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Senate to vote on bill allowing use of Medicaid funds to house Hawaii’s homeless

Updated: 
February 24, 2017 - 12:05am

KAILUA-KONA — Legislation that would classify chronic homelessness as a medical condition and allow the state to pull from its $2 billion annual Medicaid fund to house those who qualify is on its way to a vote on the floor of the Hawaii State Senate.

SB7, introduced by Sen. Josh Green, Kona and Ka’u, navigated its way through Senate committees on Human Services as well as Commerce, Consumer Protection and Health earlier this month. It cleared the Ways and Means Committee Thursday.

Through consideration by three committees, the legislation has yet to receive a “no” vote. Members of the Senate are expected to vote on the bill after its third reading on March 2. If it passes, it will move to the House of Representatives for further consideration.

“This bill is part of the larger effort to dramatically reduce homelessness in Hawaii and better use Medicaid resources,” said Green, who is also a physician. “When chronically homeless individuals receive housing, their Medicaid health care costs drop 43 percent, which could result in millions of dollars of savings against our current $2 billion annual Medicaid budget. Meanwhile, fewer families will be suffering.”

Green said there are currently 362,000 Medicaid beneficiaries in Hawaii, adding roughly 3.6 percent of them are consuming 60 percent of the Medicaid budget.

In other words, around 15,000 of Hawaii’s most vulnerable citizens — people struggling with chronic disease and drug addiction, many of whom are also homeless — are eating up $1.2 billion of Hawaii’s annual Medicaid fund.

By his projections, Green said he believes the state could save $300 million every year by addressing the root cause of many of the medical problems these people face. That starts, he said, by providing them shelter.

Not every legislator agrees, however.

Rep. Bob McDermott — a Republican and a member of the House Committee on Housing who represents Ewa, Ewa Beach, Ewa Gentry and Iroquois Point — described Green’s legislation as “twisting words around.”

He added that the universal classification of homelessness as a medical condition is not only inaccurate, but does a disservice to some members of the homeless community.

“You have got to have some integrity in the laws you pass. Words mean things,” McDermott said. “There is a population of homeless (for whom) it is clearly a medical condition — the substance abusers and the mentally ill — but other than that, it seems to be a stretch. To classify everyone else (that way) would seem like just a money grab. It’s very creative, though. I give him credit for creativity.”

Green said if SB7 were to become law, the result would be “revolutionary.”

No state in the union has ever classified homelessness as a medical condition, but others have recognized the potential of using Medicaid dollars to curb homelessness in the hopes of cutting expenditures overall.

Several states, such as New York and California, have already redirected portions of their state-funded Medicaid budgets to supplement social services.

“New York directed $400 million from its Medicaid budget directly into housing programs. This is meant to be a more elegant approach,” Green said. “The reason being is that we know that those who are chronically homeless almost universally end up with chronic disease, whether it’s mental illness, severe infections or diseases that can’t well be treated like diabetes.

“It would be an absolute win for both patients and the state to succeed in describing homelessness as a health condition.”

Hawaii’s total number of homeless pales in comparison to the counts in states like California and New York, but per capita, Hawaii has the greatest homeless numbers in the nation.

Hawaii’s Point-In-Time Count — an annual, self-reported survey conducted in every county across Hawaii — tallied 7,921 total homeless in the state in 2016. That number is up almost 1,700 individuals from 2012, when the count registered 6,246 homeless people in Hawaii.

PIT Count numbers are widely recognized, even by those who administer the count and use the data to craft policy, as being typically under representative of the actual number of homeless living in Hawaii at a given time.

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