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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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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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.   First, the “health home” benefit can be a good vehicle for funding care management and service coordination, services that make supportive housing viable as a strategy to end chronic homelessness. As the Forum audience heard, a Medicaid health home is a unique concept that has to be understood in a health policy context. But once that context is understood, it is easier to bring relevant data and analysis to Medicaid decision-makers. The business case illustrates that if Medicaid pays appropriately for care management via this new benefit, states can expand their service capacity in supportive housing. That’s because Medicaid allows the state to access federal funding to pay a portion of what the state would otherwise hav... Read More »

“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. Homeless Advocates at the Table. One facet is effective engagement at the right time in state health policymaking. How do homeless advocates get the ear of state health care officials before they make decisions that have implications for addressing chronic homelessness in a person-centered way? New York has an inspiring story of supportive housing stakeholders at the table of statewide Medicaid reform -- with results that bolster community-based strategies to end homelessness. In Louisiana, supportive housing is now viewed as a core element in Medicaid’s plans for managing care of behavioral health enrollees. In short, policy gaps have been successfully bridged with stakeholder input at high levels. Benefits and Payment Policy. Anoth... Read More »

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 »

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 »

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 »

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 »

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 »

Today's guest post was written by Alliance senior policy analyst Lisa Stand. I am a lot more familiar with health care issues than with homelessness and housing. But, now that I’ve been at the Alliance for five months, I’m starting to see the forest and the trees, the big picture of the current State of Homelessness and the amazing talented and committed people who are ending homelessness one person at a time. More often than not, that same person was just the very same one health care advocates had in mind as they worked to pass the Affordable Care Act. So why, when it comes to implementation, are there sometimes disconnects between housing and health care in the safety net? One word: Medicaid. Beginning in 2014, almost everyone with very low incomes ($10,800 for an individual) will be eligible for Medicaid – no matter where they go for treatment or support. That’s going to be a change for those chronically homeless individuals without Medicaid disability coverage or other insurance. Changes may be in store, also, for the programs that care for them. Suddenly, both patients and communities will be able to utilize Medicaid dollars they never had access to before - so Medicaid is the current topic in strategies to serve individuals in permanent supportive housing. The question is how? Medicaid is unlike any other program, in so many ways. To mention one, it really... Read More »

So, I could tell you that the week’s news has been about budgets and housing – again. I could tell you that writers from Providence, RI and Passaic County, NJ and Los Angeles, CA are discussing the role that budgets will play on housing for low-income people. And that there was a pretty cool opinion piece penned by VA Assistant Secretary for Public and Intergovernmental Affairs L. Tammy Duckworth about assisting women veterans returning from service. But it’s pretty much the same old, same old so I’ll tell you about some cool things the Alliance is doing. We’re publishing a series on “Notes from the Field” on the blog – you may have caught the first and second postings. The CAP team at the Alliance wants to share with you things that they’ve found while working on-the-ground with communities. We’re administering a survey! Help us out my taking this 5 minute, 10-question survey about advocacy around homelessness issues – and pass it on to a friend!Check out the library. We’re always updating our website with new documents, resources, and tools to help communities end homelessness. Items of note: our new domestic violence brief, information about health care reform, and the Advocacy Toolkit. Check them out! ... Read More »

Today's post comes from Alliance policy analyst, Lisa Stand. A new report from the National Association of Community Health Centers discusses the crucial role community-based health providers play in efforts to end homelessness and relieve its effects on health and quality of life. Community agencies that work with people experiencing homelessness are probably most familiar with the specialized Health Care for the Homeless (HCH) clinics, which last year served more than 800,000 people experiencing homelessness nationwide, through 208 separate projects. In addition, permanent supportive housing (PSH) programs are often connected in one way or another to a community health clinic, assuring a source of primary care for PSH residents and adding to housing stability. While community health is financed in a variety of ways, federal funding is paramount, through Medicaid and grants to Federally-Qualified Health Centers (FQHCs), to name a few federal sources. According to the NACHC report, “health centers operate in more than 8,000 locations and serve 23 million patients.” Access to community health care services helps make the business case for PSH, and health centers anchor local safety nets to help prevent homelessness. The report, “Community Health Centers: The Local Prescription for Better Quality and Lower Costs,” was released last week, as a couple thousand advocates for community health centers gathered in Washington to help Congress understand their vital role in communities across the country. Are you interested in learning more about how health care reform can help end homelessness? Email us and check o... Read More »

If you are not sure how the new health care law will help end homelessness, you are not alone. Only time will tell – and it may be a long time. That’s because some of the biggest changes do not take effect until 2014. And even then, so much depends on decisions to be made in Washington, DC and in each state – before and after 2014. In the meantime, advocates and housing providers can help shape the Affordable Care Act (ACA) as a strong part of housing strategies – especially for chronically homeless individuals. As the ACA is implemented, the Alliance will offer tools, suggestions, and information for communities to make the most of new opportunities. We will also host webinars, post issue briefs, write fact sheets, and ask you what’s happening in your neck of the woods, and – more importantly - what you need to bridge access to housing with access to health care. For starters, consider these two factoids: the ACA will extend Medicaid to an additional 16 million people nationwide; the ACA encourages states to increase access to services and supports, promoting independent living in communities. If you begin to view your housing strategies in light of these two touchstones of health reform, you are on your way to joining implementation efforts in your state. Next, organize your resources to get in the conversations about the ACA – provide a unique housing-oriented perspective, and ensure access to specific information about implementation in your state... Read More »

Yesterday marked an important moment in American legislative history. Last night (so late it was almost early this morning), the U.S. House of Representatives passed health care reform legislation. The hotly-contested legislation endured fierce debate up to the very end, and the final bill passed without any Republican support. While it may not be readily apparent, the health care reform bill has a significant effects on the homeless population. Among many other things, this legislation expands Medicaid eligibility to include people with incomes of up to 133 percent of the poverty level, covering nearly all people experiencing homelessness. Moreover, the legislation will also provide approximately $10 billion for community health centers for Fiscal Years (FY) 2011 through 2015. Typically, the Department of Health and Human Services (HHS) allocates 8.7 percent of total community health center funding toward the Health Care for the Homeless program, which can be used to provide services to people in permanent supportive housing. The health care legislation also expands early childhood home visitation programs, which provide parent education, child development, and support services to low-income, at-risk young children and their families. President Obama has said he plans to sign the legislation on Tuesday, March 23.P.S. We made the video above last summer, when the healthcare reform debate was just heating up, but it still does a pretty adequate job of wrapping up how the two are related and why health care reform matters to homelessness. Let us know what... Read More »

Happy Monday, everyone! In case you didn't catch it, we're posting Nan Roman's Huffington Post blog on here, entitled "the Healthcare-Homelessness Connection," - a look into how the current health care debate is affected by homelessness, and vice versa. The Healthcare-Homelessness Connection While health care reform is being hotly debated across the nation, one of the groups most likely to be affected by reform has been characteristically silent: people who are homeless. It's a common misconception that everybody living in poverty is eligible for Medicaid -- in truth, there are many poor people who are not currently eligible for Medicaid. Non-disabled, childless adults -- even those with health problems -- are often not eligible. The same applies to mothers with health conditions whose children have been placed in foster care, and young adults aging out of the foster care system. In fact, a 1996 nationwide study of homelessness found that only 25 percent of homeless single adults were enrolled in Medicaid. It's not always easy to see, but homelessness and health care have a clear -- and cyclical -- relationship: poor health can lead to homelessness, and homelessness can aggravate poor health. And both can be a burden on our health care system. Many people become homeless due to a lack of health care. Untreated illnesses can lead to disability and job loss -- and unemployment remains one of the leading causes of homelessness. It's worth noting here that the leading cause... Read More »

President Barack Obama just finished his address to a joint session of Congress about health care reform. The raging debate over this monstrous social issue has been the cause of many an editorial, many a pundit's diatribe, and much distress and concern among the American public. Tonight, the President reminded us about "the things that truly matter" and the importance of approaching our biggest challenges. He reminded us that we not only have a personal responsibility to take care of ourselves, but a moral and civic responsibility to look after those least among us. He reminded us that we can and must take on the hard challenges that confront us as a nation to make us, collectively, a healthier, more whole community. The President urged us to put aside our difference and focus on the common values and priorities that bring us together. We know that the President could not be more right - and we support and applaud the President in his efforts to provide necessary services to the American people, and to make sure that those who are most in need also have access to critical care. As I listened to the President discuss his priorities and agenda tonight, I could only be reminded (though perhaps because I'm surrounded by it day-after-day!) of those who really are the least among us. Not the middle class families or the post-college graduates - though their needs are equally important -... Read More »

Happy Monday, everyone! We have a GREAT treat today! Maria Foscarinis, of the National Law Center on Homelessness and Poverty (NLCHP), sent us a piece on her organization's stance on the health care debate and the homelessness. No doubt you've heard a thing or two about the raging controversy over health care. All the national papers, including the New York Times, the Washington Post and USA Today are a-buzz with recent criticisms, potential changes, and the likelihood that the administration will concede to the hysteria of the general public. In our little corner of the world, we wonder what the health care debate will mean for the homeless population. We wonder if reform - should reform pass - will make a tangible difference in their lives: will the chronically homeless get the medical attention they need? Will improved coverage curb the number of costly emergency-room visits? Will the poor and very poor be assured health care coverage under federal programs like Medicaid? And since the Post brought it up, what about the families? Here at the Alliance, we know what we'd like to see. Check out senior policy analyst Peggy Bailey outline the Alliance's goals for improving health care. And a slightly different perspective from our friends at the NLCHP. Many thanks to Maria Foscarinis and Ashley Shuler at NLCHP for their invaluable help in getting this piece posted today. Tale of two health crises By: Maria Foscarinis Twenty two... Read More »