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4/3/2018 Senate OKs two bills to use Medicaid funds to house homeless
Bills aim to improve health, reduce acute care costs

STATE HOUSE – The Senate today approved two bills aimed at creating innovative programs to use Medicaid funds to provide housing and other services to the homeless to provide stability in their lives and reduce expenses related to the overuse of emergency rooms.

“Housing the homeless might be one of the most effective and efficient investments we can make for public health. People who are homeless struggle to care for their health because their daily efforts to find shelter take precedence over activities like health maintenance. Getting people into housing removes that burden 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. Quite simply, medical care is less expensive when aligned with supportive housing,” said Senate Health and Human Services Committee Chairman Joshua Miller (D-Dist. 28, Cranston, Providence), who is the sponsor of one of the bills. In 2013, he co-chaired a Senate commission that studied ways to divert those seeking treatment for behavioral health issues away from emergency rooms and into more appropriate and less-costly treatment settings.

Said Senator Jeanine Calkin (D-Dist. 30, Warwick), the sponsor of the other bill, “Homelessness and health needs are so intertwined. Health crises are often the cause of homelessness in the first place, and it’s virtually impossible to address any health issue affecting the homeless as long as they remain homeless. Getting them out of the cold, and into a place where they are warm, dry and have their hygiene needs met has obvious and direct health benefits. But more importantly, housing vastly improves a person’s ability to stay in programs, to keep appointments and to get preventive care that prevents trips to the emergency room. Housing is very effective health care, and we should be leveraging every health funding source we can, including Medicaid, to provide it to the homeless.”

Senator Miller’s bill (2018-S 2129) directs the Executive Office of Health and Human Services (EOHHS) to use existing Medicaid waiver funds for a pilot program covering supportive housing services to people suffering from chronic homelessness. The program, called the Rhode Island Pathways Project, would provide individuals with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services. It also proposes to expand the ways Medicaid funds are used to support treatment for the homeless.

Under the bill, OHHS would be required to apply for any necessary waiver amendments to use the federal waiver funds, which are to be reserved for home- and community-based health services. If the program proves effective, Senator Miller would like to see it expanded, with eligibility rules that ensure the program is open only to the chronically homeless.

Senator Calkin’s bill (2018-S 2083) is aimed more broadly at the entire homeless population, directing the Executive Office of Health and Human Services to apply for any necessary waivers, waiver amendments, and state plan amendments to ensure the homeless have access to supportive housing services, health services and mental and behavioral health care services. Such waivers could be used to fund the Pathways Project and other initiatives to provide supportive housing to the homeless as a health service.

One of the biggest health costs related to homelessness is emergency room visits, in part due to poorer health because the homeless struggle to get preventive care, so preventable problems often do not get treatment until they become critical. Additionally, because emergency rooms cannot, by law, turn them away for inability to pay, the homeless often turn to them as a means to get services or treatment that could otherwise be provided in less-costly settings.

Studies have shown that housing the chronically homeless who are “super users” of emergency rooms reduces their use of emergency rooms by about 50 percent. And since a single night in the hospital might cost about $3,000 but rent for a month might be about $1,000, the savings are significant. Supportive housing is a win-win because it also improves the health of participants, say the sponsors.

Both bills will now be sent to the House of Representatives, where Rep. Arthur Handy (D-Dist. 18, Cranston) is sponsoring companion legislation to the Pathways Project bill.

For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903
(401) 222-1923