People with serious mental illness make up about 1 in 4 people living in homeless shelters, and over a third received no mental health services in the last year.  State and local efforts to integrate housing and health services for people with mental health conditions show great promise to improve these outcomes. Evidence shows that models like supportive housing, which integrates affordable housing with coordinated health and other services, help people with chronic health conditions and histories of homelessness or institutionalization stay stably housed and connected to care in the community.

In order for models like supportive housing to work, however, programs need to connect people to both rental assistance and health care services, and many integration efforts rely on federal programs to do so.  Federal rental assistance makes rent affordable for even the lowest-income households, removing cost as a barrier to staying housed.  Medicaid provides access to the community-based health care that some people with mental health conditions need in order to stay out of institutions.  Communities can then use a mixture of state and local resources and federal grants to cover costs that rental assistance and Medicaid can’t pay for.

Recent Trump Administration policies and proposals threaten to undermine these housing-health integration initiatives by diminishing vital federal resources:

• Medicaid is the nation’s largest payer of mental health services, covering 27 percent of adults with a serious mental illness, but the Trump Administration has approved harmful state policies that will strip Medicaid coverage from people with mental health conditions who don’t meet strict requirements to work a set number of hours each month.  Many people with mental health conditions won’t qualify for exemptions, and many who do qualify could have trouble cutting through the red tape to prove it.
• The Administration also proposes to raise rents on millions of low-income people with federal rental assistance by an average of 44 percent and let state and local housing agencies evict families or take away their assistance if they don’t work a set number of hours each month.  These policies would create more barriers to stable housing for people who already face tremendous barriers to housing and employment, including many people with mental health conditions.

The stress of housing instability and homelessness can worsen health problems like mental illness and make it harder for people to get treatment.  Rather than adopting harmful policies, the Administration should work with states to build on the Affordable Care Act’s Medicaid expansion to cover housing support services and voluntary supported employment services that help people with mental illness and other health conditions overcome barriers to stable housing and employment, as Washington State recently did. Also, the President and Congress should fund more rental assistance to meet the growing need for affordable housing and help states use federal grants to fill in the gaps.