Officials detail plan to manage homeless
CRAIG T. KOJIMA / CKOJIMA@STARADVERTISER.COM
Pictured last month is a homeless encampment in an area off Ala Moana Boulevard at Kakaako Waterfront Park. At one point in August, officials counted 293 people living in Kakaako encampments.
On Monday, following yet another sweep of the persistent Kakaako homeless encampments, a family of six decided to move into a shelter.
They are among 230 people who, since August, have left Kakaako for shelters or permanent housing following the combined efforts of law enforcement and social service outreach workers, the state’s homeless coordinator told the Honolulu Star-Advertiser on Wednesday.
“We’ve moved a significant number of people off the streets of Kakaako and into homes and that’s indisputable,” Scott Morishige said. “It’s a testament that this approach is working. The majority … were people who were homeless for a long period of time.”
Morishige, state Attorney General Doug Chin and Rachael Wong, director of the state Department of Human Services, spoke to the Star-Advertiser about the state’s wide-ranging approach to reduce the largest per capita homeless rate in the country through a mix of consistent social service outreach, systemic changes and ongoing sweeps by law enforcement officers.
Chin called the state’s approach a “balancing act.” In recent years, he said “even courts have weighed in with more guidance in terms of what they expect enforcement efforts to look like.”
That involves a “notice and outreach component, the ability to store people’s property and also the availability of shelter space — and shelter space that night. The theme we get from the court in their direction is with an understanding that we don’t want to criminalize homelessness. Rather, we want to be able to enforce laws but at the same time respect people’s various rights,” Chin said. “Then law enforcement is able to have better direction in terms of how they carry out enforcement efforts. … Frankly, I think all of that is helpful.”
An agreement to allow Honolulu police and a special city cleanup crew from the Department of Facility Maintenance to begin clearing out homeless encampments on state land between Ala Moana Boulevard and the Kakaako shoreline beginning next month is still being worked out, Chin said.
The key issue is how to coordinate the upcoming city sweeps with current efforts underway by two private companies and state sheriff’s deputies on Hawaii Community Development Authority land inside the adjacent Kakaako Makai Gateway parks and nearby Kakaako Waterfront Park.
At one point in August, officials counted 293 people living in the encampments, which have come to symbolize the difficulties of trying to reduce the islands’ homeless population.
There are no major hurdles to reaching what’s known as a memorandum of understanding between the state and city, Chin said.
“It’s a matter of planning and logistics and having operations that are going to be effective and respectful,” Chin said. “Any enforcement effort is going to require a lot of moving parts, whether it’s the city’s DFM group, or whether it’s the state sheriff’s or HPD or the third-party providers. … We understand that this entire effort is so much more than moving people around or … citing people.”
Wong said Gov. David Ige’s approach to homelessness hinges on answering the question: “What is best for people?”
“It’s a values-based administration” that works to balance the “health and safety and welfare of the homeless and the larger community,” she said.
The administration hopes state legislators approve its request for additional money to hire more social service outreach staff and provide additional one-time financial assistance to prevent people from becoming homeless — or help get them off the street by offering rental deposits or utility payments, Wong said.
As for the long term, systemic changes are underway to help overhaul Hawaii’s Medicaid program to better serve homeless people, especially those with mental illness.
“We have to put in this infrastructure,” Wong said. “It’s getting to the nitty-gritty of transforming government.”
The U.S. Department of Health and Human Services announced in February that it had selected Hawaii to participate in its Medicaid Innovation Accelerator Program. The National Governors Association Learning Lab on Population Health is also helping Hawaii leverage Medicaid funds to help homeless families, Morishige said.
At the same time, a series of emergency proclamations that Ige began signing last year are helping to streamline efforts, Morishige said.
The proclamations allow the state to bypass normal procurement procedures. They helped pave the way last week for Aloha United Way to begin dispensing $1 million worth of one-time funding to keep people from becoming homeless, or to help get them into housing, Morishige said.
The aid includes financial education and child care referrals for working families, among other services, he said.
Wong said government officials are constantly brainstorming ways to be more nimble and deploy resources.
AUW’s state contract also requires it to commission a study that looks at three specific homeless groups — unaccompanied youth, newly released prisoners and those discharged from hospitals. The results will help state officials “address those gaps on a larger scale,” Morishige said.
The focus on Hawaii’s homeless has also galvanized the community and generated offers of help, Morishige said.
“We’re really seeing the community coming together as partners,” he said.
Meanwhile, social service outreach workers and law enforcement officers from both the city and state continue their efforts every day.
While some people are clearly frustrated with the pace, the numbers of people who have moved out of Kakaako shows that the investment pays off, Morishige said. He added, “It takes time. It’s not something that happens overnight.”
6 responses to “Officials detail plan to manage homeless”
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More people are moved into shelters? It has no effect on the “homeless vagrant population. The more will just pop up abusing freedom to live rent free and pollute cities and the beaches.
The headline alone is laughable. But I’m glad efforts are being made to sweep homeless to other parts of Oahu, instead of the areas where speculators are plunking down $50 million for apartments across the street from Ala Moana Beach Park…
Quote: Systemic changes are underway to help overhaul Hawaii’s Medicaid program to better serve homeless people, especially those with mental illness. “We have to put in this infrastructure,” Wong said. “It’s getting to the nitty-gritty of transforming government.”
Since when is enforcement of basic laws and contracts considered “transforming government”? I ask this because this is what is needed regarding Medicaid beneficiaries who lack access to care and become ill, unemployed, disabled, homeless and/or incarcerated as a result.
In fact, all MedQuest plans have made legal promises to provide an adequate network of clinicians to properly care for all Medicaid members assigned to them and for whom they have received and accepted payments from the State of Hawaii – including members with severe mental illness.
HAR 17-1735.2-4 REQUIREMENTS OF PARTICIPATING HEALTH PLANS
(a) Health plans participating in the medical assistance program shall abide by the provisions of their respective contracts with the department as well as federal and state statutes and regulations.
(b) The requirements of each participating health plan shall include, but are not limited to, the following:
Development and maintenance of a sufficient network of health care providers to ensure the provision of required health services are provide to an eligible individual in a timely manner.
The common-sense policy solution to the lack of access to needed health care is to combine public education about RAPN with proper monitoring and enforcement of our existing network adequacy laws. It is not to try to make bad law, while a blind eye is turned to our health plans’ ongoing failure to aggressively confront their unlawful provider network violations.
Within our fragmented, privatized healthcare system, neither doctors, patients, nor lawmakers are responsible for ensuring access to care in underserved areas, nor have they been given the resources or authority to do so. In fact, Hawaii’s regulated health plans are legally responsible for maintaining adequate provider networks, and for the apparent failure to do so. These plans have the sophisticated state-wide systems of command and control, expertise in health care operations necessary to improve access to care, and ample resources to do so, including combined annual revenues in excess of $6,000,000,000.00.
For example, in 2013, Optum-UnitedHealthCare and Ohana-Wellcare, for-profit corporation based in Minnesota and Florida, took in over $177million more in combined annual revenue than claims paid. This was a potential profit of 16% on the over $1billion these corporations received from Hawaii taxpayers to care for Medicaid beneficiaries that year. This is enough to pay for more than 800 psychiatrists for Hawaii – more than four times the number currently in practice! More realistically, these resources could have been used for initiatives to improve access to care by adjusting fee schedules, helping with physician recruitment, reducing administrative burdens, improving provider relations, competently assessing provider needs and concerns, improving population health and reduce demand for care in the first place. There are many many other effective strategies available for plans to maintain more adequate provider networks. Unfortunately, little of this is being done.
Senator Baker, who has been responsible for oversight of Hawaii health insurance and consumer protection policy for years, has chosen to ignore the apparently illegal operations of these huge mainland corporations that have extracted many hundreds of $millions from our state over the years while endangering the health of their members and burdening other state programs (welfare, unemployment, CPS, DPS, courts and corrections, DOH, homeless programs) with hundreds of $millions more in shifted costs. Instead, she had championed this risky half-baked schemes.
Our current leaders must begin to provide effective oversight of state Insurance Division and MedQuest officials to ensure that they begin enforcing the Network Adequacy provisions in existing laws and contracts. If they remain unwilling to do so, new leadership should be called for by those truly interested in solving this crisis.
With proper monitoring and enforcement, managed health care plans in Hawaii will greatly improve the adequacy their provider networks, including psychiatric physicians and APRNs. There are numerous strategies and opportunities to increase participation rates, to recruit and retain qualified providers, to properly train more providers, to improve the efficiency of care, and to improve member health and reduce demand for services.
This is a safe, clinically-effective, and legally and fiscally-sound meta-solution to the mental health access problem, without which all other reforms will fail.
You know what happens when you continue feeding pigeons..?!!?
They multiply.
They just need to clean out that place everyday.