In court’s shadow, others connect health to housing

Washington — As lawyers at the Supreme Court this week battle over the future of the Affordable Care Act, housing advocates and others down the street were hoping the act could eventually play a major role in revitalizing public and subsidized housing.

“The health centers around you will be looking for new patients,” said Alex Lehr O’Connell to an audience of about 35 public housing advocates and residents at a conference hosted by the National Low-Income Housing Coalition. “Public housing is a great place to start.”

Hundreds from across the country are attending the conference this week to discuss housing issues in their communities, and new ways to address them in the face of shrinking state and local coffers. O’Connell, who advocates for the health of public housing residents in Philadelphia, said the federal health care law could offer new possibilities.

Because the law expands Medicaid eligibility to those earning at or below 133 percent of the poverty level, a lot more public housing residents will be eligible for health insurance. Healthier residents, he said, are more likely to pay their rent on time and push to hold housing authorities accountable for keeping their buildings livable.

In addition, as its now written, the law pumps nearly $11 billion into community health centers over the next five years. These centers will be looking for new clients to serve, and now they’ll have a new base of clients with health insurance.

“Public housing residents are an untapped group,” O’Connell said. “Because [with the Medicaid expansion] they have insurance. It may not be great insurance, but for that health center, it’s more revenue.”

A small portion of that $11 billion is set aside specifically for sites designed to serve residents of public housing. There are 63 such “public housing primary care” (PHPC) centers nationwide. Some, such as Charter Oak Health Center in Hartford, are stand-alone centers that may also serve non-public housing residents. Others may be no larger than a couple of rooms on the second floor of a housing complex that serve as a tiny clinic just for the residents.

The idea is to target a population that’s far more likely than the general population to suffer from chronic diseases like diabetes, asthma and HIV/AIDS.

“It has to do with the poor social determinants of health,” Dr. Astril Webb explained. “Lead-based paint coming down rusted pipes, people in the building who are smoking, surrounding areas that aren’t safe for exercise.” Now that Medicaid will be available those earning up to 133 percent of the federal poverty level, more of these residents will have access to it, and will, potentially, seek more health care services.


Of course, the Supreme Court proceedings and the political environment make everyone cautious about how long the dollars will be available. “There’s money that’s protected for health care for public housing residents,” O’Connell said. “The key is, will that money ever be given out?”

The health care law allotted $300 million for new public housing primary care centers, but little of that has been allocated. Last year about 10 new care centers were created. O’Connell said he’s not optimistic that number will rise.

Activities in Connecticut

Some advocates in Connecticut are coalescing around issues of housing and health, although they may not be using funds from the Affordable Care Act specifically.

“There’s a big effort and a ton of energy across housing and health care issues,” said Alicia Woodsby, deputy director of Partnership for Strong Communities in Hartford. “People are doing this on their own in communities across the state.”

The partnership applied for a $20 million grant from the Center for Medicare and Medicaid Innovation to address health as well as housing issues for thousands of residents who are homeless or about to become homeless. The plan is to work with public housing authorities to find the people in need, Woodsby said, because many of them live in public housing or used to.

“We already know some of our targets,” she said. By comparing homelessness and Medicaid data, the partnership found that the top 10 percent of homeless users of the health care system in Connecticut were costing the state almost $70,000 a year in services, usually due to emergency room visits. The group just received an $800,000 grant to reach out to that 10 percent group and provide them with housing and health services at the same time.

Mental health service providers are also teaming up with housing authorities in the state. The Yale Department of Psychiatry is working with the Housing Authority of New Haven and other agencies to reach at-risk mothers in the city who are suffering from mental health issues, and the federal government just awarded the partnership $2.5 million to expand its efforts.

“Many of these at-risk mothers live in public housing,” said Megan Smith, an assistant psychiatry professor at Yale. She hopes to one day offer group therapy sessions right inside public housing complexes –- and maybe even bill Medicaid for them.