Mitchell H. Katz, MD, was recently appointed director of the Los Angeles County Department of Health Services (DHS), and has hit the ground running with an initiative to address the health and housing needs of homeless individuals who inappropriately use health care services, referred as “frequent users.”  In collaboration with the City of Los Angeles, the DHS Supportive Housing Projects will provide scattered-site housing and integrated health and social services for 56 individuals in South Los Angeles.

Most often, individuals who are frequent users of health care services have a chronic health condition and have both untreated serious mental illness and issues with substance abuse.  They are unable to manage their health care and resort to obtaining services through expensive systems of care including the paramedics, emergency rooms, and hospitals.

A recent series in the U-T San Diego provides an excellent documentary of this issue.  The series highlights the journey of a 51-year old homeless women who cost the taxpayers nearly $60,000 in 2010.  After she received supportive housing and wrap-around services provided in 2011, her public cost was reduced nearly in half.

Prior to coming to Los Angeles last year, Dr. Katz was the Director of the San Francisco Department of Public Health, a position that he held for 13 years.  Long an advocate for the poor and homeless, one of his signature accomplishments was the creation of the “Healthy San Francisco” initiative that established primary care medical homes that improved health outcomes and reduced medical care costs.

It is often said that housing is health care.  With this initiative, which will provide housing with integrated services, Dr. Katz both walks the walk and talks the talk.

Annually, the federal government requires that all housing authorities review their Section 8 Administrative Plans, a public process, which provides community organizations the opportunity to advocate for changes.  For several years, Shelter Partnership has urged the Housing Authority of the County of Los Angeles (HACoLA) to increase their set-aside for the homeless and reduce barriers that homeless households face in accessing Section 8, especially those who experience chronic homelessness.

On April 3^rd, on a 4-1 vote, the Board of Supervisors approved immediately increasing by 150 vouchers the Section 8 Homeless set-aside.  For the homeless program, the Housing Authority will also reduce the look-back period for criminal offenses from three years to two years, and eliminate the prohibition that individuals on parole or probation be precluded from accessing the program.

These changes come at a critical time since funding for developing new permanent supportive housing has been greatly reduced due to the near exhaustion of the State Housing Bond Programs, the Governor’s elimination of redevelopment agencies, and Congressional slashing of funding of the major federal housing program, HOME.

We would like to recognize and thank the four members of the Board of Supervisors who voted to approve the Plan–Supervisors Knabe, Molina, Ridley-Thomas, and Yaroslavsky.

We would also like to recognize United Homeless Healthcare Partners (UHHP) and Home for Good for also advocating for these changes.  And special thanks go out to Sean Rogan, Executive Director, and Emilio Salas, Deputy Executive Director, of the LA Community Development Commission, who championed the changes in the Administrative Plan and are the program administrators.

In a well-thought-out Notice in the March 23, 2012 Federal Register, HUD has improved the Veterans Affairs Supportive Housing (VASH) Program by removing regulatory barriers to using Section 8 Vouchers to re-house homeless veterans. The VASH Program houses homeless veterans by providing case management services and Section 8 rent subsidies so veterans can afford rental units in the community.

If removing regulatory barriers to using Section 8 Vouchers to re-house homeless veterans is a good idea (and it is), shouldn’t HUD extend that approach to all homeless people in need of Section 8 rental assistance? And as HUD recognizes in the Notice that the flexibility it grants the misnamed “Moving-to-Work” housing authorities would undermine the VASH program’s promise to re-house homeless veterans, couldn’t HUD recognize that granting Moving-to-Work status may not be in the best interests of other homeless people living in those housing authorities’ jurisdictions?

Homeless people other than veterans still face barriers to accessing the Section 8 Voucher program. The Section 8 program could do a lot more to reduce homelessness throughout the nation, if the bureaucratic barriers HUD has removed for veterans were also removed for other homeless people.

This Notice improves the VASH Program by waiving many of HUD’s own rules and by forbidding local housing authorities from exercising discretion they normally have in running their Section 8 Voucher Programs, in instances where HUD has determined that such discretion would work against homeless veterans.

Specifically, the Notice:
• Allows recently-returning veterans to participate in VASH, even if they do not have chronic mental illness or chronic substance abuse disorders,
• Prohibits housing authority from requiring that homeless veterans wait on wait lists as a condition of receiving VASH Vouchers,
• Prohibits housing authority screening out of veterans with negative histories with HUD programs, criminal records or alcohol abuse,
• Requires housing authorities to accept VA forms instead of requiring birth certificates or Social Security cards, which many homeless veterans do not have readily available,
• Requires housing authorities to make reasonable accommodations of veterans’ disabilities so the Program works for them,
• Encourages housing authorities to mitigate problems, rather than terminating troubled veterans from the program,
• Requires that veterans be given at least 120 days to find landlords who will accept VASH Vouchers,
• Allows leases to be for less than one year so more landlords will try VASH,
• Requires VASH participants to live close enough to VA facilities to receive services, but also requires housing authorities to facilitate housing choice and appropriate moves,
• Requires all housing authorities to follow these rules, even those that have been granted waivers from HUD rules under HUD’s misnamed “Moving to Work” program,
• Promises not to penalize housing authorities on their annual report cards if the local VA is slow to refer eligible VASH participants, and
• Allows housing authorities to inspect units in advance of veterans selecting them to speed the leasing process.

HUD originally announced many of these VASH Program rules in 2008. This Notice re-states the parts of the 2008 Notice that have worked well and adds new and improved provisions.

In Los Angeles County, following each change to the CalWORKs program, there was an increase in the number of families experiencing homelessness. In fact, the number of homeless families has more than doubled­—from 5,487 in July 2006 to 11,520 in December 2011.  In comparison, the overall County CalWORKs caseload increased by 17%.

The Governor’s current proposal would reduce CalWORKs funding by more then $946 million statewide by enacting complex changes that include:  restructuring the program into two components; retroactive eligibility determinations; time-clock stopper and sanction changes; and implementing a 27% reduction to child-only grants.

Given the data from 2006-2011, if enacted, these changes to CalWORKs could very well result in even more families falling into homelessness.

In the past two years, our community has made significant progress in addressing the needs of homeless veterans, however, much remains to be done. Following U.S. Secretary of Veterans Affairs Eric Shinseki’s 2009 commitment to end homelessness among veterans, the number of homeless veterans nationwide has decreased from 75,609 homeless veterans on a single night in 2009 to 67,495 veterans who were homeless nationally in HUD’s January 2011 homeless census. This is largely due to federal government funding of 37,190 permanent housing vouchers nationally over the past four years (2,375 of those in Los Angeles County), with another 10,000 to soon be released nationally.

According to the 2011 homeless count performed by the Los Angeles Homeless Services Authority, there are an estimated 8,817 veterans who are homeless in Los Angeles County. With increasing numbers of veterans returning from Iraq and Afghanistan, without intervention, this number is likely to increase. While the federal initiative is a significant investment, there are still many barriers to successfully serving homeless veterans—especially those who have been homeless for long periods of time. Hopefully, two new initiatives will improve our success in this area. One, the VA will contract out to community-based agencies case management for many homeless veterans, including housing placement. Two, the VA has established a goal that 65% of all veterans receiving such assistance will be chronically homeless veterans.

The landscaped terrace at Westside Residence Hall II is available both to new residents and to current residents of Westside Residence Hall I (in background).

And in the community, after many unfortunate delays, housing for veterans is being developed. In December 2011, U.S. Veterans Initiative completed their 196 units of permanent, affordable supportive housing in Inglewood for homeless veterans as well as affordable housing for low-income veterans, many of whom are in the workforce. And just last week, A Community of Friends and New Directions broke ground for New Directions Sepulveda I and II in the San Fernando Valley, which will provide permanent supportive housing to 147 homeless veterans.

There is much to celebrate as our community and our nation turns its attention to those who have given so much to our country.

The attractive entrance to the Westside Residences, where final touches are being made to the exterior.

The Westside Residence Hall II terrace includes barbecues and a fireplace for the residents to enjoy together.

A gleaming industrial kitchen helps support the quality of life for the Veterans at Westside Residence Hall II.

• The poverty rate in 2010 was 15.1%, with 46.2 million people living below the poverty line, or $22,113 for a family of four.  These figures represent the third consecutive annual increase in the poverty rate, and the largest number of impoverished people since the Census began tracking poverty estimates 52 years ago.[1]
• Real median household income in 2010 was $49,445, down 2.3% from 2009.[2]
• Over 30% of female-headed households lived in poverty in 2010, another increase from the previous year.[3]

Data from The Annie E. Casey Foundation’s 2011 KIDS COUNT Data Book was just as bleak.

• 42% of children in the United States, almost 31 million, lived in low-income[4] families in 2009, a 7.4% increase from 2007.[5]
• In 2009, 20% of children lived below the federal poverty line.  The rate was even higher for Black (36%), American Indian (35%), and Hispanic/Latino (31%) families.[6]

Unfortunately, at a time when so many families are struggling, the safety net is not providing adequate support.  Contending with their own budget crises, many states are reducing welfare benefits and imposing stricter rules.  According to a recent analysis from the Center on Budget and Policy Priorities, cash benefits from Temporary Assistance to Needy Families (TANF), the federal welfare program for families, have not kept pace with inflation.  In fact, while the level of cash benefits varies, in all 50 states the incomes of families receiving TANF benefits are below half the federal poverty line.[7] In Los Angeles County, the maximum cash benefit for a family of three is a mere $762 per month.  Yet the average asking rent for a 2-bedroom apartment in Los Angeles in 2010 was approximately $1700.[8]

One need not be an economist to realize that these trends do not bode well for the ability of families to afford housing.  As it stands, families in poverty are only one crisis away from homelessness.  The future will remain uncertain for these families unless policymakers and advocates work to not only raise the employment rate and strengthen the safety net, but also to increase the supply of affordable housing.

On Wednesday, I had the privilege of participating in the California State Assembly Select Committee on Homelessness’ Los Angeles hearing. Eight legislative leaders were present, including Speaker John Perez (Los Angeles). Speakers from Los Angeles were asked by Chairperson Toni Atkins (San Diego) to present three proposals that the State could implement—with the proviso that these proposals should not cost the State any money. Based on these hearings and other input she receives, Assemblywoman Atkins’ intent is to develop a legislative packet on homelessness.

The third of four hearings, this meeting was focused on homeless families, women and youth. The major overriding theme that nearly all speakers addressed was the need for a source of financing for permanent, supportive housing for people with disabilities experiencing homelessness. Another theme was advocacy for the creation of the California Interagency Council on Homelessness modeled after the National Council.

For me, it was all a bit surrealistic to have the hearing at this time, given the dire financial strait that California is navigating and the recent actions that the State Legislature has taken. This includes the 8% grant cut to individuals on TANF, bringing the grant to the lowest real grant level in 20 years. Additionally, SSI/SSDI payments to an individual on disability were cut to the lowest level allowed by Federal law. These two actions alone will result in more homelessness in our communities.

The State budget crisis, combined with the current irreconcilable
National debate on raising the national debt ceiling, do not portend well for poor households, let alone those who are homeless or at risk of homelessness. But it’s good news that some of our State leaders care and we keep trying!

The proposed Section 8 Savings Act (SESA) contains many worthy proposals.  It also includes a change that would result in many extremely low-income households remaining homeless or at-risk of homelessness for longer periods of time.

Currently, 75 percent of admissions to the Section 8 tenant-based Voucher program and 40 percent of admissions to project-based Section 8 and public housing units must be households with incomes at or below 30% of Area Median Income (AMI) in the local area.  SESA would broaden these targets to include households with incomes at or below 30% of AMI or the federal poverty level, whichever is higher.

Backers of this change claim that housing authorities would have greater flexibility to target working-poor families and that the change would generate savings for the federal budget.

Of course, for every higher-income household admitted under a policy of “flexibility,” a lower-income household in greater need would wait longer.  And naturally such a policy would save money; higher income households require less subsidy.  But the purpose of the Section 8 and public housing programs is not to save money by leasing to higher-income households, rather it is to serve the poorest of the poor.

Immediate Impact if SESA Becomes Law

In areas with relatively high AMIs, there would be little impact.  For example, in Los Angeles County, there would be no change for households composed of one to five members, because the current federal poverty level is below 30% of AMI.  For households of six or more members, the poverty level is higher than 30% of AMI, so more of these large households would qualify.

In areas of the country with relatively low AMIs, the federal poverty level is more likely to be higher than 30% AMI, so the SESA change would have greater impact.  In these typically rural areas and high-poverty urban areas without balancing affluent households, there would be immediate winners and losers:

Potential Longer Term Impact if SESA Becomes Law

An initiative is under way to correct the statute governing the definition of the federal poverty level to more accurately reflect real costs of living.  Should this become law, the poverty level would increase significantly, so the change proposed in SESA would greatly expand the number of households that qualify for the income targeting preference, resulting in longer waits for affordable housing for those who currently qualify under the existing definition, in effect gutting the original intent of the income targeting rule.

Earlier this year, the Housing Authority of the City of Los Angeles (HACLA) and the Housing Authority of the County of Los Angeles (HACoLA) convened the Barriers to Access Working Group to review their respective admissions policies and procedures for their Section 8 Special Programs, including the Section 8 Homeless Assistance Program and the Project-Based Voucher Program.  Shelter Partnership was actively involved in the Working Group, as were other community stakeholders.  To inform the Working Group’s discussions, Shelter Partnership surveyed homeless clients in emergency shelters (with the help of New Image Shelter) and sober living homes (with the help of A New Way of Life Reentry Project).  Similarly, Skid Row Housing Trust reviewed their tenant applications for permanent supportive housing (PSH).

Among our goals was to seek alignment between the requirements of the Public Housing Authorities (PHAs) and the community stakeholders’ determination to provide housing for people who have had long periods of homelessness, often referred to as the chronically homeless.  Chronically homeless individuals often have a record of offenses that exclude them from publicly assisted housing.  Yet research and practice show that PSH is critical to their recovery and, in most cases, is key to permanently ending their homelessness.

HACLA has released its proposed amendments to the 2011 Section 8 Administrative Plan to address these issues and, under several categories, is reducing exclusionary periods for admissions to Section 8 Special Programs.  The draft version of HACLA’s proposed amendments can be found here: http://www.hacla.org/pdocs/.  Public comments will be accepted until June 28th.

Highlights of HACLA’s proposed changes for Section 8 Special Programs include:

• Reduces exclusionary period from 5 years to 2 years for prior drug-related criminal activity
• Reduces exclusionary period from 5 years to 2 years for violent criminal activity
• Eliminates exclusionary period if previously terminated from HACLA Section 8 Programs for cause due to:
  • Failure to notify before moving out of unit
  • Failure to notify before absence from unit
  • Violation of annual HQS inspection
• Reduces ban for termination from any housing assistance program for damages to unit exceeding $1,000 from 5 years to 3 years
• Reduces ban for fraud from 10 years to 5 years
• Eliminates exclusionary period if applicant who owes money to HACLA or other PHAs enters into repayment agreement

There is widespread agreement among experts that the way the federal government measures poverty is inadequate and outdated. The current formula is premised on the average family’s food cost and has been in place for more than four decades.

One of the more compelling attempts to develop a new measurement has been undertaken by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development. Begun in 2008, The Elder Economic Security Standard Index is a county-specific measure of the minimum income necessary to cover all of a senior’s basic expenses using reliable government statistics and includes housing, food, health care and transportation. Because housing costs vary so greatly by region and also by whether an individual is a renter or a homeowner, the specificity is illuminating.

The current federal poverty level is $10,870 annually. According to the most recent updated Elder Index, 1.46 million (39%) of older Californians have incomes above the federal poverty level and so are not considered “poor” yet do not have enough income to meet their basic needs.

According to the Elder Index, economic insecurity is highest among elders of color, women and those older than 75 years of age. Interestingly, more than one-third of seniors live in extended households and are highly vulnerable to economic insecurity should their living arrangements change.

One in three California seniors rely exclusively on Social Security, which is an average of $12,540 annually. However, in Los Angeles County, according to the Elder Index, a senior needs an annual income of at least $16,355 if they own their own home and do not have mortgage payments; $22,827 if they rent their housing; and $30,591 if they are a homeowner with a mortgage. Even many seniors with some retirement income fall short of these necessary incomes.

Shelter Partnership anticipates that seniors will become homeless at increasing rates in the next several years, largely as a result of their inadequate incomes and the rising cost of housing, coupled with a decline in state services. This is why we are so committed to seeing more senior housing developers accept homeless seniors in their projects and work to see more housing developed for seniors who have become homeless.

For more information on the Elder Index, go to http://www.insightcced.org/communities/besa/about-elder-index.html