It’s incontrovertible that the cure for homelessness is housing: Cities from Phoenix to Seattle have prioritized getting people off the streets and under roofs. Research has found that the “housing first” approach saves money: When academics at the University of North Carolina Charlotte compared the medical bills of a group of homeless people before and after they got into stable housing, they saw total costs drop from $2.5 million to $760,000.
A new bill introduced in Hawaii aims to further codify housing as a “cure” to homelessness–which, under this new proposal, would be classified as a medical condition. The bill would allow physicians to write prescriptions for housing, in addition to medicine.
The state senator who introduced the bill, Josh Green, also happens to be a physician; he told the Guardian that the idea for the bill arose from his experience in the emergency room, where he’d often treat homeless patients for basic ailments at exorbitant costs. “According to Green,” the Guardian wrote, “a recent internal study by a major Hawaiian insurer found that over half of the state’s $2 billion Medicaid allotment was consumed by a tiny fraction of users, many of whom are dealing with homelessness, mental illness, and substance addiction.”
But many of those health care needs for the homeless disappear once they’re housed. One successful “housing first” program in the state, the Hawaii Pathways Project, housed 41 homeless individuals in permanent supportive housing, and over the course of the program in 2015, saw a 43% decrease in monthly health care costs for each client. Green added that medical needs of homeless individuals cost the state an average of $120,000 per year, while annual housing costs are only around $18,000. Given that Hawaii–where an estimated 53 people per every 10,000 are homeless–has the highest per-capita homelessness rate in the nation, the bill could save the state billions, and serve as a crucial lifeline for many in need.
The counterargument to the “housing first” strategy goes something like this: Because homeless people are often dealing with such severe physical and mental health issues, they won’t be able to manage a home on their own. Better to treat the problems first, then let housing follow. Green disagrees. Speaking on WBUR’s Here & Now, Green said that “just treating a symptom of homelessness–which is often the mental illness, or the drug addiction, or just the devastating impact of being homeless and under assault by life on the streets–isn’t enough. We have to change the paradigm directly.”
Green told WBUR that while he very much supports housing-first programs that are seeing success across the country, he added that the dollars for these initiatives comes from the states’ Department of Health and Human Services budgets, which often aren’t large enough to meet the need. In Hawaii, Green said, the HHS budget for housing-first programs is only 10% of what it needs to be. “We’re spending $3 million now,” Green said. “We need $30 million at least to meet need.” Tapping into Hawaii’s Medicaid resources, which, at around $2 billion, are much more robust, would allow the state to deliver more complete services.
But housing, under Green’s bill, would not be dispensed carelessly: Doctors would prescribe a home on a case-by-case basis to individuals who have been homeless for at least six months and suffer from mental illness or substance addiction.
The bill is working its way through Hawaii’s state legislature; the Senate will vote on the bill on March 2. It’s faced some opposition from Republican lawmakers, who say that the proposal oversteps the purview of health care, and also from some homeless services providers. Kimo Carvalho, a spokesman for the Institute of Human Services, told the Guardian that there’s a risk that mentally ill people will not remain in the housing they’re offered; a better use for the Medicaid funding, he added, would be “targeted housing for people with specialized needs, such as mental health group homes, or addiction recovery housing, because many of the neediest clients targeted by Green’s bill might refuse accommodation.”
But among the homeless community, the proposed bill has struck a chord. One man, Stephen Williams, who’s frequently hospitalized because life on the streets in Honolulu exacerbates his psoriasis and leads to staph infections, told the Guardian: “It’s very clear to me. If I could get a place to stay, I wouldn’t have to go to the hospital so often.”