People experiencing homelessness often have serious and complex health challenges, including mental health problems and substance use disorders, chronic medical conditions like diabetes and hypertension, and infectious diseases like HIV/AIDS, Hepatitis C, and tuberculosis.
Ensuring access to quality health care must be a part of community’s response to homelessness. Health care can be most effective when it is integrated with housing assistance, as stable housing not only improves health in and of itself, but also serves as a platform for consistently delivering health care and services.
The Affordable Care Act and Medicaid expansion are dramatically increasing access to health coverage and care for people experiencing homelessness. In states that have chosen to expand their Medicaid programs, nearly all people experiencing homelessness will qualify for Medicaid based on their incomes.
In addition, the Affordable Care Act is driving larger health reforms that are shifting the focus of care from treatments and interventions to whole person health needs. With this shift, health care payers and providers are paying greater attention to behavioral health needs as well as social determinants of health — including stable housing. Specifically, more states are looking at how they can support services that help people find and maintain housing under their Medicaid programs.
The Council is focused on the following strategies:
- Encourage housing providers and health and behavioral health care providers to co-locate, coordinate, or integrate health, behavioral health, safety, and wellness services with housing, and create better resources for providers to connect patients to housing resources.
- Test new, and build upon successful, care and service delivery models to provide services in the homes of people who have experienced homelessness, including Medicaid-funded Assertive Community Treatment Teams and Home and Community Based Services for those with behavioral health needs.
- Apply lessons from evaluations of the Medicaid Health Home option to inform efforts to integrate health care and social services for people with chronic conditions experiencing homelessness.
- Seek opportunities to increase the availability of medical respite programs in communities to allow hospitals to discharge people experiencing homelessness with complex health needs to medical respite programs that can help stabilize their medical conditions and assist them to access or return to safe and stable housing.
- Ensure that people experiencing homelessness have access to expanded behavioral health services under the Affordable Care Act, including substance use disorder treatment services.
- Promote the adoption and integration of evidence-based Medicaid behavioral health services for children and youth, including intensive care coordination, peer services, intensive in-home services, mobile crisis and stabilization services, and other home and community-based services.
- Expand access to evidence-based maternal, infant, and early childhood home visiting services for families and pregnant women, and promote integration of these services with housing.
- Increase awareness of strategies to support healthy child and youth development within housing programs.
- Leverage opportunities in child welfare reform to expand evidence-based preventive services, and promote their coordination with homeless services and housing.