Supportive housing program for Californians experiencing homelessness shows promise

Offering a range of supportive services, such as assistance to secure housing and case management, may bolster the effectiveness of programs designed to help individuals experiencing homelessness as they transition into long-term housing, according to an evaluation of the Housing for a Healthy California program by the UCLA Center for Health Policy Research.

Housing for a Healthy California, or HHC, uses a "housing-first" approach with the goal of providing supportive housing to Medi-Cal beneficiaries who are experiencing chronic homelessness and frequently using costly health services. In addition to housing, the program offers needed assistance, such as linking patients to primary care providers, behavioral health care services and peer support, and care management to program participants. To encourage trust and to build rapport with those in the program, case managers are limited to assisting a maximum of 20 participants, and caseloads range from eight to 20.

"Providing housing to individuals experiencing chronic homelessness is the crucial first step, but the needs of these individuals are complex. They require substantial assistance to ensure they remain housed," said Nadereh Pourat, director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research, which evaluated HHC. "The evaluation findings highlight the importance of additional supports to transition those without stable housing into permanent housing."

As part of an Article II grant funded by the California Department of Housing and Community Development, Housing for a Healthy California awarded $60.1 million in March 2020 to grantees in six California counties: Kern, Los Angeles, Marin, Sacramento, San Francisco and San Mateo. The funding primarily supported long-term rental assistance for existing supportive housing and newly acquired or developed construction projects.

Analyses of how many people received and remained in supportive housing and the declining use of emergency departments and hospitals following being housed showed that the program achieved some early successes, Pourat said.

The evaluation covered January 2021, when the first beneficiary was housed, to the end of December 2022. During that time, a total of 230 participants were housed successfully, 161 of whom were housed in Los Angeles County. Only 41 participants moved out of their housing during the evaluation period, with the majority moving out because they found permanent housing elsewhere or they were deceased. The evaluation findings do not reflect beneficiaries who were housed later or the potential changes in their outcomes following being housed.

Total Medi-Cal payments declined by $6,771 per beneficiary from six months before to six months after they enrolled in Housing for a Healthy California, the researchers found. This decline was greater by $5,590 than the comparison Medi-Cal beneficiaries who had similar characteristics but were not enrolled in the program. Similarly, program beneficiaries saw a decline of 0.58 emergency department visits and 0.38 hospitalizations per beneficiary from six months before to six months after being housed by HHC, which were significantly greater declines compared to comparison beneficiaries.

"Our findings provide much-needed evidence that lack of housing is a likely reason for more visits to emergency rooms or hospitalizations due to harsh living conditions or inability to get timely and adequate care in non-urgent settings," Pourat said. "Providing housing first can change the health trajectory of those experiencing homelessness."
Program participants who received housing were most often ages 50 to 64 years old (49%), non-Hispanic Black or African American (43%), and had not been stably housed in more than one year (60%). They also had high rates of both physical health and behavioral health conditions.

Challenges reported by the six counties included expensive housing markets coupled with a limited supply of available units, and participants who needed a wide range of social and medical services that could be difficult to access and coordinate.

"Those challenges combined with other factors - like access to funding, staffing and the specifics of different geographic regions - mean there isn't a one-size-fits-all way to get people into stable, long-term housing," said Pourat, noting that Housing for a Healthy California's approach of offering a wide range of services accounted for that. "The Housing for a Healthy California approach provided a promising example of a successful housing model that could be replicated elsewhere."

Tags: research | homelessness | health policy | health | public policy | California