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In this report, the authors present the final evaluation of the Pima County Housing First (PCHF) Initiative, which offers permanent supportive housing (PSH) and case management for individuals who are involved with the criminal justice system and have experienced homelessness. Those who have been placed in detention, including jail or prison systems, encounter significant barriers to reentry and reintegration, and individuals with complex physical and behavioral health conditions are at heightened risk of homelessness. This study is one of the first to examine the impact of PSH on such individuals. In its first two years, the PCHF Initiative enrolled 314 adult clients. Over 70 percent of these individuals were provided with a housing voucher, and close to 60 percent were provided with supportive housing. Among those tracked for 12 or more months from program enrollment, criminal justice system service utilization declined by over 50 percent and hospital-based health care utilization declined by more than 40 percent. These reductions in services offset the programmatic costs of housing and social services attributable to the PCHF Initiative. However, to determine whether the relationship between program participation and shifts in service utilization are causal, a more rigorous study design would be needed.

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Although rates of homelessness have remained fairly steady in the United States over the past decade, the number of people experiencing homelessness in California has continued to grow. California now has an estimated 151,000 people experiencing homelessness, more than any state in the nation. Permanent supportive housing (PSH) has been recently adopted by health plans, hospitals, and large health systems as a way to address one of the key social determinants of health: stable housing. This report represents a second examination of a PSH program operated by a large not-for-profit Medicaid and Medicare managed care plan in Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. In this report, the authors provide an overview of implementation to date, including information about referrals and enrollment into the program, housing placements, and participant characteristics. The authors also assess the short-term impact of the program by examining health care service utilization and associated costs in the six months prior to and six months following enrollment in PSH in comparison with an observational control group of adult plan members who did not receive PSH. The authors also examine the PSH program costs during this period.

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Homelessness, which refers to the lack of a fixed, regular, and adequate nighttime residence, is a pervasive public health issue. This report presents results from an implementation and outcome study of an ongoing permanent supportive housing (PSH) program—including service utilization and associated costs review—operated by a large not-for-profit Medicaid and Medicare managed care plan serving more than 1 million members in the Inland Empire area of Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. The aim of this report was to determine whether programmatic costs incurred by the health plan supporting the PSH program were partially or fully offset by decreased costs attributable to health care utilization within the health system. The evaluation used a quasi-experimental research design with an observational control group. The authors differentiated the program's effect during the transitional period—that is, after program enrollment and prior to housing placement—from its effect during the period after members were housed. In addition, the authors present participant flow through the key program milestones (e.g., referral, enrollment, housing placement, program exit) and describe health care utilization and associated costs for members who exited the program. Finally, they report the PSH programmatic expenditures relative to the changes in health care costs to provide an overall picture of the intervention's benefits and costs to the health plan.

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Psychiatric and substance use disorder (SUD) treatment beds are essential infrastructure for meeting the needs of individuals with behavioral health conditions. However, not all psychiatric and SUD beds are alike: They represent infrastructure within different types of facilities. For psychiatric beds, these vary from acute psychiatric hospitals to community residential facilities. For SUD treatment beds, these vary from facilities offering short-term withdrawal management services to others offering longer duration residential detoxification services. Different settings also serve clients with different needs. For example, some clients have high-acuity, short-term needs; others have longer-term needs and may return for care on multiple occasions. California's Merced, San Joaquin, and Stanislaus Counties, like other counties throughout the United States, have sought to assess shortages in psychiatric and SUD treatment beds. In this report, the authors estimated psychiatric bed and residential SUD treatment capacity, need, and shortages for adults and children and adolescents at various levels of care: acute, subacute, and community residential services for psychiatric treatment and SUD treatment service categories defined by American Society of Addiction Medicine clinical guidelines. Drawing from various data sets, literature review findings, and facility survey responses, the authors computed the number of beds required - at each level of care - for adults and children and adolescents and identified hard-to-place populations. The authors draw from these findings to offer Merced, San Joaquin, and Stanislaus Counties recommendations to help ensure all their residents, especially nonambulatory individuals, have access to the behavioral health care that they need.

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Homelessness is a pervasive public health problem in the United States—affecting more than half a million individuals on any given night. Recently, state Medicaid expansion and movement away from fee-for-service payment models have fostered an increased interest in supportive housing programs implemented by health plans, hospitals, and large health systems to address homelessness and high health care service utilization. In this report, the authors assess the baseline implementation of a permanent supportive housing (PSH) program administered by a large not-for-profit Medicaid and Medicare managed care plan in Southern California—describing program operations; participant demographic, clinical, health service utilization characteristics; and medical costs. This effort drew from electronic medical records and programmatic data tracking systems. The program enrolled 164 adult health plan beneficiaries with self-reported homelessness and multimorbid medical or behavioral health conditions from April 2018 through October 2019. Program participants were predominantly male, middle-aged, and racially/ethnically diverse, with complex, multimorbid health conditions. The median number of past-year health conditions recorded was 17, generating an average health care expenditure of