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OPINION: Medicaid 1915i Increases Services to The Homeless


Submitted by Charles Duarte

Imagine you are a 25 year-old woman just discharged from the hospital after suffering an acute psychotic episode related to a recent diagnosis of schizophrenia.  You have no family or friends who can help.  You are confused, unable to think clearly but somehow have to continue to remember to take your medication, pay your bills and earn a living.  You realize you are behind in your rent only after getting an eviction notice.  Now you are homeless, on the street and vulnerable.

Now instead, imagine that upon discharge the hospital social worker connects you with a case manager.   She helps arrange appointments with a psychiatrist. She sends texts to remind you to take your anti-psychotic medication and visits two times a week to make sure you have food in the apartment.  She intervenes with the property owner to make sure you can keep the roof over your head.  She helps you apply for food stamps and social security disability. Over the next several weeks, she even helps you find a new job with a supportive employer.

Two very different outcomes made possible by services paid for by Medicaid.  The program, referred to as “1915(i)” – a reference to a section of the Social Security Act – pays social service agencies to provide supportive housing and employment services that can include a wide array of services that are person-centered.  By helping clients with a serious mental illness maintain tenancy, there is an improvement in the client’s overall health and a proven reduction in the revolving door of homelessness, hospitalization and jail time.  Ultimately, these common-sense services save money and lives.

To date, these types of supportive services were available for the frail elderly, as well as individuals with physical and intellectual disabilities.  They were not available for individuals with a serious mental illness, unless funded by grants, which do not provide a long-term sustainable funding stream for agencies to provide these types of vital services.

That is changing.  One legislative initiative is making its way through the 80th Session of the Nevada Legislature. SB425 proposed by Senate Majority Leader Nicole Cannizzaro, would require the Department of Health and Human Services to expand Medicaid Home and Community-Based Services, and include services that facilitate housing as healthcare. If approved, Medicaid will be able to provide a stable funding source for agencies to help individuals maintain tenancy as well as their dignity while avoiding unnecessary costs associated with chronic homelessness.

I applaud Senate Majority Leader Nicole Cannizzaro for making these services a priority for some of our most vulnerable friends, neighbors and family members.  

Charle’s Duarte is the CEO for Community Health Alliance and an ACTIONN member.

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