Sunday, February 24, 2013

Care for the Homeless Files Medicaid Process Recommendations

Care for the Homeless has joined the National Health Care for the Homeless Council (where our Executive Director, Bobby Watts, currently serves as Board President) and 22 other national, regional or local organizations across the country that provide services to or advocate for people experiencing homelessness, to file a set of reactions and recommendations regarding eligibility and enrollment in an expanded Medicaid program under the Affordable Care Act (“ACA”).  The filing submitted to the Centers for Medicare and Medicaid Services on February 21st designed to make the Medicaid process and exchanges operated under the ACA more effective, more efficient and to enable greater access for homeless people and in turn cut costs of the program.

The recommendations deal with the special needs of poor and unstably housed persons. For example, one recommendation suggests flexibility in documentation requirements and provision of assistance in meeting enrollment requirements for those experiencing homelessness, victims of domestic violence, those with limited English proficiency and those displaced from disasters (such as Hurricane Sandy), who often have difficulty providing  certain documents or getting through the enrollment process.

The filing also argues for including those suffering from substance abuse disorder as medically frail. Scientific research supports the biochemical basis for addiction and dependence in certain medically vulnerable people as is recognized in the current Diagnostic and Statistical Manual of Mental Disorders, the standard psychiatric reference used by mental health professionals.

Care for the Homeless, in reacting to proposed rules, opposed out of pocket costs on patients in deep poverty because “we know from decades of service provision” that any copays, premiums or cost sharing directly results in denying access to the very population most in need and in the poorest health. “On most days,” we wrote, “a single $4 charge is unaffordable to most people experiencing homelessness, who live at the lowest income levels…copays of $50 or $100 for inpatient care are unrealistic for this population; that they might be able to pay 50% of one day’s cost of hospitalization is an absurdly unrealistic thought.”

Providing homeless people with access to adequate health care, including appropriate preventative services, assures better health outcomes and reduced overall health care costs. Those are the goals of the Affordable Care Act.

Friday, February 22, 2013

Six Days Till the Funding Cut Catastrophe No One Wants!

It’s the part of the so-called “fiscal cliff” Washington calls “sequestration.” We call it a catastrophic cut to programs America’s neediest citizens count on for vital health care, housing assistance and basic necessities, and it’s scheduled to take effect on March 1st. It’s been pushed back repeatedly because every policy maker agrees this is bad public policy; but if the House of Representatives, the Senate and the President can’t agree and pass an alternative before March 1st, it’ll happen. So what’s been going on in Washington: the House of Representatives has been out of session for the last couple of days, and won’t be back in town until next week. There’s no compromise in sight, but lots of finger pointing.

Here’s what we do know: if the across the board cuts do fully go into effect hundreds of thousands of poor individuals and families in America will be hurt. Many poor and homeless individuals and families will lose access to health care. Hundreds of thousands of people struggling to maintain their homes will be at risk of homelessness. Funds will be cut to health and social service providers to homeless people.

The poorest, neediest and most vulnerable Americans will be devastated yet again. That’s wrong, and it doesn’t actually save money, either. Poor and homeless people are often very young, very old, frail or disabled. Most suffer from multiple chronic health and emotional problems. Cutting adequate health care and services will aggravate their health and other issues – but it won’t stop them from having those issues. Instead of access to appropriate care with better outcomes, they’ll wind up sicker, worse off and in emergency care at higher costs. Providing worse services with worse outcomes at higher costs is not efficient or effective for anyone whether you call it “austerity” or “cost cutting” or not.

There is still time to contact your member of Congress and ask them to work to save programs that provide services to homeless people and those at risk of homelessness. Let them know that cutting these programs is just the wrong thing to do, and it absolutely does not save taxpayer dollars.  It’s easy to call your United States Senators and U.S. House of Representative member using the Capitol Hill switchboard number: 202-224-3121. 
-Jeff Foreman, Director of Policy at Care for the Homeless

Tuesday, February 12, 2013

The State of the City Speech Includes Ideas to Fight Homelessness

On Monday afternoon, February 11th, New York City Council Speaker Christine Quinn gave her final “State of the City” address as Council Speaker at City Hall. She spoke about education, jobs, economic development, New York City as a collection of neighborhoods, and much of the coverage of her speech was about its focus on affordable housing for New Yorkers. You might not have heard as much about the part of her speech that addressed homelessness, but take a look at these 3 paragraphs from her address:
"As we work to provide all our neighbors with an affordable place to live, we can’t ignore the growing number of homeless New Yorkers. There are currently 10,000 families living in homeless shelters in New York City, some with children just a few months old. If these kids are going to have a fighting chance, we need to get their families back on the path to stable housing. But for many, our shelter system has become a dead end. Without a rental assistance program for the homeless, most families have no way to access long term housing.
They either end up back on the street, or return to crowded shelters night after night. That’s not the New York City we know. This is a city that catches you when you fall, and helps set you back on your feet. That’s why Council Member Annabel Palma and I are calling on the City to create a new program to get homeless families off the streets, out of the shelters, and into their own homes.
Working together we can create a brand new rental assistance program to help families cover rent in private buildings. And we need to prioritize homeless New Yorkers for NYCHA apartments and Section 8 vouchers, so we can get even more families into long term stable housing. By the way, this isn't just the right thing to do, it’s the fiscally responsible thing to do. The average cost of a rental subsidy for a family of four is $800 a month. To house that same family in a shelter? $3,000."
We thank Speaker Quinn for recognizing issues that affect homeless people as central to the state of our city and its future. What’s more, as Care for the Homeless has testified to City Council in the past, she’s right that a new rental subsidy program and targeted federal housing programs are needed to help people experiencing homelessness transition into permanent housing. And we couldn't agree more that these good public policies aren't just the right thing to do, but that over time they are really the most cost effective approach.  

Monday, February 11, 2013

Three weeks until federal spending cuts

The “fiscal cliff” issues drag on in Washington. There are three impending financial deadlines coming up: going over the nation’s statutory debt limit, which could mean no money to operate government (or even pay bills already incurred); the end of current federal appropriations, meaning no authorization to spend which would force a shutdown of “non-essential” government functions; and the so-called “sequestration” requiring a cut of 8.2% to almost all domestic programs and much of the military, which as now scheduled to happen in 3 weeks. This isn’t just an argument over money or ideology. These programs are life-and-death, or at least life altering, necessities for many millions of Americans.
Don’t forget, for many of the federally funded programs these decisions will affect any cut this year comes on top of significant cuts last year that already stained budgets and stretched safety nets.
Care for the Homeless Executive Director Bobby Watts made that plea to our representatives in Washington. He told them proposed automatic cuts will create 146,000 homeless people by a $159.7 million cut in HUD McKinney-Vento Homeless Assistance grants. Cuts to Section 8 Rental Assistance of over $1.5 billion will affect over 186,000 tenants. Slashing $8.2 million from Runaway and Homeless Youth Act funding and taking e $5.5 million from Transition from Homelessness projects will put people in the streets. Reducing Health Care for the Homeless funding by millions means denying vital health services to truly needy Americans. Cutting HUD rental assistance by $30 billion, impacting 428,000 households, means unbearable hardships for people already suffering.
The irony is that no one, Republican or Democrat, thinks across-the-board cuts are good policy. The OMB report on sequestration in September said sequestration was “…a mechanism to force Congress to act on further deficit reduction” but “sequestration itself was never intended to be implemented.” 

Ending homelessness should be a bipartisan concern. Cutting federal funding and creating more homeless people or slashing their medical care and social services does not save money. It just shifts costs in an even more expensive and less effective way. It‘s morally unacceptable and financially inefficient. It makes us less productive and robs people, many of them children or elderly, of their dignity in a way that will harm communities and individuals for generations.

We all want to get past the “fiscal cliffs.” But not just any solution to avoid confrontation is acceptable. We need to find a way to avoid sequestration that holds the least influential poor and homeless Americans, many of them frail or disabled, harmless, and get to work on a plan to prevent and end homelessness in America. Our clients have no powerful lobbyists to look out for them in Washington. They have only their grass roots advocates and their representatives in Congress. 

-Jeff Foreman, Director of Policy at Care for the Homeless

Wednesday, February 6, 2013

Social Services January Update!

January may be a slower month than the busyness of December, but the Care for the Homeless social services team was hard at work providing Medical Case Management services at 13 different sites in a total of 240 visits for 151 homeless clients.  Psychotherapy services where provided at two more sites with 27 homeless clients coming in for a total of 47 visits.
In addition, during January, the Social Service staff collaborated with the CFH Health Education team and medical departments to implement pap smear initiative events at six sites. The staff provided a variety of services including PHQ9 screenings, Perceived Stress Scales (PSS) screenings and co-facilitated a workshop with the Health Education team on the barriers to accessing and engaging in medical treatment.
Without the Social Services teams, a large sect of the homeless population Care for the Homeless works with would go without mental health counseling and would be unable to access treatment. Their role is critical to helping homeless men, women and children find the stability they need to move into permanent housing and move on with their lives.

Saturday, February 2, 2013

Doesn't It Feel like Groundhog's Day?

“Groundhog’s Day” used to just mean the fun, iconic event in rural Punxautawney where a phenomenal ground hog emerged from its burrow and, depending on whether it was cloudy or clear, would accurately predict either an early spring or 6 more weeks of winter. But ever since the famous Bill Murray movie by the same name, Groundhog’s Day is now short-hand for the same things happening over and over again for no good reason.

Sometimes fighting for homeless people, and better public policy, can seem like that. Four months ago Care for the Homeless Executive Director Bobby Watts testified to New York City Council about it.

“We know what works,” he said, “The cynical notion that it’s too expensive to address homelessness is just as wrong financially as it is morally. The most expensive, least effective and most inhumane method of handling the problem is what we are doing now: not dealing with long-run policies of rent supports, supportive housing and services to avoid homelessness.”

But if we know what would work better (because it has actually worked better), and if the long range costs of doing what’s best for people experiencing homelessness is also less expensive than continuing to do what isn’t working, why don’t we just do what works? Issues about homelessness really need to be part of New York City’s civic discussion this year, or it’ll still seem like Groundhog’s Day (the Bill Murray kind, not the weather predicting furry animal kind) next year February, all over again.

-Jeff Foreman, Director of Policy at Care for the Homeless