How Washington is treating housing as health care

Washington is trying something new when it comes to housing: treating it as health care.

Apple Health and Homes is a multi-agency state program launched last year that focuses on providing housing to people with health and behavioral health challenges. What’s unique is that the program taps Medicaid dollars to pay for housing subsidies, tenant services and more.

“This is a big paradigm shift in how the system helps people with housing,” said Melodie Pazolt, managing director of the Office of Apple Health and Homes at the Department of Commerce.

Apple Health and Homes builds upon the state Health Care Authority’s Foundational Community Supports initiative, which provides both housing and employment services to people enrolled in Apple Health. Apple Health is the state’s Medicaid program.

People who are chronically homeless, or who have behavioral health needs, substance use disorders or other health issues can qualify for Foundational Community Supports benefits.

The program helps people gain housing through application and home search assistance, and also offers tenant supports, such as rental aid and treatment programs.

Matt Christie, Foundational Community Supports supervisor at the Health Care Authority, said Washington was one of the first states to begin using Medicaid funding for housing and related services, but now that’s become a popular use across the country.

“We were pioneering the way,” Christie said.

Since it launched in 2018, Foundational Community Supports has enrolled more than 31,000 people. Currently, about 8,680 people are enrolled in the program’s housing services and 3,400 people in employment services, Christie said.

Foundational Community Supports operates under a Medicaid Section 1115 demonstration waiver, which enables states to use Medicaid funding for services that wouldn’t traditionally be permitted by the program’s rules. A federal-state partnership, Medicaid provides health coverage for millions of low-income Americans.

Health care lens for housing

Apple Health and Homes takes the Health Care Authority’s efforts a step further, offering housing, tenant supports and recovery services through one system, Pazolt said.

Those who qualify must be enrolled in Apple Health. They need to meet other criteria as well, including having a mental health need, substance use disorder or chronic health condition, and being homeless or having a history of stays at shelters or other temporary housing facilities.

The program helps coordinate a host of services for people who may have health challenges. That includes housing vouchers and subsidies, units to live in, and shelter or other supportive services for people experiencing homelessness.

It focuses on getting people into permanent supportive housing, which the state defines as housing with no length-of-stay limits. The program also prioritizes people who need comprehensive support services.

Pazolt said the program works to match people with an environment that would best suit them. For example, they would try to avoid placing someone in a neighborhood where that person may have started using illegal drugs.

The program focuses on thinking about housing as a part of health and wellness, she said.

For example, it’s difficult for someone to recover from substance use disorder or other behavioral health challenges while homeless. And for people who have health conditions like diabetes or asthma, it can be difficult to keep track of medications without a home to go to.

Housing can have “incredibly dramatic” positive effects for people with behavioral health conditions, Pazolt noted, and the Apple Health and Homes can help. “It really does shine a light on how to address homelessness and looking at it from a health care lens,” she added.

New funding, high demand

In the last year, the Department of Commerce gave out $41 million in capital funding for projects across the state that will provide units for the Apple Health and Homes program.

Kitsap Community Resources, Muckleshoot Housing Authority, the Olympic Community Action Program and the Vancouver Housing Authority are among the recipients. The awards will provide 119 more housing units for Apple Health and Homes.

And there’s more funding on the way.

The Legislature set aside over $100 million from the state’s Housing Trust Fund for the program.

Applications are open for organizations who want a chunk of that money to build more housing.

But demand will likely outpace available funding. The Department of Commerce estimates Washington will need 122,000 permanent supportive housing units over the next 20 years. Until that target is met, there will always be a scarcity of resources to help people, Pazolt said.

“We’re going to chip away at the mountain,” she added, “and serve people as best we can.”

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