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Linking Health Care to Housing through HRSA Safety Net Programs

Summary: When people have stable living conditions, it positively impacts their health. Recognizing this, HRSA programs have linked health care services and housing.

When people have stable living conditions, it positively impacts their health. Programs across the Health Resources and Services Administration (HRSA) recognize this connection and have linked health care services and housing, whether directly through grant awards or through partnerships across the Federal Government.

Federal Home Visiting Program

Today, 1.6 million American children, many under the age of 5, are without a stable home and are vulnerable to many adverse health factors. Research shows that children who experience homelessness experience higher rates of chronic illness, developmental delays, anxiety, and depression than children who live in stable homes.  Our approach to remedying these challenges requires collaboration with other agencies. Through HRSA’s Federal Home Visiting Program, grantees provide a number of evidence-based services to pregnant women and parents – some homeless or at risk of homelessness – with young children up to kindergarten entry. These services help to improve maternal and child health, prevent child abuse and neglect, encourage positive parenting, and promote child development and school readiness. Our grantees collaborate with homeless shelters, Housing and Urban Development (HUD) Continuum of Care projects, and local homelessness initiatives to establish stable housing for vulnerable families.

Interagency Collaboration

To this end, the U.S. Departments of Health and Human Services, Housing and Urban Development, and Education released an interagency policy statement on early childhood homelessness. As this new infographic shows, in the United States, a person is most likely to experience homelessness in their first year of life, followed by ages 1 to 5. Homelessness during pregnancy and in the early years is harmful to children’s development. The statement recommends ways early childhood and housing providers at the local and state levels can collaborate to better meet the needs of pregnant women and families with young children who are experiencing or are at risk of homelessness.

Health Center Program

HRSA’s Health Center Program provides high-quality primary health care to patients regardless of their ability to pay. In 2015, HRSA-funded Community Health Centers served more than 1.19 million people who experienced homelessness.  Many health centers received specific funding to focus on individuals and families experiencing homelessness. Even while the national homeless population has decreased, health centers saw a 3 percent increase in homeless patients.  HRSA is working to increase the number of health centers providing services or engaged in partnerships that address issues such as housing, education, employment, transportation and food security, which are very important to homeless populations.

Ryan White HIV/AIDS Program

For people living with HIV/AIDS and also facing homeless challenges, their health and treatment often takes the backseat.  According to 2014 data, HRSA’s Ryan White HIV/AIDS Program clients with unstable housing are significantly less likely to take their medications and have lower percentages of viral suppression than clients with stable or temporary housing. Research by multiple agencies has found that rates of disease and addiction are much higher among those who are unstably housed. HIV infections are estimated to be at least three times higher among homeless people, according to a 2011 HUD report [PDF 368 KB]. And over 16 percent of Ryan White clients are in temporary or unstable housing situations.

Given the importance of housing status on HIV health outcomes, HRSA launched a multi-site demonstration through the Special Projects of National Significance (SPNS) Program. The Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations initiative supports organizations to design, implement and evaluate innovative interventions to improve timely entry, engagement and retention in HIV care. Supportive services for HIV-positive homeless and unstably housed people with mental illness and/or substance use disorders are also critical.

HRSA also issued a clarification notice to make certain housing support services clearer to grantees. These services include: transitional housing, short-term or emergency housing and housing referrals (i.e., assessment, search, placement, advocacy and the fees associated with these services). To address the housing needs of low-income individuals living with HIV/AIDS and their families, HRSA actively encourages Ryan White grantees to collaborate with HUD’s Housing Opportunities for Persons With AIDS (HOPWA) Program Exit Disclaimer grantees. HOPWA grants may be used for a wide range of housing, supportive services, program planning, and development costs.

HRSA will continue to focus on the key linkage between health and housing, focusing on new innovative approaches through our grant programs or through partnerships with others across the federal government and private sector.