Permanent Supportive Housing Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018) / Chapter Skim
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7 Program and Policy Barriers to Permanent Supportive Housing
7 Program and Policy Barriers to Permanent Supportive Housing
Pages 104-124
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From page 104... ...
§ 3604, in a case alleging the segregative siting of Low Income Housing Tax Credit properties in minority areas of the Dallas region, and the exclusion of these affordable housing properties from predominantly white neighborhoods.
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From page 105... ...
Nonetheless, PSH increases an individual's ability to remain housed, and that plausibly alleviates a number of conditions that negatively impact health, such as exposure to extreme elements or lack of refrigeration for medications, etc. The committee describes below the key policy and program barriers to bringing PSH and other housing models to scale to meet the needs of those experiencing chronic homelessness.
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From page 106... ...
106 Permanent Supportive Housing agencies operate at a city level, others at a county or regional level. States are also involved as their housing finance agencies allocate LIHTC, the primary source of capital funding for affordable housing.
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From page 107... ...
HUD Housing Choice Vouchers are the primary source for operating subsidy. The coalition will likely try to secure a contract with its local public housing authority (PHA)
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From page 108... ...
2016. Boulder County Permanent Supportive Housing Study.
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From page 109... ...
Thus, PSH providers operate in an affordable housing environment of scarce resources and competition for inadequate funding. In recent years, both Congress and federal agencies have made the end of chronic homelessness and homelessness among veterans a national priority.
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From page 110... ...
This includes HUD's assisted programs (e.g., Housing Choice Vouchers, Public Housing, and Federal Housing Administration multifamily subsidized housing) , as well as Medicaid (USICH, 2015c, p.
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From page 111... ...
The commission recommended that the United States transition to a system, similar to those of western European countries, in which households with extremely low incomes (at or below 30 percent of AMI) receive a housing allowance through a reformed Housing Choice Voucher program (BPC, 2013)
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From page 112... ...
But HUD and Treasury do not share in the cost savings if PSH results in reduced emergency department use or jail stays for the high utilizers among people experiencing chronic homelessness. HUD's budget is subject to the caps on the discretionary side of the federal budget and cannot easily be expanded to scale up PSH.
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From page 113... ...
. Focusing specifically on individuals experiencing chronic homelessness, individuals with disabilities, and older adults needing long-term support services, the bulletin describes how "certain housing-related activities" can be reimbursed via Medicaid.
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From page 114... ...
The supportive housing would be targeted to high users of Medicaid services among populations that include adults experiencing chronic homelessness who are physically disabled, suffer from mental illness and/or substance abuse, or are living with HIV/AIDS. In support of this request, the state cited potential savings of $16,281–$31,291 in annual Medicaid costs for every individual served, or $142 million–$273 million annually (New York State Department of Health, 2012)
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From page 115... ...
Many PSH providers started as affordable housing or human services organizations and are not licensed or qualified to deliver Medicaid services (Thiele, 2014) , or they may not meet the requirements established by their state or by managed care organizations to obtain Medicaid reimbursement for the services they deliver (Buitrago, 2016)
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From page 116... ...
Market and Regulatory Barriers That Impede Scalability of PSH Affordable housing efforts, PSH included, face a formidable array of barriers aside from the challenges of assembling financing. The two primary models for providing PSH units -- scattered-site and single-site multifamily buildings -- both face barriers (Community Strategies Institute, 2016)
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From page 117... ...
. It is widely recognized by economists and federal officials across the political spectrum that local barriers to new housing development slow the permitting process, artificially increase the cost of developable land, and limit the efficacy of government housing assistance programs (Advisory Commission on Regulatory Barriers to Affordable Housing, 1991; BPC, 2013; White House, 2016)
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From page 118... ...
The private housing market exposes people experiencing chronic homelessness using vouchers to housing discrimination. Landlord refusal to accept vouchers is prevalent nationwide, especially where strong real estate markets and regulatory barriers constrain the supply of rental housing and increase competition among renters.
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From page 119... ...
Even when federal funding is involved, the delivery systems that support affordable housing programs, such as HUD Continuum of Care services for people experiencing homelessness and public health, are generally carried out at the municipal or county government levels. Often communities attribute homelessness in their midst to "outsiders," when in fact most of the homeless population is local (see Parker and Dykema, 2013, for evidence that individuals experiencing homelessness are actually less mobile than the general state population)
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From page 120... ...
(Advisory Commission on Regulatory Barriers to Affordable Housing, 1991, p.
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From page 121... ...
For example, one program that had a medical clinic on the bottom floor spoke of having to go to clients' apartments to accompany them to the clinic because they would not go on their own. THE ROLE OF INNOVATION TO ACHIEVE PSH SCALABILITY From the presentations that the committee heard, the answer to whether current models of supportive housing can be scaled up to meet the national goals of ending chronic homelessness is negative -- not with the resources currently available and not unless substantial progress is made in reducing regulatory barriers and increasing coordination across agencies and levels of government.
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From page 122... ...
To the extent that this model could create a residential enclave segregated by race, ethnicity, gender, family status, disability status, or economic status, it would run afoul of the Fair Housing Act. CONCLUSIONS As described above, the committee's assessment of the literature and other efforts indicate that there is no substantial evidence that PSH improves the health of people experiencing chronic homelessness.
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From page 123... ...
In studies ranging up to 2 years, PSH has been shown to be effective in maintaining housing stability for most people experiencing chronic homelessness. Although the committee found no substantial published evidence that PSH improves health, PSH increases an individual's ability to remain housed, and that plausibly alleviates a number of conditions that negatively impact health.
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From page 124... ...
Finally, the construction of PSH is often hindered by regulatory barriers that make it more difficult and more expensive to address chronic homelessness. The committee reiterates the findings of the Advisory Commission on Regulatory Barriers to Affordable Housing from more than 25 year ago: Local land-use regulations that apply to the siting and construction of new housing present substantive barriers to expanding the availability of affordable housing, including PSH.
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