Homelessness a medical condition in Hawaii bill

HONOLULU — As an emergency room doctor, Hawaii 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 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 sixmonth 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.

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 prospects of Green’s proposal passing are 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 for affordable housing, public housing renovations and homeless shelters.

Representatives from the state’s two largest insurers — Kaiser Permanente and Hawaii Medical Service 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 attempting 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.