When a person is homeless, every other problem is worse — and more expensive.
Providing supportive housing to homeless individuals who are in the most expensive 10 percent of Medicaid users would save thousands of dollars per year per person, according to a study released Tuesday in Billings by the Montana Healthcare Foundation and the Montana Department of Public Health and Human Services.
The study, conducted by the Corporation for Supportive Housing, analyzed the costs of caring for Medicaid patients who were in the costliest 10 percent of all Montanans using Medicaid and who also were identified as homeless. The report estimates that $445,766 annually in state of Montana costs could have been avoided in if these 187 people were living in stable housing. The federal government pays the bulk of Montana Medicaid expenses. State and federal savings combined was estimated at $1.3 million annually. That huge savings is the net after subtracting costs of subsidizing housing and assistance to help each individual locate and retain safe housing.
The 187 homeless Montanans in this study had an average annual Medicaid cost of $53,463. Savings from a more robust supportive housing program would lessen the burden on taxpayers while improving the health and quality of life for people who have been very sick and chronically homeless.
"Housing is so essential to what we do. We will have better outcomes if we work together," DPHHS Director Sheila Hogan told an affordable housing conference audience in Billings. Montana Medicaid already provides supportive housing through limited programs for disabled elders, people with seriously disabling mental illness or developmental disabilities. The new reports indicate that much more could be accomplished by getting homeless Montanans with complex medical needs into safe housing and keeping them housed with continuing case management or other supportive services. For example, Montana Medicaid doesn't cover supportive housing for pregnant women nor for people with substance abuse disorder as their primary diagnosis.
Montana law should be revised to help get these folks into housing, because homelessness is miserable for them and expensive for the rest of us.
The Montana Healthcare Foundation has offered community planning grants for initiatives to house homeless people who are high users of health care. So far, the foundation is working with Missoula, Butte, Great Falls, Helena and Bozeman. Local hospitals are part of the Housing is Healthcare efforts, said Ted Madden, chief operating officer for Montana Healthcare Foundation.
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"It's difficult, if not impossible to improve health care without a home," Madden told The Gazette. "Initiatives working with hospitals have been shown elsewhere to reduce medical costs."
Billings has not applied for that planning grant, but over the past couple of years, 16 local organizations have united to form the Continuum of Care Leadership Team with the goal of ending homelessness in Yellowstone County. Billings health care organizations are part of the team that is chaired by Tumbleweed Executive Director Erika Willis.
"Our goal is to make homelessness rare, brief and a one-time event," Willis said.
Members of the leadership team are Alternatives Inc., Billings Clinic, Billings Housing Authority, CASA of Yellowstone County, Community Crisis Center, District 7 HRDC, Mental Health Center, Montana Department of Corrections & Parole Division IV, Montana Rescue Mission, Rimrock, RiverStone Health, St. Vincent Healthcare, Tumbleweed, Volunteers of America and YWCA Billings. United Way of Yellowstone County serves as the fiscal agent and backbone of the coalition.
So far, the team has invested $146,840 from grants and member contributions to train their employees in assessing homeless clients' needs, using a common assessment tool and shared data system with access to a stock of available housing. The team launched the Coordinated Entry process designed to ensure that the most vulnerable persons get housed first, Willis said. Since Oct. 1, 316 people have come through this process, including 60 children. Fifty-six were housed and 35 were currently on the list ready to be housed when team leaders made a presentation to the Yellowstone County Commission on June 6.
Billings has some supportive housing, but obviously not nearly enough.
The Montana Healthcare Foundation, DPHHS and the Yellowstone County continuum partners are commended for pursuing holistic approaches to prevent and end homelessness. Partnerships between local, state and federal agencies are key to marshaling and sustaining the resources necessary to reach the goal of housing medically needy Montanans. Now is the time to highlight successes — such as 16 organizations uniting — and to start building the case for local and state public policies that will result in better health for indigent individuals and less costly Medicaid bills for taxpayers.