Miller bill would create pilot program tapping Medicaid to house the chronically homeless
STATE HOUSE – Senate Health and Human Services Committee Chairman Joshua Miller has reintroduced legislation that would launch a pilot program testing the effectiveness of using Medicaid waiver funds to treat chronic homelessness.
Senator Miller’s proposal (2018-S 2129), called the Rhode Island Pathways Project, will be heard by the Senate Committee on Health and Human Services today at the rise of Senate session.
Modeled after an innovative bill in Hawaii, the legislation 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.
“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 and concern to shelter than to the treatment options in place,” 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.
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 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.
Senator Miller based the legislation, which passed the Senate last year, on a bill introduced last year by Hawaii state Sen. Josh Green. An emergency room doctor by trade, Senator Green devised the plan after treating the same patients 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 OHHS 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 be required to apply for any waiver amendments to use the federal waiver funds, which are to be reserved for home- and community-based health services. Furthering the process would call for the implementation of eligibility rules, ensuring that the program is open only to the chronically homeless.
The legislation is cosponsored by Sen. Michael McCaffrey (D-Dist. 29, Warwick), Sen. V. Susan Sosnowski (D-Dist. 37, South Kingstown, New Shoreham), Sen. Ana Quezada (D-Dist. 2, Providence) and Sen. Gayle Goldin (D-Dist. 3, Providence).
For more information, contact:
Legislative Press Bureau,
State House Room 20
Providence, RI 02903