The idea is simple: chronically homeless individuals are suffering and cost taxpayers thousands of dollars through ER visits, jail stays, and inpatient treatment. But without stable housing, they are very unlikely to recover. What if Medicaid could provide these individuals with housing, helping them get back on their feet and saving taxpayers money?
According to the National Alliance to End Homelessness, roughly 20% of homeless individuals are defined as chronically homeless, meaning they have been homeless for at least a year and suffer from chronic and complex health conditions including mental illnesses, substance use disorders, and medical conditions. Without stable housing, they cycle in and out of emergency departments, inpatient hospital stays, psychiatric centers, detoxification programs, and jails, costing taxpayers roughly $35,000 per year as of 2017.
Modeled after an innovative bill in Hawaii, the legislation (2023 H-5098) directs the Executive Office of Health and Human Services (EOHHS) to commission Medicaid waiver funds for a pilot program covering supportive housing services to people suffering from chronic homelessness. The program would provide individuals with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services. Arizona and New York have similar programs, housing thousands of chronically ill individuals and saving taxpayers in both states.
To Senator Miller, who chairs the Senate Health and Human Services Committee, the idea could benefit all Rhode Islanders. “The acute correlation between homelessness and adverse health conditions is a heinous reality. Unfortunately, issues tend to be aggravated since the tragedy of homelessness brings more attention to shelter than to treatment options,” said Chairman Miller (D-Dist. 28, Cranston, Providence). “Getting people into housing removes the burden of finding shelter and allows for the freedom to get connected with programs and employment opportunities, while directly engaging in the most effective preventative care mechanism we have, a roof,” he said.
Rep. Bennett (D-Dist. 20, Warwick) is a registered nurse who has seen the impact of housing first hand. “As an RN case manager, I’ve worked with a lot of these folks. When they don’t have a roof over their heads, it’s very hard to make sure they’re taking their medications regularly, make sure they’re going to the doctor. But once they have housing, they can recover and stand on their own two feet again.”
One of the biggest health costs related to homelessness is emergency room visits, said Senator Miller, who co-chaired a 2013 Senate commission that studied ways to reduce ER visits. Homeless individuals show up to emergency rooms for many reasons. They often struggle to get preventive care, so regular problems may not get treatment until they become critical. Emergency rooms cannot, by law, turn anyone away for inability to pay, so homeless individuals can use them to address more mundane health issues. Sometimes, shelters are full and families just need somewhere warm to sleep.
“An ER bill can cost significantly more than a month’s rent,” Senator Miller said. “By helping people break the cycle of chronic illness and homelessness, we’re doing the right thing by them and the taxpayers.”
To Representative Bennett, who has worked as a mental health nurse his whole career, there’s never been a more urgent time to try a new approach. “Our hospitals can’t find enough nurses as it is,” he said, “and our shelters are full. If we can get these folks into housing, it will help them recover and make sure there’s an ER bed ready for you when you need it.”