking advantage of substantial federal Medicaid subsidies to do so. The ACA cannot require states to expand their programs, but still offers to pay them 90-100% of the cost of covering all uninsured adult citizens who earn around $15,000 or less annually.
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Supportive Housing and Medicaid – Moving the Agenda in States
June 11, 2012
Leaders and innovators in supportive housing convened in Chicago last week for a multi-faceted look at integrating housing and health care. The Leadership Forum, sponsored by the Corporation for Supportive Housing, was also the occasion for the release of a “business case” for states to tap Medicaid to pay for key services in permanent supportive housing. The presenters at the day-long conference and the paper on the business case speak to recent innovations with health care and supportive housing — demonstrating what’s possible under the Affordable Care Act, and what’s actually happening in communities where state government and homeless providers are proactive.
Two stand-out ACA provisions enable homeless advocates to persuade state policymakers that supportive housing is a worthwhile Medicaid investment.
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Ending Chronic Homelessness State by State: Strategies for Medicaid to Make a Difference
May 14, 2012
States vary” – a top research finding in virtually every field studied inside the Beltway. When it comes to understanding how Medicaid is relevant to ending chronic homelessness, we would like to be more helpful. True, Medicaid’s relevance to ending chronic homelessness in your community depends greatly on the profile of your state. Still, success in another state is worth looking at, along with assessing what can be borrowed effectively. A pre-conference session for early arrivals at the Alliance’s summer conference will offer an opportunity to do just that. The half-day mini-conference is co-sponsored by the U.S. Interagency Council on Homelessness. We will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless.
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The ACA Can Help Us End Chronic Homelessness
March 27, 2012
On Tuesdays in March, the Alliance has been blogging about the Affordable Care Act (ACA), which was enacted two years ago and is today (literally, today) the center of attention in the U.S. Supreme Court. As we and our partners have pointed out, the ACA is already helping very vulnerable people, including people experiencing homelessness – for instance, through a limited amount of new funding for community health centers. Other changes are coming on-line this year, such as Medicaid health homes, a state option that can help communities do a better job of coordinating health care and homeless assistance.
Still bigger changes are yet to come. If the key Medicaid expansion is upheld as constitutional, chronically homeless and at-risk adults who do not qualify now will have access to Medicaid benefits, starting in 2014. Even then, the promises of the ACA can fall short, if those benefits are not sufficient for people who need housing stability to recover and improve their health status. It is important for homeless advocates to have a voice in designing Medicaid benefits that make that link with concrete solutions when housing is necessary to complete an effective, person-centered care plan.
There is much work to be done. The ACA offers resources and innovative policies. Whatever the outcome in the Supreme Court, homeless advocates will continue to strive for community networks that seamlessly provide supportive housing, primary care and behavioral health services. We know this approach is n... Read More »
A Word from Our Partners about the ACA and Chronic Homelessness
March 20, 2012
It has been two years since passage of the Affordable Care Act. Next week, key parts of the ACA will be debated in Supreme Court oral arguments. The nine Justices will hear from lawyers on both sides – those who are challenging and those who are defending the law. Yet it could be several months (at least) before we know how the highest court in the land decides.
Whatever happens, there is no denying that the ACA has been helping people, as we noted in our March 6 blog. As we also noted, some of the ACA’s greatest promises are still unfolding for the nation’s most vulnerable people who still lack health care coverage. The Medicaid expansion, for instance, will not take effect until January 1, 2014 – assuming this part of the law is upheld by the Supreme Court. Even so, progress is being made.
For this week’s ACA blog, the Alliance asked some of our national partners how they view the impact of the ACA. Here’s what we heard:
From Barbara DiPietro of the National Health Care for the Homeless Council:
“Homelessness is hazardous to your health. Poor health causes homelessness, and in many cases, the experience of homelessness creates new health care conditions and exacerbates existing ones. It is very difficult to become stable in employment or housing when there are untreated health care conditions.
Under the ACA, serving the most vulnerable homeless people will require more capacity in community he... Read More »
The ACA and mental health, substance abuse treatment
December 15, 2011
Last week, we re-ran an earlier blog post about how expanding Medicaid through the Affordable Care Act (ACA) is critical to ending chronic homelessness. Starting in 2014, the vast majority of vulnerable adults not already on Medicaid will have the opportunity to enroll in a health benefits plan. We talked about what this means for individuals and their access to care, and what it means for communities, given new opportunities to access Medicaid funding.
Today, we look deeper into the crystal ball to explore what health care reform might mean for mental health and substance abuse treatment.
Behavioral health services, including treatment for substance use disorders, will be part of new Medicaid benefits. Between now and 2014 – and for a long time after – policy officials and advocates will be talking about what those benefits might look like in any given state. What kinds of services will Medicaid pay for? In what kinds of settings, for how long, and by whom? These are key questions that policymakers will gradually answer as implementation proceeds. No matter what, though, it is clear that the ACA is meant to transform behavioral health care delivery, as it transforms the rest of the health care system.
Consider, for instance, that 61 percent of people served under state substance abuse programs have no insurance. Some 87 percent of those uninsured behavioral health consumers will be eligible for Medicaid. So already we can see that Medicaid will play a much bigger role than... Read More »
Ending Chronic Homelessness: Medicaid Will Make a Difference
September 16, 2011
This post is part of a series of blogs from the Alliance staff. Each day a different expert is taking the reins of our blog, Facebook and twitter accounts to share with you their perspectives and knowledge on ending homelessness. For more information, see this introductory post. Today’s post comes from Lisa Stand, Senior Health Policy Analyst.
HUD Secretary Shaun Donovan recently called Medicaid “our greatest chance to make the biggest difference for the most people to move the needle on all of homelessness.”
Why? Perhaps because Medicaid is getting ready to sign up millions more low-income people. Because of the Affordable Care Act, all uninsured citizens with incomes under $15,000 per year will be eligible for Medicaid starting in 2014. That means vulnerable people who have been experiencing homelessness without access to health care will have one less barrier to housing stability.
And what a big barrier lack of coverage can be! Studies show that chronically homeless people tend to be physically burdened by conditions like cardiovascular disease, HIV/AIDS, diabetes, and untreated injuries. These illnesses often compound mental illness and substance use disorders, which are themselves made worse by homelessness.
Access to health care – including behavioral health care – can make an enormous difference for someone living on the street, or even a person barely hanging on with health-related burdens in subsidized or market housing. The most basic medical benefits pay for physicians, prescription drugs, lab tests, mental health services, and much ... Read More »
Introducting: Guest bloggers, tweeters, and Facebook friends for the week
September 09, 2011
Greetings Alliance friends and supporters!
The week of September 12, we – the usual guards of the Alliance blog, Facebook, and Twitter accounts – will be away from the office. But during that time, you will have the great opportunity to hear directly from some of our colleagues.
Each day, a new expert will take the reigns of our online community and share with you their perspectives on the Alliance, our work, and ending homelessness.
Monday, September 12: Elizabeth
Our resident fundraiser will share with you news from our latest Annual Report, how fundraising happens here at the Alliance, and how your hard earned donations make the difference in our program and policy work. If you have questions about the way the Alliance conducts fundraising, nonprofit development news, or have suggestions about online fundraising for the Alliance, make sure to shoot a note to Elizabeth on Facebook or Twitter on Monday!
Tuesday, September 13: Pete
Research associate and fan favorite Pete will share with you the poverty data that the U.S. Census Bureau will release that day and help break down what the data means for low-income and homeless people. It’s no surprise that many poor people are at risk of experiencing homelessness and that poverty is often associated with the highest homelessness risk factors including doubled up housing situations, severe housing cost burden, unemployment and/or low wages, and the like. Got research questions? Tuesday’s the day for them!
Wednesday, September 14: Kim &am... Read More »