Hawaii bill would classify homelessness as medical condition
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Hawaii bill would classify homelessness as medical condition

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    A homeless at Kakaako Gateway Park in May 2016. Sen. Josh Green last week introduced a bill in the state Legislature to classify chronic homelessness as a medical condition and require insurance companies to cover treatment of the condition.

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As an emergency room doctor, Sen. Josh Green sees homeless patients suffering from diabetes, mental health problems and an array of medical issues that are more difficult to manage when they are homeless or do not have permanent housing.

That’s why Green says he wants to homelessness classified under Hawaii state law as a medical condition.

If homelessness is a disease, he reasons, then doctors should be able to write prescriptions for the cure: Housing.

“It is paradigm shift for sure, but the single best thing we can do today is to allow physicians and health care providers in general to write prescriptions for housing,” Green said.

Green last week introduced a bill in the Hawaii Legislature to classify chronic homelessness as a medical condition and require insurance companies to cover treatment of the condition.

But if a doctor wrote a prescription for six months of housing, where would the patient fill the prescription?

That’s where Green wants Medicaid to step in.

He wants to redirect some of Hawaii’s $2 billion annual Medicaid budget to pay for housing.

He says the state could spend less Medicaid money by dedicating some of it to housing instead of paying for frequent visits by homeless people to emergency rooms. A recent University of Hawaii survey found health care costs for chronically homeless people dropped 43 percent when they had decent housing for an uninterrupted six-month period.

“Housing is health care, because it does afford a person a much greater chance of sustaining their health,” said Connie Mitchell, executive director for the Institute for Human Services, Hawaii’s largest homeless services provider.

But she cautioned that choosing who qualifies would be a challenge.

“You need to really look at when that’s appropriate, because there’s a lot of people that become homeless,” Mitchell said. “Just because they become homeless doesn’t mean it entitles them to write a prescription for a unit.”

Hawaii had the highest rate of homelessness of all U.S. states in 2015, with 53 homeless people for every 10,000 residents, according to The National Alliance to End Homelessness.

The isolated state’s high food and housing costs have prompted thousands of locally-born residents and transplants to erect tents and makeshift structures for homes in parks and sidewalks on Oahu, the state’s most populated island.

Concerned about impacts on tourism, city officials have banned sitting and lying down in public spaces in the beachfront neighborhood of Waikiki and other parts of Honolulu.

The prospect of Green’s proposal passing is unclear, but Hawaii officials appear receptive to offbeat solutions. State officials last year directed more money than ever to homeless support services.

And this week, 20 state senators proposed issuing $2 billion in state-backed bonds to build affordable housing, public housing renovations and homeless shelters.

Representatives from the state’s two largest insurers — Kaiser Permanente and Hawaii Medical Services Association — and the chairwoman of the legislative committee that will first consider the bill declined comment, saying they have not had time to review it.

National homelessness experts said they are unaware of any other U.S. state attempt to classify homelessness as a medical condition.

But more than a dozen states — including California, Louisiana, New York and Texas — have found alternative ways to use Medicaid money for social services to help people stay in housing, like employment services or counseling, according to the Corporation for Supportive Housing, a New York-based group.

And New York is searching for ways to redirect the state-funded portion of its Medicaid budget toward housing payments.

“To date, no one is able to pay for rent using Medicaid. That’s the line in the sand,” said Barbara DiPietro, senior director of policy at the National Health Care for the Homeless Council, referring to federal Medicaid money.

Green’s idea is in line with an ongoing push in in Hawaii to expand Medicaid coverage so it will pay for services such as social workers who help people secure housing.

“The state realizes there’s a strong intersection between housing and health care, and I think that really is a critical component of our efforts to address homelessness here locally,” said Scott Morishige, the homelessness coordinator for Gov. David Ige, a Democrat.

Illness and injuries can lead to homelessness, through loss of income or inability to pay medical bills. When people become homeless, chronic diseases such as high blood pressure, asthma, diabetes and mental health problems are more difficult to manage, according to the National Health Care for the Homeless Council.

“If you don’t have stable housing, if you don’t have a stable place to live, how are you managing medications and going to doctor appointments?” said Marcella Maguire, a director at Corporation for Supportive Housing.

The Queens’ Health System, a Honolulu hospital, billed $80 million for treating homeless people in 2014 and $89 million in 2015, said Lyndsey Garcia, a hospital legislative analyst. More than $10 million goes uncompensated annually, she said.

Some homeless patients visit emergency rooms dozens of times per year, Green said.

“I’ve heard it described as you go to Queens as a two-day vacation,” he said. “It’s going to cost probably $2,000 to $3,000 per day, so Queens is going to eat that cost, just for basic shelter.”

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    • 2 Billion dollars could pay for a huge housing complex.
      There would be obvious other maintenance and fees incurred, but, would our money not be better spent if we actually create housing for these people to live in?

    • Problem is, medicaid doesn’t have the money nor expertise to deal with the homeless problem. If anything, this distraction will take away funds from true healthcare services when it’s already underfunded. Dr. Green seems to think that there’s lots of money to go around. Where are his numbers?

      • Sen. Josh Green last week introduced a bill in the state Legislature to classify chronic homelessness as a medical condition and require insurance companies to cover treatment of the condition. Really? This is the best idea this guy can dream up?

        He willfully fails to understand limited Medicaid funds can only be spent according to federal guidelines. His feel nice bill does nothing, trumped by federal law.

        Worst part of all Nei bureaucrats would see the funds as more fodder for their special interest bosses. Only pennies to actually spend on them.

        We need to follow the lead of Maine where anyone receiving assistance must put in a set number of hours per month of work. Soon as the state started this welfare numbers dropped. Proving people were just leeching off of taxpayers.

        Nei bureaucrats, others like this guy lack the cojones to really get work done. Sad.

        • Good one. And yes, those that are receiving assistance should be put to work. They could “earn” assistance by helping to clean our beaches, parks, roadsides, and homeless camps because there is a ton of trash all over the place. I always see these abled bodies hanging out at IHS waiting for free meals.

        • Enacting this bill would likely have the same result Obamacare did – raise everyone else’s medical insurance costs. As if they weren’t high enough already, we’ll all be paying $1000 a month for health insurance. Businesses will cut employees or reduce hours to avoid paying for required employee health coverage. The end result will be less employment, less healthcare coverage and expanded medicare rolls.
          It’s a dumb idea but I see the appeal for a doctor like Josh Green who wants the power to prescribe housing and bleed the medicare system dry.

    • IMO this is a very poor solution that has not been thought out or vetted. First do we have the affordable housing? No we don’t for if we did there would be way less homeless. What new and inefficient state bureaucracy would have to be created to execute this? What is the return on investment and where could and should these Medicare funds be used? Seems like an overly simplistic answer to a very complex problem…surprising for a supposed medical doctor. If we could only write a prescription to cure all for all of society’s ills.

    • We find such profoundly stupid ways to spend taxpayer dollars. How about instead, a) paying down state long term debt, and b) do a better job of funding government employee pensions, and c) fix out state and county buildings that are falling apart. FOCUS!

      • State should have started moving new hires to the 401k retirement plan when they started in the early 80s. We would not have the current, endless pension money pit we have today.

        Sadly all responsible bureaucrats were spayed/neutered. Very poor stewards of taxpayer’s dollars.

    • Oh yeah, let’s use medicaid. It’s money from thin air. No it’s still welfare and tax dollar funded. If there are mentally ill people out there that can’t take care of themselves, then institutionalize them. They are dangerous roaming the streets.

  • Is Green saying that all the homeless have a medical condition? And please, do not have us taxpayers paying for this bill. Never heard of a prescription that says “housing”. Ridiculous!

  • Dumb, dumb, dumb. Doctors now making public policy? What’s next? Homeless wanting to make their own prescirptions? Dr. Green, stick to what you are good at. Obama left last week and so should these ideas that cost us middle class income-earners more in taxes. If MDs fund this idea, fine.

    • Even if a doctor writes a prescription for housing, it’s not like we have a “room” that their patient can simply transfer to. They still need to be screened and placed. There are still rules to be followed and some of these folks have pets that they are unwilling to part with. What then?

  • A rather dumb idea. Those who become homeless do so for a variety of reasons. Those suffering from chronic illness of course do not fare well and present a big financial
    problem for the medical establishment. If Green wants to reduce the medical costs of treating these people, he needs to work to establish medical clinics that provide
    emergency and ongoing care for the homeless so they do not need to go the ER’s for care at the point where they are in dire need.
    Clinics could be set up at shelter locations in addition to traveling clinics.

    • That makes way too much sense Fiveo. But how are the democrats going to profit from free medical clinics for the homeless? You know they don’t do much they can’t somehow profit from.
      If they were smart, they’d use medical students, recent grads and doctors from UH to provide such services to the extent possible. An internship of sorts – for the medical school and nursing school students. Common sense you would think but apparently not so common anymore, particularly among the corrupt democrats in the legislature.

      • The answer is simple. Put Dr. Green in charge of setting up medical clinics assisting homeless where they live. He can personally work in one of them to do the work he has talked about.

        Later we’ll see if he still likes the idea.

  • I’m all for solutions to homelessness but the prescription should not be free housing. Prescription should read: Treatment and rehab at tent city on Kahoolawe. We can help them but homelessness should not be a pleasurable option of free home, food, and amenities.

  • Pay for relocation costs to a place where the housing is cheaper, so they have a real shot at self-sufficiency. Why bother keeping them as wards of the state forever, live they’re animals in a zoo who will never be independent?

  • This person needs a reality check! If they do that, I’ll go sleep on the sidewalk and let them label me of having a homelessness sickness. Then they can place me in a small place and take care of me forever. Oh no, I got a home now so I’m really not homeless. Josh Green, get a life!

  • Hawaii already has a dearth of housing for frail elderly and/or disabled dependent adults. Adults with mental health and substance abuse problems have medical issues requiring specific therapeutic venues to meet their unique needs. Homeless insulin-dependent diabetics and/or those on dialysis also deserve support. The list goes on and on. I fear medically needy people from elsewhere will flock to Hawaii for a Medicaid-funded life in paradise. There is no easy answer. What to do?

  • Make homelessness illegal. Then give them a choice. Be put into a giant, fenced in tent city similar to what’s in Arizona, or go to a shelter and start getting acclimated back into society.

    I guarantee you that 90% of them would gladly move to the available shelters currently UNUSED now.

  • “That’s where Green wants Medicaid to step in. He wants to redirect some of Hawaii’s $2 billion annual Medicaid budget to pay for housing.”

    Is this a solution or another more complex problem to the already stressed Medicaid budget that’s dwindling? With sky-rocketing housing costs – is borrowing from Medicaid the answer ? You’re basically re-directing much needed money away from the ever-growing senior population. This results in less of the pie.

    How bout using the ‘Hurricane Fund’ as well?

    • Rail rail funding. Plenty of money to go around.

      Oh wait. HSTA said they need $500 million to solve all their self made educational problems. Biggest leeches ever on taxpayers.

  • Great…another state mandate that will shift current social service costs to private insurers thus increasing my premiums. Enough already. Homelessness needs a tough love approach and not another “society us to blame” guilt trip. This idiotic plan would attract more homeless from the mainland.

  • Detroit has plenty of homes for a $1. Pack them up and ship them out on the next cargo ship destined for the mainland with a deed in their hand to one of those nice Detroit homes! I’ll even volunteer to help pack their $h!t onto the cargo ship!

    Sources with HTTP Links in title…
    1. $1 Detroit homes

  • “If homelessness is a disease, he reasons, then doctors should be able to write prescriptions for the cure: Housing.”

    finally a solution to the homeless problem: a prescription. will there be name brand housing available or generic housing only?

    and, as a reminder, the majority of the mentally ill homeless already have prescribed medications that they refuse to take.

    • Correct! On top of that, many mentally ill refuse to even see a Dr.

      When you have patients that don’t want to see the Dr nor do they trust the drugs that will be prescribed to them because they must follow directions to correctly administer the drugs the program will be a complete waste of taxpayers money to create an medical community with no patients! LOL

  • Ok give them two aspirin and they’ll no longer be homeless. Are you kidding me. I never thought that lawmakers could get any more ridiculous than they already are.

  • yeah…and criminal behavior is a disease. Give me a break. The homeless who have been dumped on the street by failed state mental health system probably qualify as medical condition, but the vast majority of the rest are either professional bums or displaced houseless.

  • These doctors did such a good job dealing with chronic pain by simply writing their prescriptions, thanks for the heroin/opiate epidemic. I’m sure they couldn’t bungle homelessness.

  • I couldn’t quite make the connection between homeless and Medicaid until I did a bit of research on this topic. In 1983, funds allocated to federal affordable housing programs had been cut drastically. In 1978, the Housing and Urban Development budget was $83 billion in 2004 constant dollars. In 1983, funding was drastically reduced to $18 billion when adjusted to inflation, again using 2004 dollars. Without question the drastic cuts to federal affordable housing programs such as HUD have led to an exponential increase in homelessness. Coincidentally, for the first time since inception in 1965, 1982 was the first year where all states in the U.S. participated in Medicaid. From 1995 to 2011, over 650,000 existing housing units and Section 8 units were lost, During this same period, Medicaid spending skyrocketed from $89 billion to $275 billion. As drastic cuts to HUD continue, Medicaid spending has exploded, to the tune of $376 billion in 2016. It has been said that here in Hawaii, if we provide modest housing for our homeless, this will actually cost taxpayers less than if we were to leave them on the street. This appears to be the case on a national scale where we save federal taxpayer dollars on affordable housing funding yet pay much more in Medicaid expenses.

    • Don’t forget cost of poloce, jails, courts, prisons, CPS, homeless sweeps and clean ups, HSH, etc…

      Maybe housing for truly needy high medical utilizers would cost much less.

      Having to call homelessness a “medical problem” is not right though.

      A more accurate description is that these folks need extra “support” in the community to be able to avoid deterioration in their health status.

      For some this support will be stable housing, for others case management, for others education and coaching, and forsome it may all of the above.

      But this will still be cheaper than repeated ER and hospital visits at $2000 per day or more.

    • The state needs only to create medical clinics at every homeless shelter in the state and use UH professors, medical students and nursing students to staff it. If our politicians had any sense at all, they’d be doing this already. Instead they look for ways to spend more taxpayer money that will benefit them or their donors, as well as address the problem.

  • So will they be written a prescription to reside in Kona/Kau … the district that he represents? Or maybe send them to Pennsylvania, where he was educated for comprehensive treatment.

  • Just what the heck is Green smoking? Homeless a Medical Condition…looks like Green has a Mental Condition…and we folks keep putting these idiots in office…

  • Thanks for the comments:

    Some facts; the homeless are the very people who 1. Are on Medicaid and 2. Are often the highest utilizers of these resources.

    3.6% of our 362,000 Medicaid enrolled consume 60% of the $2 Billion budget.

    So about 16,000 people are using $1.2B, often these health dollars are just bandaids or quick ER visits (after an expensive ambulance ride) that do little but patch a problem for a day or two.

    When we pay for one of these individuals to be housed their health spend drops 43-44% immediately, SAVING INCREDIBLE $$$ that can be better used to help many MORE Hawaii citizens. BTW that savings is AFTER including the cost of housing the person.

    Thus we help a struggling person AND make better use of taxpayer $$$.

    I hope these facts help people understand this proposal.

    Sen. Josh

      • The housing supports would be for those few who are costing us $1,200,000,000.00 per year in preventable medical bills.

        It is impossible to fake the diabetic crises, recurrent severe infections and other life threatening illnesses that this subset of medically fragile homeless folks have.

        These are those few homeless people who are so profoundly disabled and medically fragile that they cannot maintain stable health status without stable housing and other supports.

        Housing would not be provided to others under this proposed program. There are other homeless programs for that.

        If you’d rather waste $1.2 billion, I don’t know what to say except that makes no sense.

        Good idea Sen Green.

        • If you feel that housing is a legitimate solution for medical conditions, you fail to explain why these individuals don’t go to a shelter for housing and medical treatment. ANSWER: Because it’s a lifestyle choice for most. Regardless if it’s the desire for drugs/alcohol or freedom from rules, the bottom line is that it a choice. Enabling only contributes to the problem.

    • Sen Green, a career bureaucrat, clearly has no background in finance. Mistakenly thinks there are endless funds for free housing for the homeless. Just give them a home, problem solved.

      We would first have to vet all the homeless. Tell anyone who came here from the mainland for a handout they will not get anything but a free ticket back home.

      Locals would have commit to actually working to “Earn” a place to live. No free rides. Nothing is free. Would have to do a set number of hours of work to qualify. Home would also have to be inspected regularly to ensure no damage, drug usage. People told housing is only temporary, they have to get off their rear, get a job. Yes, this may mean leaving the Nei for a lower cost of living state.

      As we have seen for decades, you can never, ever, ever, trust an elected bureaucrat. They will lie to your face, fingers crossed behind your back. Car sales reps have higher integrity.

      Lets not forget how back in 2004 the Mufster actually told taxpayers the 20 miles of rail would only cost, are you ready, $2.7 billion. Now we stand at $10 billion, over a 300% increase with no end in sight.

      Sorry Sen Green but you lack credibility. Stick to whatever it is you do. Spending taxpayer’s money isn’t it.

    • please, it sounds like a plan to house those who are un-houseable by their choice or worse civil rights.

      1. 30% of oahu homeless are already diagnosed as severely mentally ill. there was a time when those diagnosed as severely mentally ill were housed involuntarily before it was determined that such involuntary housing violated their civil rights. so they were released and most rejected housing and now live on the streets.

      2. the 2016 hawaii state homeless point in time count listed 7921 homeless in hawaii. extrapolating oahu’s 30% to hawaii’s homeless population works out to about 2400 severely mentally ill homeless that already reject health services and housing services and who still do not qualify for involuntary incarceration even if it’s called housing for the homeless.

      3. some of the homeless on medicaid are cofa immigrants living in hawaii in violation of the cofa compact which requires cofa immigrants to maintain a level of self sufficiency or face deportation back to their cofa community. enforce the cofa compact and the homeless population will be lowered and the subsequent drain to hawaii’s medicaid budget will be eased.

      4. concentrate on providing transitional housing to homeless with families, working, elderly or veterans first. enforce the cofa compact and return cofa immigrants who depend on hawaii welfare services to cofa authority. violating the civil rights homeless who suffer severely from mental illness with forced housing will not survive hawaii’s courts.

      5. hawaii is depending on the legislature and government to resolve the homeless problem. keep trying.

    • How will you stop the influx of homeless people coming to the state after word gets out that Hawaii will house homeless in paradise and provide free healthcare too?

      • the democrat party has just declared hawaii an open borders state welcoming all, offering sanctuary to all, promising state services to all without vetting and without regard to criminal background.

        homeless people will no longer be the overriding problem it is today once we import criminals and terrorists into hawaii.

    • Typical bureaucrat trying hard to spin their failing ideas. Using “CAPS” to shout out more shibai. Like we need more.

      Throwing our money at the homeless in the hopes it will go away. Fails to understand people need to work to earn benefits.

      In October 2014, Maine began requiring about 16,000 able-bodied childless adults to work, train, or volunteer on at least a part-time basis in order to continue receiving food stamps. Adults who refused to comply with the new requirements would cycle off after three months of benefits.

      After implementing these reforms, Maine quickly moved thousands of able-bodied adults out of dependency and into self-sufficiency. By January 2015, the number of able-bodied adults on food stamps had dropped to 4,500 and has continued to decline.

      http://www.forbes.com/sites/theapothecary/2016/05/19/new-report-proves-maines-welfare-reforms-are-working/#468ea64da4c7

      We need to do the same. Get people off their rear end and get to work. Other states have set the standards, we need to follow.

  • With all due respect to Sen. Josh Green, this is the sort of thing that will get Hawaii ridiculed worldwide in a manner we haven’t seen since the HPD embarrassed us by fighting to keep their right have sex with prostitutes as part of their job – despite the fact that no other police force in the world felt it was necessary.

    By classifying homeless as a medical condition, you are making an end run around the law and draining off resources that are supposed to directed for medicine and healthcare and sending it into housing. Let’s not do that.

  • I can see why Queens Hospital charged me such an astronomical bill after I was picked up unconscious after a bicycle crash right across from the hospital and released after four hours. If I had been conscious, I would have refused to be sent there. As a result, I was rendered homeless myself for eight years in Oahu. I never sought medical treatment again, just took better care of myself. Eventually I left Oahu and am no longer homeless.

  • I can see why Queens Hospital charged me such an astronomical bill after I was picked up unconscious after a bicycle crash right across from the hospital and released after four hours. If I had been conscious, I would have refused to be sent there. As a result, I was rendered homeless myself for eight years in Oahu. I never sought medical treatment again, just took better care of myself. Eventually I left Oahu and am no longer homeless.

  • These are the kind of dumb ideas that give “liberals” a bad name. What happens when enough people figure out that they also want to catch the homeless “disease” that you reach the tipping point (and we are already very close to it) where you don’t have enough people paying into the pot to keep up with the people sucking the life out of it? Kids will say, “Why work and study hard to get into a good college, study long and hard again, then get a job and work hard for the rest of my life when I am just giving my hard-earned money to all of those other guys who dropped out and qualified for the “disease?” How do you explain that? It will snowball. This is motivation to entirely removing an very basic human value called pride.

  • Actually other States do give out homeless prescriptions already…a shower…a meal…and a one way plane ticket to Hawaii. The prescription says “year round warmer climate required!”

  • You people DO REALIZE that SO MANY bills introduced are NEVER expected to pass first reading, much less even be scheduled for hearing?

    The politicians just want us to THINK they’re making busy and not having fundraisers 24/7 and potlucks in their staff offices every day!!!

    Green can claim he TRIED… but was shot down…

  • Isn’t homelessness more of a result of various conditions – some medical, some psychological – rather than a medical condition in and of itself? I agree, helping people to work – and mandating some form of work while folks are on public assistance – as well as helping them get access to appropriate care, might work better.

  • Homelessness isn’t a medical condition. The underlying cause of the homelessness may very well be a medical condition (psychiatric, etc.) which needs to be treated.

  • Who label who sponsors these miss directed BILLS ..ends justify the means ..later ..the children thinks this is how things are done …short sighted solutions aloha

  • This s an extremely bad bill. Take money urgently needed for health purposes and spending it on housing and possible other things like food, job counseling, etc. Who’s going to fund actual Medicaid needs?