Due to an experimental recent program geared toward easing the state’s profound homelessness crisis, some Californians now can get housing help from an unlikely source: their medical health insurance plans.
With the launch this yr of CalAIM, California is reimagining medical coverage by marrying healthcare and housing statewide for the primary time. Under the brand new approach, certain high-risk and low-income Medi-Cal recipients can use their insurance coverage for greater than doctor’s visits and hospital stays — they’ll get help finding inexpensive or subsidized housing, money for housing deposits, help stopping an eviction and more.
Proponents say this system acknowledges what doctors and social staff have known for years — it’s incredibly difficult to maintain people healthy in the event that they’re living on the streets or liable to losing their home.
“There isn’t a medicine as powerful as housing,” said Dr. Margot Kushel, professor of drugs and director of the UCSF Center for Vulnerable Populations. “And the health care system spends infinite money and achieves poor outcomes because people don’t have access to housing.”
This system targeting Medi-Cal — California’s version of the federal Medicaid system that gives medical health insurance to low-income Americans — might be particularly powerful within the Bay Area, where greater than 30,000 people lack housing. A lot of those persons are sick. In each Alameda and Santa Clara counties, a couple of quarter of unhoused residents report chronic health problems.
But CalAIM is restricted in scope. It applies only to Medi-Cal’s most vulnerable patients — people who find themselves homeless, leaving jail or prison, have a serious mental illness, and/or are continuously out and in of hospital emergency rooms, psychiatric wards and other institutions — leaving some experts anxious that individuals who could use housing assistance will fall through the cracks. And while CalAIM can assist participants find housing and provides them limited money for security deposits and first and last month’s rent, federal law prohibits this system from paying their rent on an ongoing basis. Nor can it conjure more housing in a state with a dire shortage of inexpensive options.
“It’s the outlet in the midst of the donut,” said Dr. Kathleen Clanon, director of the Alameda County Health Care Services Agency.
Early pilot programs testing the CalAIM model showed that while patients visited the emergency room less often, most homeless participants didn’t secure housing.
There are 14 recent advantages that insurance coverage can offer patients under CalAIM, starting from housing services and assistance securing healthy food to assist removing mold and other asthma triggers from their home. Insurance policy pick which options to supply, with the goal of eventually scaling as much as all 14. This system is anticipated to cost about $1.5 billion per yr over the following two years.
Gov. Gavin Newsom has thrown his support behind the initiative, which began Jan. 1, as a key piece in his plan to cut back homelessness. The governor has poured billions into efforts to wash up encampments and create homeless housing, and needs to tackle mental illness by launching a recent “CARE Court” program that might place some unhoused, untreated people in court-ordered care.
Nevertheless it’s unclear how many individuals CalAIM can house. Alameda County’s Whole Person Care pilot — a precursor to CalAIM that ran from 2016 through 2021 — served about 30,000 people, two-thirds of whom were homeless. Of those homeless participants, 69% received some form of roof over their heads, including emergency shelter beds and temporary hotel rooms. Just 36% ended up with everlasting housing.
“I wish it were higher,” said Clanon, the county’s medical director. Even so, she called 36% a hit. Prior to the pilot program, just 10% of unhoused people within the county’s homeless services system received everlasting housing annually, she said.
In Santa Clara County, an identical pilot program called Health Homes was run by the county’s Medi-Cal insurance coverage. In the primary half of last yr, Santa Clara Family Health Plan saw a 25% drop in emergency room visits and a 30% drop in longer hospital stays for its pilot patients. A complete of 211 homeless patients enrolled in this system between 2019 and 2021, and 54 received housing services and were subsequently housed.
“It’s very difficult to seek out housing even when you could have a sturdy housing navigation program,” said Lori Anderson, director of long-term services and supports for Santa Clara Family Health Plan.
Results were similar statewide. Of participants who were homeless or liable to homelessness within the third quarter of 2020, 68% received housing services, but just 7% were housed, in response to a recent report on Health Homes pilots in 12 California counties.
HAYWARD, CALIFORNIA – MAY 4: After being homeless, Janice Anderson is comfortable to have a recent apartment where she just moved-in per week ago, she said, in Hayward, Calif., on Thursday, May 12, 2022. Anderson participated in an Alameda County pilot program called Whole Person Care that helped her find the brand new apartment. (Ray Chavez/Bay Area News Group)
For Janice Anderson, 55, CalAIM already has been a hit. Anderson left her partner last yr partially because she said he enabled the drug addiction she was trying to overcome. But that also meant leaving the Livermore apartment they shared.
Anderson slept in her automotive briefly before moving into a brief shelter in an Oakland motel. As a Medi-Cal patient, Anderson was eligible for CalAIM. Case staff called her often to walk through the steps to get into housing — from cleansing up her credit to attending housing fairs to filling out rental applications. When she found a one-bedroom apartment in Hayward, this system paid her first and last month’s rent, and helped her secure a federal emergency housing voucher that reduced her rent to $960 a month.
Anderson moved on this month, and the very first thing she did was hang string lights on her front porch. She desires to turn her balcony right into a “Zen area” where she will be able to drink tea and meditate before reporting to her job as a peer advocate for HIV-positive women.
“It’s just nice to know that in the event you ask for help, and you discover the assistance, and you place within the work, life is sweet,” she said. “It’s amazing.”