In the one of nation’s most ambitious effort to address housing needs, a $12 billion five-year initiative, launched in 2022 under Medi-Cal, has expanded the state’s version of Medicaid to provide services for the unhoused. The intintive includes stable housing navigation, rent deposit aid, and tenancy-sustaining support through a program known as HTSS (Housing, Tenancy, and Sustaining Services).
Medi-Cal insures nearly 15 million Californians, 40 percent of the state. In the third quarter of 2024 alone, nearly 50,000 Californians received housing navigation, deposit, or tenancy services paid for by the healthcare sector.
“Housing providers do HTSS all the time. They’re involved in early identification of housing barriers, they help residents communicate with property management, and they help with lease compliance and safety visits,” said Tessa Nápoles, a postdoctoral scholar with UC Berkeley’s Terner Center for Housing Innovation, at a Tuesday, April 22 briefing by the Terner Center on housing through CalAIM. “Unfortunately, traditional housing subsidy programs often don’t provide enough funding to cover all the supportive services that residents need,” she continued. “So using medical dollars to fund HTSS is crucial for individuals who have experienced the trauma of long-term homelessness, which is often paired with unmet mental and physical health needs.”
In Terner-led statewide talks with staff of Medicaid insurance plans, known as managed care plans, “some of the initial return on investment data was not promising,” said Nápoles of CalAIM housing initiatives. “But to me, that wasn’t surprising,” she continued. “This is a very long, long game. Housing someone today does not mean they won’t get hospitalized tomorrow. Still, we are seeing that at 12-18 months, there’s a decrease in costs in things like emergency department encounters and inpatient admissions.”
Frank Lopez, senior program manager with Jamboree Housing — a CalAIM housing pioneer in Orange County, said. “We have a housing-first model. We’re going to house somebody and start taking care of everything else, but we wanted to find a way to sustain that housing, and a lot of times, we were overwhelmed with all the documentation and the paperwork.”
To help, since the CalAIM rollout, he explained that Jamboree has collaborated with local Medi-Cal-certified organizations, most prominently Housing for Health OC, “so we’re taking their information about what services we can provide through Medi-Cal and using them to create screenings, case plans and benefit navigation for individuals that are homeless, and especially those dealing with substance abuse and mental health issues.” While HTSS is typically approved for six or 12 months, many unhoused patients need help for much longer. “We can’t look at health as just completing a goal, and you’re good to go. We need to get you to the point where we’re not needed anymore,” said Lopez. “If patients still unready for stable housing are achieving the goal we set in their care plans, we add a new goal. And that way, we can reauthorize HTSS. We even have people coming up to the two-year mark of working with us now.”