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R.I. legislators call for using Medicaid funds to house people who are chronically homeless

Senator Joshua Miller says “the most effective preventative care mechanism (is) a roof”

In 2021, Providence removed this homeless encampment from the city’s West End, moving tents into storage and erecting new fence around the site.Brian Amaral

PROVIDENCE — For five years, Senator Joshua Miller has been sponsoring a bill that would allow Rhode Island to tap Medicaid funding, usually reserved for health care costs, to provide people who have been chronically homeless with housing.

And for five years, that legislation has gone nowhere in the House of Representatives.

But with the state’s housing crisis and homelessness at the center of attention, Miller is hoping this is the year the measure passes.

Miller, a Cranston Democrat, and Representative David A. Bennett, a Warwick Democrat, have introduced the legislation, known as the “Rhode Island pathways project.”

“The idea is simple: chronically homeless individuals are suffering and cost taxpayers thousands of dollars through ER visits, jail stays, and inpatient treatment,” the legislators said in a statement. “But without stable housing, they are very unlikely to recover. What if Medicaid could provide these individuals with housing, helping them get back on their feet and saving taxpayers money?”

Miller said he first heard about the idea at a National Conference of State Legislatures meeting when talking with a Hawaiian legislator, Dr. Josh Green, an emergency room doctor who is now governor of Hawaii.

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While Hawaii was the first to secure a Medicaid waiver for housing, Arizona and New York now have similar programs, and Miller said he hopes those precedents help convince Rhode Island to take that step.

Miller, chair of the Senate Health and Human Services Committee, said there is a clear connection between homelessness and poor health.

“Getting people into housing removes the burden of finding shelter and allows for the freedom to get connected with programs and employment opportunities, while directly engaging in the most effective preventative care mechanism we have — a roof,” he said.

About a quarter of people who are homeless are chronically so, and without stable housing, they cycle in and out of emergency departments, inpatient hospital stays, psychiatric centers, detoxification programs, and jails, costing taxpayers roughly $35,000 per year as of 2017, according to the National Alliance to End Homelessness.

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Miller co-chaired a 2013 Senate commission that studied ways to reduce emergency room visits, which are one of the biggest health costs related to homelessness, and he said one trip to the emergency room can cost as much in Medicaid payments as a month’s rent.

“By helping people break the cycle of chronic illness and homelessness, we’re doing the right thing by them and the taxpayers,” he said.

Bennett, a registered nurse, said he has seen the impact of homelessness on patients.

“As an RN case manager, I’ve worked with a lot of these folks,” he said. “When they don’t have a roof over their heads, it’s very hard to make sure they’re taking their medications regularly, make sure they’re going to the doctor. But once they have housing, they can recover and stand on their own two feet again.”

The legislation would require the state Executive Office of Health and Human Services to ask the federal government for permission to use Medicaid funds to support housing for homeless people and to conduct a study to assess the impact of using Medicaid funds to provide coverage for the treatment of people who have been chronically homeless.

The program would provide people with behavioral health services, case management, personal care and assistance services, home and community-based services, and housing support services. Miller said the proposal would include seeking permission to use Medicaid funding for rent.

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Bennett, who has worked as a mental health nurse, said there’s never been a more urgent time to try a new approach.

“Our hospitals can’t find enough nurses as it is, and our shelters are full,” he said. “If we can get these folks into housing, it will help them recover and make sure there’s an ER bed ready for you when you need it.”


Edward Fitzpatrick can be reached at edward.fitzpatrick@globe.com. Follow him @FitzProv.