Miller bill would use Medicaid funds for housing as a means to improve health
STATE HOUSE – Modeled after an innovative bill introduced this year in Hawaii, legislation sponsored by Senate Health and Human Services Committee Chairman Joshua Miller would launch a pilot program to test the use of Medicaid funds to treat chronic homelessness.
The legislation (2017-S 0745), which Senator Miller introduced last week, would direct the Executive Office of Health and Human Services (OHHS) to use Medicaid waiver funds to conduct a pilot program to provide coverage for supportive housing services to chronically homeless people, and report on its effectiveness. The bill would essentially classify chronic homelessness as a medical condition to be treated with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services.
“Homelessness does correlate with high rates of many adverse health conditions, such as unaddressed mental health or behavioral health issues, poor nutrition and diabetes. Those issues and many more are further aggravated when a person doesn’t have a home, because when a person is struggling to find shelter every day, the other needs take a back seat. Homeless people struggle to connect with and stay connected to the services that are available, resulting in more serious health problems,” said Chairman Miller (D-Dist. 28, Cranston, Providence).
“Getting people into housing takes away that giant roadblock, making it easier and more likely for them to stay connected with services, programs and employment, all of which improves their health in direct and indirect ways. There are strong indications that their health will cost less if they are not homeless. I’m confident a pilot will show improved health for the population, and I’m very interested in determining the cost benefits,” he said.
One of the biggest health costs related to homelessness is emergency room visits, said Senator Miller, who in 2013 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.
The incidence of emergency room visits among the homeless is high, in part due to poorer health because the homeless struggle to get preventative care, so preventable problems often do not get treatment until they become critical. 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 be provided in less-costly settings as well.
Senator Miller based the legislation on a bill introduced this year in Hawaii by a state senator there, Sen. Josh Green. An emergency room doctor by trade, Senator Green devised the plan after treating the same individuals weekend after weekend and seeing the high costs — both human and financial — associated with homelessness. Senator Miller contacted Senator Green for assistance in crafting his own legislation. Under Senator Miller’s bill, the pilot project would be called the Rhode Island Pathways Project, after a similarly named project connected to the Hawaii bill.
A recent University of Hawaii survey found health care costs for chronically homeless people dropped by 43 percent when they had decent housing for six uninterrupted months.
Senator Miller’s bill would direct the Executive OHHS to run a pilot program to provide coverage for supportive housing services for chronically homeless people, and to include services such as outreach, housing search assistance, education on rights and responsibilities of tenants and independent living skills, coordination of primary care and care for mental health and substance abuse, and links to education, job training and employment. OHHS would need to apply for any necessary waiver amendments to use the federal waiver funds, which are to be used for home- and community-based health services. OHHS would need to establish eligibility rules to ensure that the program is open only to the chronically homeless.
OHHS is then to report to the General Assembly by Jan. 1, 2018, the status of its efforts, the description of the services being provided, an analysis of the effectiveness of the program and estimates of the cost and potential savings of expanding the program to meet the needs of the chronically homeless in the state.
The legislation is cosponsored by Sen. Harold M. Metts (D-Dist. 6, Providence), Sen. Ana B. Quezada (D-Dist. 2, Providence), Sen. Gayle L. Goldin (D-Dist. 3, Providence) and Sen. Maryellen Goodwin (D-Dist. 1, Providence).
For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903