Legislators tackle homeless health in Hawaii

Hawaii had the highest rate of homelessness in the U.S. in 2015, with 53 homeless people for every 10,000 residents. This was a 10 percent increase from 2014, according to the National Alliance to End Homelessness. The national rate was 17 homeless people per 10,000 residents in 2015.

In 2016, Governor Ige issued the Sixth Supplementary Proclamation on Homelessness, extending his 2015 Emergency Proclamation Addressing Homelessness. The proclamation is supposed to facilitate establishing a temporary transitional shelter and contracting with private providers of homeless services to help address Hawaii’s homelessness problem.

This legislative session, several bills were introduced to help address the issues of homelessness, with a focus on health services and housing for homeless individuals.

Senator Josh Green introduced a resolution that would have declared homelessness a medical condition in order to use Medicaid funds to help cover housing. The resolution did not pass but does build upon a national movement of linking housing to health. California’s and Washington’s1115 waivers address housing for the homeless population.

However, Green’s SB2, which requires the auditor to assess the impact of using Medicaid funds to provide coverage for the treatment of homelessness, passed unanimously though the Senate.

Another of Green’s bills, SB7 is still alive and would require the Department of Human Services and the Department of Health to pursue efforts to use federal Medicaid funding to provide the chronically homeless with housing services.

Out of Hawaii’s homeless population, 18 percent is considered chronically homeless, meaning they have a disabling condition and have been continuously homeless for at least one year or have experienced at least 4 episodes of homelessness in the last 3 years. The national rate of chronic homelessness is 15 percent of the homeless population.

Hawaii has already implemented the Hawaii pathways project to provide permanent supportive housing to chronically homeless individuals who struggle with substance use and mental illness. The DHS and DOH must review the pilot’s progress as part of the bill.

SB7 recommends the DHS ad DOH consider benefit eligibility, supportive housing services, amending the state’s 1115 waiver, and financing and reinvestment strategies in order to accomplish the goal.

The bill received support from the Department of Human Services, Ho’omana Pono, and Hawaii Pacific Health.

Both the Governor’s Coordinator on Homelessness and the Department of Human Services appreciate the intent of the bill but ask the legislature to focus on appropriations in the Governor’s Executive Budget that will address homelessness in their testimonies.

The bill unanimously passed the Senate and is currently in the House Committees on Health and Finance.

Providing homeless individuals with access to sustainable housing helps save the state in the long term, especially in medical costs.

The legislature found that The Queen’s Medical Center lost more than $10 million in 2014 and 2015 caring for homeless patients. One unsheltered patient reportedly received treatment over 12,000 times during that period. Housing stability reduces barriers to regular care access, potentially saving the system millions in charity care and bad debt.

Two more bills, HB527 and SB347, aim to offset health care costs and improve access to care with the creation of two mobile clinics to serve the homeless population.

The bills, if passed, would appropriate an unspecified amount for the two clinics. The clinics would be staffed by one primary care provider, one nurse, one pharmacist, and one psychiatrist.

The bills have support from The Queen’s Health Systems, Hawaii Pacific Health, and Hawaii Youth Services Network.

The Department of Human Services testified in opposition of HB527, requesting that the Legislature focuses on homeless outreach instead, citing concerns over the governor’s executive budget. The Governor’s Coordinator on Homelessness also testified against the bill, again citing budget concerns.

Both bills passed their chambers with no opposed votes.