Executive Summary

The United Nations’ Declaration of Human Rights states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”1 And yet, according to the U.S.Department of Housing and Urban Development (HUD) “on a single night in 2016, 549,928 people were experiencing homelessness in the United States. That translates to about 1 in 500 people in the United States being homeless on any given night. 16 percent of these individuals are considered chronically homeless. HUD defines someone as “chronically homeless if he or she is homeless now, has one or more disabling conditions and has been homeless continuously for a year or more or has had four or more homeless episodes in the previous three years.”

While the very definition of chronic homelessness is tied to one’s health, housing and health authorities continue to grapple with the issue in silos. The U.S. Department of Housing and Urban Development states, “[S]table housing is fundamental to both maintaining good health and minimizing the costs of unnecessary emergency room utilization and hospital admissions.” Despite this awareness, interventions to address the homelessness crisis continue to exist independently of one another and as Band-Aid solutions. The declining stock of affordable housing exacerbates the problem as housing subsidy wait-lists continue to rise. According to the Urban Institute, in 2015, there were only 28 adequate and affordable housing units available for every 100 renter households with incomes at or below 30 percent of the area median income. Coupled with this, the 2010 passage of the Affordable Care Act and the increasing Medicaid-eligible homeless population brought to light the pressing need for health and housing agencies to come together to not only reduce costs, but to improve the lives of this historically underserved population. In the absence of federal policies to tackle homelessness, health plans are developing innovative solutions and investing in efforts to address these social determinants of health which go outside the traditional boundaries of health care.

This paper highlights 10 of the 61 health plan membersof the Association for Community Affiliated Plans (ACAP) that are leaders in addressing the needs of their
homeless populations and developing initiatives that address the social determinants of health. It summarizes federal Medicaid and housing laws that impact homeless Medicaid recipients and outlines a variety of solutions health plans have implemented, taking into consideration the challenges they continue to face.

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