Promoting Supportive Housing at the State Level
According to the National Conference of State Legislatures (NCSL), state governments have increasingly focused on enhancing services and protections at the intersection of housing and health — including on topics such as eviction prevention, recovery residences, and supportive housing — since the coronavirus pandemic began. On March 2, 2022, NCSL hosted a webinar during which participants discussed the benefits of supportive housing, barriers to more widespread implementation of supportive housing, and state-level efforts to make supportive housing available to those who would benefit from it. Panelists included Marcella Maguire, director of health systems integration at the Corporation for Supportive Housing; Cathy Alderman, chief of communications and public policy officer at the Colorado Coalition for the Homeless; and Maxwell Ruppersburg, director of the office of supportive housing at the Georgia Department of Behavioral Health and Developmental Disabilities.
The contours of a supportive housing approach
Maguire summarized what supportive housing entails and how supportive housing programs are typically funded. At its core, supportive housing is a model of care in which housing functions as the nexus for accessing services, integrating health care, senior support, reentry, education, child care, and other historically siloed systems to meet individual and family needs and improve community outcomes. A supportive housing approach, says Maguire, offers providers the flexibility to connect individuals and families to the housing and services that best meet their needs and goals.
The Corporation for Supportive Housing estimates that the supply of supportive housing units falls short of the nationwide need by approximately 1.2 million units — impeded, in part, by the complexity and limitations of financing them. In general, a supportive housing project needs to coordinate its capital needs to fund construction, an operating subsidy to ensure that rents are kept affordable, and flexible access to services for tenants.
Breaking cycles of homelessness and incarceration in Colorado
Alderman discussed the Denver Supportive Housing Social Impact Bond initiative, an effort to use supportive housing to prevent people experiencing homelessness from cycling in and out of jail. Thanks to a partnership with the Urban Institute, which evaluated the effectiveness of the undertaking, Alderman’s organization is equipped with data to help shape state-level efforts to expand access to supportive housing.
Launched 6 years ago, the initiative worked with 250 chronically homeless individuals who had significant mental and physical health challenges and were often involved with the criminal justice system. The program participants’ frequent interactions with emergency systems cost up to $50,000 annually per individual. After being connected to housing and moved from emergency to office-based medical care, 77 percent of program participants remained stably housed after 3 years and reduced their use of expensive public services, including detox centers, hospital emergency departments, and emergency shelter. Overall, costs were reduced by nearly half for participants.
The second phase of the program will continue to promote supportive housing, using federal funding alongside local resources to realize cost savings to Medicare and Medicaid. Future efforts, says Alderman, will also be focused on breaking down other silos. Alderman said that policymakers are examining increased data sharing among agencies and easing reimbursements for nonclinical care providers as two areas in which Colorado can further improve its supportive housing efforts.
Connecting housing and mental health services in Georgia
Ruppersburg reported that the Georgia Housing Voucher Program (GHVP) is aiding individuals earning less than 50 percent of the area median income who have diagnoses of serious and persistent mental illness and are experiencing homelessness, currently living in transitional housing, or at risk of experiencing homelessness. GVHP helps these individuals stay stably housed in their communities while receiving needed treatment. Despite progress in streamlining approval, however, significant challenges remain to getting voucher holders into housing. Since the program launched in 2010, the average time between program referral and voucher issuance has dropped from 100 days to 10, but participants still have difficulty with successfully securing housing with a voucher. As of 2021, only 37 percent of voucher recipients succeeded in finding housing within 90 days. To help address this problem, Georgia has extended the time allotted for voucher holders to locate housing and has created flexible bridge funding that voucher holders can use for application fees, security deposits, furniture, or other expenses needed to secure housing. As in Denver, the funding required for this supportive housing program is more than offset by savings to Medicaid.
Despite the nationwide shortage of supportive housing units and the challenges to program implementation, panelists agreed that state policymakers are becoming more aware of the importance of a supportive housing approach to service provision. With recent research validating the efficacy and efficiency of supportive housing, panelists see improvements in funding and implementation emerging at the state level.