Could classifying homelessness as a health condition be key to solving the problem? State Sen. Josh Green thinks so.
Hawaii senator and practicing ER doctor, Josh Green, sees the issue first-hand and wants to redefine chronic homelessness as a medical disease that allows doctors to prescribe housing using Medicaid funds. “I see the same patients over and over again,” he said. “Every time they come to the hospital the bills are thousands and thousands of dollars. And they don’t get better. They have the same problems when they come out,” said Green, chairman of the state Senate Human Services Committee.
Vice News Correspondent, Caroline Modarressy-Tehrani, went to Hawaii to talk to about his proposal as well as the homeless Hawaiians who would benefit. “I think one of the most shocking things for anyone who watches this story is really that juxtaposition of thinking Hawaii is this glamorous paradise island and then really seeing first-hand the level of crisis,” Caroline expressed. Her story focuses on a proposal before lawmakers that would allow doctors to use money from Medicaid to get chronically homeless people into housing. “There is a discourse going on across the country right now about health care and this story really is a component of that conversation.”
Hawaii receives $2 billion a year in Medicaid, but that money is often spent as inefficiently as possible. 3.6 percent of recipients, many of whom are homeless, use 61 percent of the state’s Medicaid budget on emergency care. Hawaii has the highest homelessness rate of any American state — and it was the first to declare the problem an official state of emergency, in 2015. According to outreach workers, the majority of people living on the street’s in the islands suffer from some type of mental illness. Roughly 19,000 (18%) people in the state are considered to be chronically homeless — that is, on the streets for an extended period of time, and with a disabling condition. Lack of affordable housing in the islands remains the single biggest reason so many people find themselves on the streets.
We know that when you pair people with severe mental health and substance abuse issues with housing, their condition improves dramatically.
Senator Josh Green introduced a resolution that would declare homelessness a medical condition in order to use Medicaid funds to help cover housing. The resolution does build upon a national movement of linking housing to health. While the idea has sparked controversy, the plan continues to move forward at the Capitol. Green’s proposal requires the auditor to assess the impact of using Medicaid funds to provide coverage for the treatment of homelessness. Green believes it would cost the state an extra $200 million a year to restore the state’s mental health and drug treatment facilities. Hawaii’s behavioral health safety net shouldered deep cuts during the recession, and Green said re-allocating some of the state’s $2 billion Medicaid budget could help better fund those programs. “If we spent some of this which is private insurance money on this as a health problem then we won’t have to rely on major increases on the state budget,” Green said.
Trisha Kajimura, executive director of Mental Health America of Hawaii, said better funding is part of the solution. “We need more doctors and more staff in general, especially psychiatrists and people who are able to prescribe medications for mental illness,” she said. Kajimura added that if the money isn’t spent now, the problem could persist for decades. She added that people can’t heal without a roof over their head. “In terms of affordable rental housing, if we don’t build more stock and make that available to people who are almost homeless, at risk for homelessness or homeless, we’re not going to get anywhere,” she said.
One of the most shocking things for anyone who watches this story is really that juxtaposition of thinking Hawaii is this glamorous paradise island and then really seeing first-hand the level of crisis.
The state is part of an effort to get 30 chronically homeless people off the streets and moved in to Oahu apartments by June. “It will be interesting to see if others states go down this road of trying to think a little more creatively,” Modarressy-Tehrani said. Honolulu officials and social service agencies are working to get homeless residents into two apartment complexes in Honolulu under the state’s Housing First program. The homeless residents will also get moved in to market-rate rental units across Oahu, where they will have access to social services for help with drug and alcohol problems and mental illness.
State officials said the University of Hawaii’s Center on the Family will monitor the residents’ progress. The goal is to fill the gaps that often prevent people from securing housing or having access to social services. “We’re getting the people with the highest needs off of the streets and putting them in a stable place where they can get better and not return to homelessness,” said Scott Morishige, the state’s homeless coordinator. “We know that when you pair people with severe mental health and substance abuse issues with housing, their condition improves dramatically.”