Housing access and stability are primary health-related social needs (also referred to as social determinants of health) that impact individuals’ wellbeing. Like the rest of the nation, Arizona is battling a housing affordability crisis, as well as a housing shortage. At the 2023 Arizona State of Reform Health Policy Conference, healthcare leaders discussed ways they are promoting sustainable housing through policy initiatives.
Gabriel Jaramillo, director of healthy communities at Vitalyst Health Foundation—an organization that works to support and inform efforts that improve the health of Arizona individuals and communities—is focused on the intersection of different social determinants of health. Jaramillo said rent prices have skyrocketed by 30 to 50 percent in the past year, depending on the area of Phoenix an individual lives.
“We’re at a point where the average person can’t afford the cost of a home, and what that leaves is families in a cost-burdened situation, so when they’re paying more than 30 percent for the cost of their home, that puts more pressure on every other decision.”— Jaramillo
Joan Serviss described herself as a “FANG,” or “Former Advocate Now Government,” and works as the director of the Arizona Department of Housing. She spoke about the importance of having a reliable funding stream for housing initiatives.
“We don’t have sustainable funding at all, but the good news is, not only did the governor appoint me to serve in this role, she also has recently made affordable housing and addressing our unsheltered population a key priority for her administration,” Serviss said.
Serviss highlighted how during Gov. Katie Hobbs’ first week in office, she reconvened the Interagency and Community Council on Homelessness and Housing, which focuses on the development and implementation of a plan to prevent and end homelessness in Arizona. She said this past legislative session, the government called for historic investments in affordable housing—almost $200 million.
Elizabeth Da Costa, housing administrator for the Arizona Health Care Cost Containment System (AHCCCS), emphasized that housing is currently a luxury item. She noted that AHCCCS sought an 1115 waiver, which was approved in October of 2022, to pay for services related to social determinants of health, which has brought new federal dollars into Arizona to cover rental assistance, pre-tenancy and tenancy supports, and other benefits.
“We’re also, at the Medicaid system, looking for a reduction of total cost of care for individuals who are successfully housed,” Da Costa said.
According to Da Costa, AHCCCS is looking to turn high inpatient healthcare costs, like emergency department visits for folks who don’t have housing, into rental assistance. Currently, AHCCCS can only pay up to six months of rental assistance under the 1115 waiver. Concerns about the average rental lease being 12 months come into play, as individuals receiving rental assistance may not be able to afford to pay for the remaining six months of the lease, potentially leading to a cycle of homelessness.
Da Costa said finding alternative, long-term sustainable housing resources will get these individuals through the full 12 months of the lease, and is done by flipping to a different funding source.
Serviss said one solution is to leverage local dollars for wraparound housing services, and to stretch every dollar further. Although $36 million was brought in locally, Serviss said this funding is “a drop in the bucket of what is needed.”
“We spend a lot of time talking about how we better integrate and collaborate, and also pull the levers when they’re appropriate to pull,” Serviss said.
When looking at policy, it’s crucial to understand where partnerships are leveraged, but Serviss believes funding from cities, towns, Medicaid, and trust fund dollars need to be leveraged. While the state is putting money into solving the short-term housing crisis—like getting individuals off the streets and into short-term living facilities—it must also develop long-term sustainable housing solutions.
Serviss said leaders must be more creative, including rethinking what shared housing looks like for older adults, and to shift the culture to make living with roommates more acceptable and the “new norm” for housing.