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Co-Occurring Disorders and Homelessness

Financing Options for Co-Occurring Services When Individuals are Homeless

Over the years, SAMHSA has provided a variety of grant opportunities focused on providing mental health and substance abuse services for people who are homeless. Recent examples of discretionary grants include:

  • Development of Comprehensive Drug/Alcohol and Mental Health Treatment Systems for Persons Who Are Homeless (Short Title: 'Treatment for Homeless Persons' or 'Grants to Benefit Homeless Individuals'/'GBHI')
  • Services in Supportive Housing grants
  • Collaborative Agreements to Benefit Homeless Individuals (CABHI)

Resources to assist organizations applying for SAMHSA grants are online at http://www.samhsa.gov/Grants/apply.aspx.

Two programs funded through the federal Health Resources and Services Administration (HRSA) can be used to provide integrated services for individuals without health insurance or other means to pay:

  • Health Care for the Homeless
  • Community Health Centers

Health Care for the Homeless (HCH)

HCH emphasizes a multi-disciplinary approach to delivering care to homeless persons, combining street outreach with integrated systems of primary care, mental health and substance abuse services, case management, and advocacy. HCH recognize the complex needs of individuals experiencing homelessness and strive to provide a coordinated, comprehensive approach to the care they provide. The vast majority of individuals served by the HCH Program are uninsured.

Community Health Centers (CHCs)

CHCs, also known as Federally Qualified Health Centers, are local, non-profit, community-owned health care centers serving low-income and medically-underserved communities. CHCs provide primary care and preventive services, and often provide mental health and substance abuse services as well as other services such as on-site dental and pharmaceutical. CHCs tailor their services to fit the special needs and priorities of their communities, and provide services in a linguistically- and culturally-appropriate setting.

Another federal funding stream that can be used to finance mental health services is Projects for Assistance in Transition from Homelessness.

Projects for Assistance in Transition from Homelessness (PATH)

PATH services are for people with serious mental illness, including those with co-occurring substance use disorders who are at-risk of or experiencing homelessness. PATH services include outreach, mental health, substance abuse, case management and other support services, as well as a limited set of housing services.

Medicaid

While individuals with co-occurring disorders experiencing homelessness may be eligible for Medicaid coverage, relatively few are enrolled. Barriers to enrolling and renewing Medicaid coverage include lack of documentation, cost-sharing and premiums, and system barriers such as lengthy and complex enrollment procedures and lack of accommodation for individuals with educational or functional limitations. Physicians, psychologists, and other medical professionals can help individuals access SSI/SSDI benefits and qualify for Medicaid by providing medical evidence of substance use and mental health impairments. Learn more.


Resources and Links

  • Under health reform, uninsured people with comorbid mental and medical conditions will move into the formal health system, particularly Medicaid. This RWJF report examines the rate of comorbidity between medical and mental conditions and why it is so common; the associated mortality, quality of care, and cost burdens of comorbidity; and the current evidence-based approaches for addressing comorbidity.

  • Information and perspectives on Medicaid under the Affordable Care Act. This issue brief focuses on 1) eligibility for previously uncovered adults, 2) community-based services to expand access and reshape service delivery, and 3) streamlining entry and enrollment. There is potential for the ACA to expand Medicaid benefits at the State level for mental and behavioral health treatment, psychosocial supports, and case management, thus benefiting individuals at risk of and experiencing homelessness.