Senate OKs Miller bill to create program tapping Medicaid to house and assist those experiencing homelessness


STATE HOUSE – The Senate today passed legislation sponsored by Senate Health and Human Services Committee Chairman Joshua Miller to use Medicaid funds to pay one-time transitional costs to help people experiencing homelessness get into housing, and to create a pilot program of restorative and recuperative care for those experiencing homelessness to recover from illness, injury or medical treatment.

“Homelessness is a health issue. There is an acute correlation between homelessness and adverse health conditions. When you are homeless, finding shelter is a daily struggle and always your top priority. Health takes a back seat, so health issues tend to snowball until they become emergencies,” said Chairman Miller (D-Dist. 28, Cranston, Providence). “Permanent housing is really the most effective and imperative health care mechanism for people experiencing homelessness. Getting people into safe, healthy housing should be the primary goal, because we can’t expect any other health intervention to succeed without it.”

The bill (2023-S 0277A), which has passed the Senate several times before in a somewhat different iteration called the Rhode Island Pathways Project, has been refined this year based on recommendations from the federal Centers for Medicare & Medicaid Services (CMS). Chairman Miller said he is hopeful that the state could succeed in establishing the program this year, since this is the first time CMS has worked cooperatively with the state toward shaping the proposal into one that is more likely to get federal approval for Medicaid waiver funding. The amended bill is modeled on Medicaid-funded programs in New York, Arizona, Arkansas and California.

The legislation would establish two kinds of benefits through Medicaid funding to treat homelessness: one to provide funding that enables beneficiaries to get into permanent housing, and the other to provide acute and post-acute health care for those experiencing homelessness and health problems.

The legislation directs the Executive Office of Health and Human Services (EOHHS) to use Medicaid waiver funds to provide coverage for one-time transitional supports for people who receive services under the existing Medicaid home stabilization program. Those supports could include payment of a security deposit and the first and last month’s rent; up to six months of rent payments; costs associated with establishing utilities, including past-due amounts; any necessary remediation of asthma triggers or pests, and purchase of necessary household goods such as mattresses and furniture, linens, kitchen items and pantry stocking, as approved and according to family size.

The second part, the restorative and recuperative care pilot program, would provide services to those experiencing homelessness to prepare for, undergo, and recover from medical treatment, injuries, and illness, as medically necessary. The length of stay will be limited to active treatment and/or recovery, limited to 36 months, paid for through the state’s Medicaid waiver funds.

The idea behind the program, according to Senator Miller, is that helping people establish permanent housing and get healthy costs less— both in terms of funding and the human toll — than homelessness.

One of the biggest health costs related to homelessness is emergency room visits, said Senator Miller, who co-chaired a 2013 Senate commission that studied ways to reduce ER visits. People experiencing homelessness often struggle to get preventive care, so health problems may not get treatment until they become critical. Emergency rooms cannot, by law, turn anyone away for inability to pay, so sometimes people turn to them to address non-emergency health issues.

“An ER bill can cost significantly more than a month’s rent,” Senator Miller said. “By helping people break the cycle of chronic illness and homelessness, we can actually save the public money at the same time as helping people live healthier, safer and more stable lives.”

The legislation was inspired by a program in Hawaii that provided housing to people experiencing chronic homelessness. 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 program 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.

The legislation will now be forwarded to the House of Representatives, where Rep. David A. Bennett (D-Dist. 20, Warwick, Cranston) is sponsoring companion legislation (2023-H 5098).

The Senate bill is cosponsored by Senate Finance Committee Chairman Louis P. DiPalma (D-Dist. 12, Middletown, Little Compton, Newport, Tiverton), Sen. Dawn Euer (D-Dist. 13, Newport, Jamestown), Sen. Alana M. DiMario (D-Dist. 36, Narragansett, North Kingston, New Shoreham), Sen. Pamela J. Lauria (D-Dist. 32, Barrington, Bristol, East Providence), Sen. Valarie J. Lawson (D-Dist. 14, East Providence), Sen. Linda L. Ujifusa (D-Dist. 11, Portsmouth, Bristol), Sen. Meghan E. Kallman (D-Dist. 15, Pawtucket, Providence),  Sen. Melissa A. Murray (D-Dist. 24, Woonsocket, North Smithfield) and Sen. Bridget Valverde (D-Dist. 35, North Kingstown, East Greenwich, South Kingstown).