HHS PROGRAMS AND INITIATIVES TO COMBAT HOMELESSNESS

Overview: Each year about 1 percent of the U.S. population, some 2 to 3 million people, will experience homelessness. Although individual circumstances differ, homelessness is especially pronounced among those who are poor - between 5 percent to 6 percent of the poor population will experience homelessness in any given year. While some individuals may be homeless for only a short period of time, approximately 200,000 individuals are chronically homeless.

The U.S. Department of Health and Human Services (HHS) is an integral part of the federal government's efforts to combat homelessness. A member of the Interagency Council on the Homeless, HHS works with the Department of Housing and Urban Development (HUD) and other federal agencies to promote greater collaboration among federal partners and partners at the state and local levels to improve the coordination of services provided to homeless individuals.

The President's fiscal year 2003 budget requests $348 million for programs dedicated specifically for homelessness, an increase of 14 percent over the fiscal year 2002 level of $304 million. In addition, individuals who are homeless may be eligible to receive assistance from a number of the department's mainstream programs including Medicare, Medicaid, Temporary Assistance for Needy Families (TANF) and programs providing health care, mental health, social and substance abuse services.

Background: According to a 1999 report funded by the federal Interagency Council on the Homeless, more than two-thirds of people who are homeless and receiving services are male and more than half are nonwhite. Nearly half have never been married; almost 40 percent have less than a high school diploma. In addition, 60 percent of homeless women and 41 percent of homeless men have minor children. Over a quarter of these children live with their homeless parent. The survey also found that two-thirds of those surveyed reported mental illness, substance use disorder or both during the previous month. In the area of physical health, 26 percent reported a current acute infectious condition and 46 percent identified a chronic condition such as diabetes or hypertension.

HHS PROGRAMS AND SERVICES FOR PEOPLE WHO ARE HOMELESS

HHS supports a number of programs that provide critical supports for homeless people to help them obtain and keep stable housing. In addition to programs designed specifically to meet the special needs of the homeless, some of the department's mainstream services such as substance abuse and mental health treatment are available to eligible homeless individuals.

Policy and training. HHS agencies working together to serve homeless individuals and to combat the causes of homelessness include the Centers for Medicare & Medicaid Services (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Administration for Children and Families (ACF) and the Health Resources and Services Administration (HRSA) in addition to the Office of the Assistant Secretary for Planning and Evaluation (ASPE).

• Policy Academies. In 2001 and 2002, these agencies are collaborating with HUD and the Department of Veterans Affairs to sponsor two regionally based policy academies to provide assistance and training for state policymakers to develop action plans to improve access to health care and services by persons who are homeless or are at risk of becoming homeless. Following the regionally based academies, the agencies will convene a national meeting to showcase the plans that have been devised. More information is available at http://www.hrsa.gov/policymakers.htm.
  
  
• Taking Programs that Work to the Community. Working with national organizations, SAMHSA sponsored a December 2001 national conference, "We Can Do This!," for community-based providers, policymakers and consumers to share promising practices in service delivery and housing; promote local collaborations to combat homelessness for people with mental illness or substance abuse disorders; describe how to create better integrated service systems; and identify proven paths to recovery. Another national training conference is being planned for 2003.
  
  
• Building Partnerships for Access. In September 2000, the department sponsored a "Building Partnerships for Access" national conference to discuss and develop strategies to improve access to health care and services, including mental health and substance abuse services, for the homeless. For more information on this conference, please see hhttp://cms.hhs.gov/medicaid/homeless/900conf.asp [http://cms.hhs.gov/medicaid/homeless/900conf.asp].

Health Care for the Homeless Program. This HRSA program improves access by homeless individuals to primary health care and mental health and substance abuse services. The program awards grants to community-based organizations including community health centers, local health departments, hospitals and community coalitions in both rural and urban areas. It is currently developing a clinical practice manual and outreach curriculum to help mainstream health providers more effectively treat homeless people and has recently released publications on rural homelessness and homelessness among veterans and youth. For fiscal year 2002, $110 million has been appropriated for the program. More information about the Health Care for the Homeless Program is available at http://bphc.hrsa.gov/homeless/.

Substance Abuse and Mental Health Services. SAMHSA administers programs for people who are homeless and living with serious mental illnesses, substance abuse or both. Its grant programs help states and localities create new systems of community-based services to reach the large number of homeless people who also have these disorders. Outreach through technical assistance, national conferences and training helps bring these innovative practices to communities nationwide.

• Projects for Assistance in Transition from Homelessness (PATH). With $40 million in grants to the 50 states, District of Columbia, Puerto Rico and four U.S. Territories in fiscal year 2002, PATH supports community-based services for people with serious mental illnesses or co-occurring mental and substance use disorders who are either homeless or at risk of homelessness. States choose the services that respond best to local needs. The President's fiscal year 2003 budget would increase funding for this program to $47 million.
  
  
• Mental health and substance abuse treatment programs. Through its Programs of National and Regional Significance, SAMHSA will provide $28 million for projects specifically benefiting homeless individuals in fiscal year 2002. The President's fiscal year 2003 budget would increase funding for those projects to $44 million. It includes a $10 million program to help communities strengthen their drug and alcohol treatment systems for homeless individuals with substance abuse and mental disorders.

More information on SAMHSA's services for the homeless is available at http://www.cmhs.samhsa.gov.

Runaway and Homeless Youth Program. This ACF program is funded at $88 million in fiscal year 2002 to assist homeless youth with making the transition to independent living. It includes the following programs:

• The Basic Center Program proprovides grants to community-based public and private agencies to provide outreach, crisis intervention, temporary shelter, counseling, family reunification and aftercare services to runaway and homeless youth and their families.
  
  
• The Transitional Living Program helps homeless youth ages 16 through 21 make a successful transition to self-sufficient living and avoid long-term dependency on social services by funding comprehensive services in a supervised living arrangement for up to 18 months.

In addition, ACF's Street Outreach Program provides grants for prevention of sexual abuse and exploitation to eligible private, nonprofit agencies for street-based outreach, education and referral for runaway, homeless and street youth who have been subjected to or are at risk of being subjected to sexual abuse. The program is funded at $15 million in fiscal year 2002.

For more information on ACF's programs for runaway and homeless youths, please see http://www.acf.dhhs.gov/news/facts/youth.htm.

Services through mainstream HHS programs. In addition to programs and services focused specifically on homelessness, mainstream HHS programs, including programs that serve millions of low-income Americans and people with disabilities, also may provide eligible individuals who are homeless with other services and support.

• Medicare and Medicaid. Medicare is the nation's largest health insurance program, covering approximately 40 million Americans including people age 65 and over and certain people with disabilities. Medicaid is a jointly funded, federal-state health care program for certain low-income and needy people including eligible children, the aged, and people who are blind or disabled. More information on these programs is available at http://cms.hhs.gov/.
  
  
• Temporary Assistance for Needy Families (TANF). This block grant provides funds to states to design creative programs to help low-income families to become self-sufficient. More information is available at http://www.acf.dhhs.gov/news/welfare/index.htm.
  
  
• Ryan White CARE Act. The AIDS Drug Assistance Program (ADAP), administered by HRSA and authorized under Title II of the Ryan White CARE Act, provides medications to low-income persons with HIV. HRSA has published a technical guide, "Housing is Healthcare: A Guide to Implementing the HIV/AIDS Bureau Ryan White CARE Act Housing Policy," providing information on how to use funds to assist homeless individuals. More information on the CARE Act is available at http://www.hab.hrsa.gov.
  
  
• Substance Abuse Prevention and Treatment and Mental Health Block Grant Programs. SAMHSA encourages states to use funds from both of these block grants to provide services to vulnerable populations, including those who are homeless. The block grants total nearly $2.2 billion in fiscal year 2002, with $1.7 billion for substance abuse services and $433 million for mental health services. More information is available at http://www.samhsa.gov.
  
  
• Domestic abuse programs. ACF awards grants to state agencies, territories and American Indian Tribes for the provision of shelter services to victims of family violence and their dependents and for related services such as alcohol and substance abuse prevention and family violence prevention counseling. ACF also supports a national, multilingual, toll-free telephone hotline for victims of domestic violence at 1-800-799-SAFE. More information on ACF's domestic abuse programs is available at http://www.acf.dhhs.gov/programs/opa/facts/domsvio.htm.
  
  
• Community Health Centers. Any of HRSA's approximately 3,400 community health center sites may provide services to the homeless population. In his fiscal year 2003 budget, President Bush recommended a $114 million increase for these health centers. This increase represents the second installment in a multi-year initiative to increase or expand the number of health center access points by 1,200. More information on community health centers is available at http://bphc.hrsa.gov/CHC/.
  
  
• Maternal and Child Health (MCH) Services Block Grant. The MCH block grant program supports states' activities to improve the health status of pregnant women, mothers, infants and children by addressing key health issues for low-income women and their children. These programs also serve eligible homeless individuals. More information on the MCH block grant is available at http://mchb.hrsa.gov/.

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