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Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals

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It is always a challenge to assemble the resources to sustain supportive housing tenants in their housing, due to long histories of homelessness and complex health and behavioral health conditions.  Current strategies in the United States for financing supportive services are far from optimal.  Funding for homeless, behavioral health and other health care services currently in use is often fragmented across many public sector programs and agencies and the non-profit service providers they support.

The hardest element of care to fund is “the glue” that holds them all together in the service of providing PSH tenants with holistic care. “The glue” includes:

  • Early activities to induce prospective tenants to accept housing and stabilize new tenants in housing and to engage them in the services and supports that will address their health, mental health, and addictions problems.
  • Care coordination, including planning, involving staff able to offer all the different services needed, assuring regular consideration by team members of the tenant’s well-being and challenges to it, and, most of all, establishing a relationship of trust, openness, and support with each tenant.
  • Team-building with support staff from multiple disciplines, training, and agency affiliation, independent of handling individual cases, including cross-training. Making this happen often requires external influence to bring the relevant parties together and keep them together.

This document, from the U.S. Department of Health and Human Services’ Environmental Scan, reflects existing published and unpublished literature on permanent supportive housing (PSH) for people who are chronically homeless. 

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Very often a lack of jobs and money is not the cause of poverty, but the symptom. The cause may lie deeper in our failure to give our fellow citizens a fair chance to develop their own capacities, in a lack of education and training, in a lack of medical care and housing, in a lack of decent communities in which to live and bring up their children.

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