OKs Miller bill to create pilot program tapping Medicaid to house the chronically homeless
STATE HOUSE – The Senate today passed legislation sponsored by Senate Health and Human Services Committee Chairman Joshua Miller to launch a pilot program testing the effectiveness of using Medicaid waiver funds to treat chronic homelessness.
The bill (2022-S 2079A) will now be forwarded to the House of Representatives, where Rep. David A. Bennett (D-Dist. 20, Warwick, Cranston) is sponsoring companion legislation (2022-H 7181).
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 has passed the Senate several times, on a bill introduced in 2017 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 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. A study of the Hawaii Pathways project found that from baseline to follow-up, health care costs per client per month decreased by 76 percent with a net savings equated to $4,247 per month per client.
Senator Miller’s bill would direct EOHHS to include services such as behavioral health services, including mental health and substance abuse services, case management, personal care and personal assistance services, home and community-based services and housing support services, including rental assistance. EOHHS 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. The legislation requires EOHHS would be required to report to the legislature annually on the effort, including an analysis of its effectiveness and costs and savings estimates of expanding it to meet the needs of the chronically homeless population.
The program the bill would create is separate from the Pay for Success pilot program approved by lawmakers last year as part of the state budget bill. Pay for Success is to create a public-private partnership and create permanent supportive housing. Pathways would be funded through Medicaid using a waiver to fund rent as part of participants’ treatment.
The legislation is cosponsored by Sen. Bridget Valverde (D-Dist. 35, North Kingstown, East Greenwich, Narragansett, South Kingstown), Sen. Melissa A. Murray (D-Dist. 24, Woonsocket, North Smithfield), Sen. Alana M. DiMario (D-Dist. 36, Narragansett, North Kingstown), Sen. Samuel D. Zurier (D-Dist. 3, Providence) and Sen. James A. Seveney (D-Dist. 11, Portsmouth, Bristol, Tiverton).