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  Mental Health and Military Appreciation

  May 09, 2013

  In our media-driven, socially-conscious era, every month has its many associations, and May is no exception. Did you know that May is National Salad Month? Neither did I. It’s also National Mental Health Awareness month and Military Appreciation Month. It’s fitting that these two issues share a month because, due to over ten years of continuous conflict, they are inextricably linked.

  With a small, all-volunteer military pressed into duty for over a decade, many service members have faced multiple deployments and experienced  sexual trauma, horrifying urban combat, traumatic head wounds, and they have suffered from lack of employment opportunities when they return home. All of these factors can contribute to mental health issues.

  As many as 40 percent of all veterans will experience some form of mental health or trauma related symptoms as a result of their service.  These are complex and often long lasting conditions that veterans will live with for many years. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) have both struggled to come to grips with this growing problem.

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  What I Learned from My Son’s Chronic Homelessness

  November 20, 2012

  Recently, I argued this point in an essay for Health Affairs that later appeared in the Washington Post. I wrote that the mistakes of an earlier generation of policy makers – a generation of which I was a part – caused so much of the problem.

  Many years ago, we emptied our state psychiatric institutions for good reasons. They were often monuments to neglect or abuse. But when we emptied them, we failed to put in place the community-based service delivery system we needed.

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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. Access to health care services – including behavioral health and recovery support – can be a key part of successful housing outcomes for the 107,000 people who experience chronic homelessness on any given night. Without funding for health care, many communities struggle for sustainable solutions – specifically, adequate permanent supportive housing (PSH), which is proven effective to address chronic homelessness. Since Congress passed the ACA in 2010, homeless assistance systems have anticipated the Medicaid expansion – to help individuals and to enhance safety net capacity. Full Medicaid coverage will not be a ... Read More »
• 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.   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 »
• Senate Passes Reauthorization of the Violence Against Women Act (VAWA)

  April 30, 2012

  On Thursday, April 26, the U.S. Senate voted to pass S. 1925, the Violence Against Women Reauthorization Act of 2011 in a vote of 68 to 31.  This reauthorization, sponsored by Senator Leahy from Vermont and co-sponsored by 61 bipartisan Members of the Senate, has stronger language to help protect LGBT, tribal, and immigrant survivors which gained the bill its 31 “nays” in the Senate and fairly wide media attention. Perhaps of more importance in the field of homelessness assistance is another provision of the bill, it would provide particular protections for survivors in a variety of HUD programs.  Current law provides survivors with protections from eviction and the opportunity to transfer in Section 8 and Public Housing.  This reauthorization bill would extend those protections to a variety of other HUD programs, including McKinney-Vento Homeless Assistance grant, Sections 202 and 811, and the Low Income Housing Tax Credit (LIHTC) program, among others.  And, if transfer is not possible, it requires HUD to establish a policy for how a survivor can access a Section 8 voucher instead. VAWA was first passed in 1994 and since then has created a number of successful programs to help protect survivors of domestic violence, dating violence, sexual assault, and stalking.  One of those programs, the Office of Violence Against Women’s (OVW) Transitional Housing Grants administered by the Department of Justice helps survivors leave abusers and access safe housing with voluntary support services to help the survivor and their family stabilize in housing.  Providers who implement these progr... Read More »
• 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 »
• Medical Homes and Person-Centered Care

  March 13, 2012

  If you spend your day helping people who have experienced chronic homelessness, you know a lot about “person-centered” care. It means organizing services and supports around the specific needs of an individual – a place to live first and foremost, then recovery supports, medical treatment, supported employment, and so on. In a world of service silos and payment mazes, it also often means a headache of coordination – you braid together programs and accounts, keep an eye on staff resources, manage partner relationships, and try to catch whatever falls off the table before it lands on your client. (You’re welcome). Fortunately, the health care system just might be catching up to you. There is one area of health care reform that doesn’t draw much partisan controversy. It’s the drive to make the system work smarter with the resources dedicated to people who use the most services. We are all aware of the problem. In health care, the highest share of spending is associated with a small percentage of people who have very complicated health and functional profiles. How much of the costs can be managed better by paying more attention to care management and service coordination? Medicaid policymakers think the answer is “a lot,” and they have gotten behind new strategies to prove it. This is welcome news for homeless advocates.   The medical home (or health home) is one of the most promising ways to integrate health care with supportive h... Read More »
• Re-Run: Chronic Homelessness and Medicaid

  December 07, 2011

  Today's post is a re-run about the impact that Medicaid (and health care reform) can have on ending chronic homelessness. For more about Medicaid, check out our blog archive and our website. 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 more. Uninsured poor people who now line up for such services in busy emergency rooms will finally be able to get this treatment in communi... Read More »
• HUD appropriations are finished, now what about HHS?

  December 01, 2011

  On November 18, President Obama signed into law federal funding for the Departments of Housing and Urban Development (HUD), Transportation, Commerce, Justice, and Agriculture.  Along with this funding, he signed another stopgap funding measure to fund the rest of the government until December 16, thus allowing Congress more time to work on the remaining appropriations bills. So what are those remaining bills and what’s happening with them? In particular, coming off the back of homeless youth awareness month, what’s happening with Runaway and Homeless Youth Act (RHYA) funding (within the Department of Health and Human Services – HHS)? In recent years, funding for HHS has been a sticking point in finalizing appropriations due to its size and complexity.  HHS couches programs as varied as the Low-Income Heating and Energy Assistance Program (LIHEAP), the Substance Abuse and Mental Health Services Administration (SAMHSA), and Head Start, to name just a few.  And these are just a small subset of programs serving low-income or disadvantaged people.  The sheer size and complexity of the funding bill means Members of Congress often haggle over a range of provisions. In particular the Labor, HHS, and Education (Labor-H) bill is stalled due to its inclusion of funding for certain portions of the Affordable Care Act, the health care overhaul legislation of 2009. Due to its unpopularity with certain portions of Congress, the bill has become an even bigger sticking point.  So much so, in fact, that the House Appropriations Labor-H Su... Read More »
• Tell the Super-Committee to Protect Medicaid

  October 13, 2011

  Last week, we told you about the Super-Committee and why we need to ask them to protect homeless assistance programs.  Last month, we told you what the Super-Committee needs to know about ending homelessness. Today (and tomorrow), we need you to pass that message along to the members of the Super-Committee. Specifically, we’re talking about Medicaid. The Medicaid Coalition, led by Families USA, will be having call-in days today, Thursday, October 13 and tomorrow, Friday, October 14. We’re asking you to call the Members on the Super-Committee and urge them to reject any cuts to Medicaid. Medicaid is a critically important part of the social safety net that protects homeless and other vulnerable people. Why tomorrow? Because tomorrow is the deadline for congressional committees that work on Medicaid to relay their expert recommendations to the Super-Committee. All committees that work on Medicaid – on both the House and Senate sides – have the opportunity to send the Super-Committee their thoughts on how the Super-Committee should approach Medicaid tomorrow. This is another great chance to contact your Members of Congress, build upon your emerging relationship with lawmakers, and make a difference in the lives of those suffering most in this economic climate. Reaching out to your Members on this issue is an important step in letting congressional leadership know that homelessness programs like Medicaid, TANF, the McKinney-Vento Homeless Assistance Grants and other low-income housing and homelessness programs are key to stabilizing millions of families a... 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 »
• Talking Medicaid: First Steps in Building Effective Homelessness-Health Care Partnerships

  April 06, 2011

  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 »
• Friday News Roundup: Check Us Out

  April 01, 2011

  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 »
• Community-based health providers preventing and ending homelessness

  March 28, 2011

  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 »
• How Health Care Reform Will Affect Homeless or At-Risk Populations

  February 28, 2011

  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 »
• Guest Blog: Health Care and Homelessness, by Abe Oudshoorn

  December 16, 2010

  Today’s guest blog post comes from Abe Oudshoorn, RN, PhD(c), Year 4 Coordinator, School of Nursing, The University of Western Ontario. After spending three years on a Dissertation research study about homelessness and health care, I realized that I nearly missed the point. I am a registered nurse by trade, and my clinical background is working with people who are experiencing homelessness in a community-based clinic. Based on my observations of the importance of healthy client-provider relationships, I set out to study these relationships, and particularly how power comes into play in health care relationships. I had a lot to work with going into the study: I knew that people who are experiencing homelessness face the worst morbidity rates in Canada, I knew that homeless persons face multiple barriers to accessing health care, and I knew that negative attitudes of health professionals have consistently been identified as the primary barrier to care for homeless people. So I did my study, and - sure enough - I heard and saw much conflict in client-provider relationships. But when I set about to write, my committee members asked about how policy impacts on my findings. And this is what I almost missed: Indeed, health providers do use and abuse control with homeless clients, but much of the workplace context is beyond their control. For example, in the clinic I was studying, there were very limited resources (socks, bus tickets, food and clothing) a... Read More »
• Alliance welcomes Lisa Stand and Andre Wade

  November 10, 2010

  Special thanks to Rachel Costas, Alliance intern, for her help with today’s blogpost. The Alliance is delighted and lucky to announce two new members of our staff! André Wade joins us to serve as point person on youth policy; Lisa Stand offers her expertise on health care policy. Throughout his career, André worked with children/families who experienced homelessness at some point in their lives and learned that children exiting foster care children often experiencing homelessness as young adults. Upon arriving at the Alliance and examining homelessness and homelessness policy, he (like most of us) was surprised by the lack of data on homeless youth and dearth of policy around the issue. He also observed much more closely that homelessness is, in fact, a problem that exists “literally everywhere.” Luckily, Andre is eager and ready to join the mission and work on LGBTQ homeless youth issues and youth and child welfare issues as they relate to homelessness. Our new youth programs and policy analyst is a Las Vegas native with a fondness for white chocolate chip cookies. Our new senior policy analyst, Lisa Stand, comes to us with a strong background in health care policy and an enthusiasm for the new health care reform policies. She especially interested in health care reform as it could aid people who need it most – namely, people experiencing homelessness. Our new analyst has worked in health policy for her entire career; her most recent po... Read More »
• Friday News Roundup: Making Progress

  October 15, 2010

  This week we have heard some powerful arguments for Housing First and supportive housing. Our good friends Rosanne Haggerty of Common Ground in New York and Martha Kegel of UNITY in New Orleans authored a fantastic piece in defense of supportive housing. A proposed project in New Orleans – a city still suffering the effects of a hurricane five years past - would redevelop an abandoned nursing home into supportive housing for people with disabilities and low-income working people is facing opposition from the local community. Rosanne and Martha do such a great job articulating the argument, I’ll let them speak for themselves: “Homelessness is a humanitarian crisis, but it is bad for a community in many other ways as well. By converting abandoned buildings into beautifully renovated apartments, supportive housing offers an opportunity to help solve several of New Orleans' pressing problems at once. Housing the homeless is good for everyone.” In other news: Massachusetts is kicking butt in implementing and executing their plan to end homelessness; the state has helped place 376 people in housing and has helped prevent almost 11,000 families from becoming homeless through a Housing First model.  Even as the Massachusetts Housing and Shelter Alliance reports the numbers of new families and individuals seeking help continues to grow in the area, Boston's Pine St. Inn claims to have eliminated 10 percent of their shelter beds due to successful housing placements – at an estimated savings of $9,000 per person. Way to go, MA! A new... Read More »
• Meet Jeremy Nichols, our new Advocacy intern!

  October 04, 2010

  Hello blogosphere! My name is Jeremy Nichols and I am the Alliance’s new Advocacy intern. In one short month, my time with the Alliance has already been filled with emailing member’s offices, conducting webinars, and getting used to the nonprofit world’s love of abbreviations (TANF ECF, HEARTH, HPRP, the list goes on). I’ve been drawn to the issue of homelessness since high school. I grew in Baton Rouge, Louisiana and during my first week of high school, life ground to a halt when Hurricane Katrina hit. As people began to pick up the pieces in the weeks following the hurricane, it became clear to me that those families and individuals teetering on the brink of financial stability were about to be pushed off the edge. Like so many, I tried to do my part. I volunteered through my church and worked with at-risk individuals living in the FEMA trailer parks. As the trailer parks began to be phased out, those left stranded were often mentally and physically incapable of holding jobs, paying rent, and fending for themselves. We worked to help such people: we secured benefits, dealt with landlords, and found stable living environments. The entire experience opened my eyes to the stark scarcity of resources available for people experiencing homeless. Moreover, it became clear that the few resources that do exist are mired in miles of red tape that can seem impossible to navigate. I’m also a ... Read More »

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