Thanks to an experimental new program aimed at easing the state’s deep homelessness crisis, some Californians can now get housing assistance from an unlikely source: their health insurance plan.
With this year’s launch of CalAIM, California is reinventing medical coverage by marrying health care and housing statewide for the first time. Under the new approach, some high-risk, low-income Medi-Cal recipients can use their insurance plans for more than doctor visits and hospital stays — they can get help finding affordable or subsidized housing, money for housing deposits, help preventing eviction and more.
Proponents say the program recognizes what doctors and social workers have known for years – it’s incredibly hard to keep people healthy if they live on the streets or risk losing their homes.
“There is no medicine as powerful as housing,” said Dr. Margot Kushel, professor of medicine and director of the UCSF Center for Vulnerable Populations. “And the health care system spends endless money and performs poorly because people don’t have access to housing.
The program targeting Medi-Cal — California’s version of the federal Medicaid system that provides health insurance to low-income Americans — could be particularly powerful in the Bay Area, where more than 30,000 people are homeless. Many of these people are sick. In Alameda and Santa Clara counties, about a quarter of homeless residents report chronic health conditions.
But CalAIM has a limited reach. It only applies to Medi-Cal’s most vulnerable patients – people who are homeless, released from jail or prison, with severe mental illness, and/or frequently entering and leaving hospital emergency rooms , psychiatric services and other institutions – leaving some experts worried that people who could benefit from housing assistance will fall through the cracks. And while CalAIM can help participants find housing and give them limited cash for security deposits and first- and last-month rent, federal law prohibits the program from paying their rent on an ongoing basis. Nor can he conjure up more housing in a state sorely lacking in affordable options.
“It’s the hole in the middle of the donut,” said Dr. Kathleen Clanon, director of the Alameda County Health Services Agency.
Early pilot programs testing the CalAIM model showed that while patients visited the emergency room less often, most homeless participants did not find housing.
There are 14 new benefits insurance plans can offer patients through CalAIM, ranging from housing services and help securing healthy food to help eliminate mold and other triggers of mildew. asthma from their home. Insurance plans choose which options to offer, with the goal of eventually expanding to all 14. The program is expected to cost about $1.5 billion a year over the next two years.
Governor Gavin Newsom has pledged his support for the initiative, which began Jan. 1, as a key part of his plan to reduce homelessness. The governor has invested billions in efforts to clean up encampments and create housing for the homeless, and wants to tackle mental illness by launching a new program that could place some unhoused and untreated people in court-ordered care.
But it’s unclear how many people CalAIM can house. Alameda County’s Whole Person Care pilot — a precursor to CalAIM that ran from 2016 to 2021 — served approximately 30,000 people, two-thirds of whom were homeless. Of those homeless participants, 69% received some sort of roof over their heads, including beds in emergency shelters and temporary hotel rooms. Only 36% ended up with permanent housing.
“I wish it was higher,” said Clanon, the county medical director. Even so, she called 36% successful. Prior to the pilot program, only 10% of homeless people in the county’s homeless-services system received permanent housing each year, she said.
In Santa Clara County, a similar pilot program called Health Homes was run by the county’s Medi-Cal insurance plans. In the first half of last year, the Santa Clara Family Health Plan saw a 25% drop in emergency room visits and a 30% drop in longer hospital stays for its pilot patients. A total of 211 homeless patients enrolled in the program between 2019 and 2021, and 54 received housing services and were subsequently housed.
“Finding housing is very difficult even when you have a strong housing navigation program,” said Lori Anderson, director of long-term services and supports for the Santa Clara Family Health Plan.
The results were similar across the state. Among participants who were homeless or at risk of homelessness in the third quarter of 2020, 68% received housing services, but only 7% were housed, according to a recent on Health Homes pilots in 12 California counties.
For Janice Anderson, 55, CalAIM is already a success. Anderson left her partner last year in part because she said he allowed the drug addiction she was trying to overcome. But it also meant leaving the Livermore apartment they shared.Anderson slept briefly in his car before moving to temporary shelter at an Oakland motel. As a Medi-Cal patient, Anderson was eligible for CalAIM. She was called regularly by social workers to walk through the steps of accessing housing — from cleaning up her credit to attending housing fairs to filling out rental applications. When she found a one-bedroom apartment in Hayward, the program paid her first and last month’s rent and helped her get a federal emergency housing voucher that lowered her rent to $960 a month. .
Anderson moved in this month, and the first thing she did was hang some string lights on her porch. She wants to turn her balcony into a “zen space” where she can drink tea and meditate before reporting for her job as a peer advocate for HIV-positive women.
“It’s just nice to know that if you ask for help, find help, and get to work, life is good,” she said. “It’s incredible.”