Due to an experimental new program geared toward easing the state’s profound homelessness disaster, some Californians now can get housing assist from an unlikely supply: their medical health insurance plans.
With the launch this 12 months of CalAIM, California is reimagining medical protection by marrying healthcare and housing statewide for the primary time. Below the brand new strategy, sure high-risk and low-income Medi-Cal recipients can use their insurance coverage for greater than physician’s visits and hospital stays — they’ll get assist discovering inexpensive or backed housing, money for housing deposits, assist stopping an eviction and extra.
Proponents say this system acknowledges what docs and social employees have recognized for years — it’s extremely tough to maintain individuals wholesome in the event that they’re dwelling on the streets or liable to dropping their dwelling.
“There isn’t a medication as highly effective as housing,” mentioned Dr. Margot Kushel, professor of medication and director of the UCSF Heart for Susceptible Populations. “And the well being care system spends infinite cash and achieves poor outcomes as a result of individuals don’t have entry to housing.”
This system concentrating on Medi-Cal — California’s model of the federal Medicaid system that gives medical health insurance to low-income People — could possibly be significantly highly effective within the Bay Space, the place greater than 30,000 individuals lack housing. Lots of these individuals are sick. In each Alameda and Santa Clara counties, a few quarter of unhoused residents report persistent well being issues.
However CalAIM is restricted in scope. It applies solely to Medi-Cal’s most susceptible sufferers — people who find themselves homeless, leaving jail or jail, have a critical psychological sickness, and/or are regularly out and in of hospital emergency rooms, psychiatric wards and different establishments — leaving some specialists fearful that individuals who may use housing assistance will fall by the cracks. And whereas CalAIM might help individuals discover housing and provides them restricted money for safety deposits and first and final month’s hire, federal legislation prohibits this system from paying their hire on an ongoing foundation. Nor can it conjure extra housing in a state with a dire scarcity of inexpensive choices.
“It’s the opening in the midst of the donut,” mentioned Dr. Kathleen Clanon, director of the Alameda County Well being Care Providers Company.
Early pilot applications testing the CalAIM mannequin confirmed that whereas sufferers visited the emergency room much less usually, most homeless individuals didn’t safe housing.
There are 14 new advantages that insurance coverage can provide sufferers underneath CalAIM, starting from housing providers and help securing wholesome meals to assist eradicating mildew and different bronchial asthma triggers from their dwelling. Insurance coverage decide which choices to supply, with the purpose of finally scaling as much as all 14. This system is anticipated to price about $1.5 billion per 12 months over the subsequent two years.
Gov. Gavin Newsom has thrown his assist behind the initiative, which began Jan. 1, as a key piece in his plan to scale back homelessness. The governor has poured billions into efforts to wash up encampments and create homeless housing, and desires to deal with psychological sickness by launching a brand new “CARE Court docket” program that might place some unhoused, untreated individuals in court-ordered care.
But it surely’s unclear how many individuals CalAIM can home. Alameda County’s Entire Particular person Care pilot — a precursor to CalAIM that ran from 2016 by 2021 — served about 30,000 individuals, two-thirds of whom had been homeless. Of these homeless individuals, 69% acquired some form of roof over their heads, together with emergency shelter beds and short-term resort rooms. Simply 36% ended up with everlasting housing.
“I want it had been larger,” mentioned Clanon, the county’s medical director. Even so, she known as 36% successful. Previous to the pilot program, simply 10% of unhoused individuals within the county’s homeless providers system acquired everlasting housing annually, she mentioned.
In Santa Clara County, an analogous pilot program known as Well being Houses was run by the county’s Medi-Cal insurance coverage. Within the first half of final 12 months, Santa Clara Household Well being Plan noticed a 25% drop in emergency room visits and a 30% drop in longer hospital stays for its pilot sufferers. A complete of 211 homeless sufferers enrolled in this system between 2019 and 2021, and 54 acquired housing providers and had been subsequently housed.
“It’s very difficult to search out housing even when you’ve gotten a strong housing navigation program,” mentioned Lori Anderson, director of long-term providers and helps for Santa Clara Household Well being Plan.
Outcomes had been comparable statewide. Of individuals who had been homeless or liable to homelessness within the third quarter of 2020, 68% acquired housing providers, however simply 7% had been housed, in response to a current report on Well being Houses pilots in 12 California counties.
For Janice Anderson, 55, CalAIM already has been successful. Anderson left her associate final 12 months partly as a result of she mentioned he enabled the drug habit she was attempting to beat. However that additionally meant leaving the Livermore condo they shared.
Anderson slept in her automotive briefly earlier than shifting into a short lived shelter in an Oakland motel. As a Medi-Cal affected person, Anderson was eligible for CalAIM. Case employees known as her usually to stroll by the steps to get into housing — from cleansing up her credit score to attending housing gala’s to filling out rental purposes. When she discovered a one-bedroom condo in Hayward, this system paid her first and final month’s hire, and helped her safe a federal emergency housing voucher that decreased her hire to $960 a month.
Anderson moved on this month, and the very first thing she did was dangle string lights on her entrance porch. She needs to show her balcony right into a “Zen space” the place she will be able to drink tea and meditate earlier than reporting to her job as a peer advocate for HIV-positive girls.
“It’s simply good to know that when you ask for assist, and you discover the assistance, and you place within the work, life is nice,” she mentioned. “It’s wonderful.”