by Megan Hart, KHI News Service
Community mental health centers in Kansas are doing more to get homeless people off the streets and into treatment, but limits on Medicaid coverage and a lack of rental housing have slowed their efforts.
Kristen Whitney is service coordinator for the Cooperative Agreements to Benefit Homeless Individuals grant at Wyandot Center in Kansas City, Kan. She said Wyandot Center employees can reach out to people who are homeless, encourage them to accept treatment and emergency shelter, assist them with applying for benefits, help them locate a permanent apartment and meet with them weekly to smooth issues that may arise. But that still isn’t enough to meet everyone’s needs, she said.
Some clients require daily check-ins, particularly if they have lived on the street for years and aren’t accustomed to caring for an apartment, Whitney said, while others need someone to bring them groceries or teach them how to use the bus system. In Kansas, Medicaid doesn’t cover those kinds of supports, she said.
States have some control over which services their Medicaid programs cover. Missouri has more permissive rules, allowing community mental health centers to get paid for having someone on staff at all times in a supported housing building, Whitney said. So far, arrests and emergency room visits are down for people receiving the extra support in Missouri, she said.
In Kansas, Medicaid is a privatized program known as KanCare run by three managed care organizations. One of those managed care organizations has shown an interest in investing in supportive housing, said Tom Page, service coordinator for the homeless outreach team at Wyandot Center.
If clients can become more stable and stop cycling through the emergency room, the savings can far outweigh the cost of the housing, he said.
Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said changing what Kansas Medicaid covers would require the state to propose a service expansion, which federal officials would have to approve.
The state has put some funding toward housing for people recovering from mental illnesses. In fiscal year 2016, which ended June 30, Kansas community mental health centers received almost $1.3 million in grants related to homelessness. Some of the grants were federally funded, with KDADS distributing the money.
The state recognizes the importance of providing stable housing for people with mental illnesses, de Rocha said.
“Housing is an issue because often individuals with behavioral health problems are homeless. It is hard to recover without a place to live, let alone be able to recover enough to find employment,” she said in an email.
Meeting basic needs
Sherrie Watkins-Alvey, senior director of Wyandot Center, agreed that it’s vital to meet clients’ basic needs before they can begin to focus on their psychological well-being.
Not all mental health centers can provide those services, however, because they can’t bill Medicaid for staff time spent on outreach or supports, like assistance with budgeting, planning meals or working out disagreements with a landlord.
“The first intervention, the most important intervention for them is housing,” she said. “It’s to combat homelessness, but also to increase recovery.”
Grants for housing have been reasonably stable over the years, though they haven’t kept up with inflation, she said. Centers do have to compete for most grants, so they aren’t guaranteed year to year, she said.
The grant to focus on chronic homelessness, for example, lasts three years, Watkins-Alvey said. Right now, Wyandot Center is trying to get qualifying clients on Medicaid and find other funding sources to cover at least some of the services that clients need, she said.
“When we have the funds, we get in, we work hard, we work fast, we try to make connections to community partnerships,” she said. “At the end of the day, if we don’t do it, there’s no one standing in line saying, ‘We’ll do it for free.’”
Housing isn’t just a matter of a roof over someone’s head, however. People need privacy and stability before they can begin working on their mental health needs, said Theresa Douthart, housing specialist at Valeo Behavioral Health Care in Topeka.
“At the (Topeka) Rescue Mission, they have 200 people,” she said. “It’s hard to get your thoughts together and focus.”
Apartment supply is low
Even if funding is available, however, not all Kansas communities have a stock of open apartments.
Sharon Zehr, who leads the homeless outreach team at Bert Nash Community Mental Health Center in Lawrence, said the center has a case manager who encourages people who are homeless and have mental illnesses to enroll for treatment and helps with basic needs like shoes or sleeping bags to help build a relationship.
People who are homeless don’t have to agree to receive therapy or drug treatment before the case manager will assist them with finding housing, Zehr said.
“We try to have a housing-first outlook in that we’ll help people wherever they’re at,” she said.
Bert Nash Center also runs an eight-bed transitional home for people recently released from jail or an inpatient hospital stay. Employees assist the transitional residents, who pay a small amount of rent, as they search for jobs and apply for benefits like food stamps while they continue to receive therapy, Zehr said.
“Having a little more stability while they’re transitioning is helpful,” she said.
It isn’t as easy to find longer-term housing, however. Lawrence has plenty of apartments, Zehr said, but most of them rent to students who can afford more than people trying to leave homelessness behind. Few apartments rent for less than $450 per month and the wait for federal housing vouchers is more than a year, she said.
“That’s more than half of your monthly income on rent” if you rely on disability payments, she said.
Bert Nash Center has worked with the Salvation Army and the Lawrence-Douglas County Housing Authority to increase the number of vouchers, Zehr said. In a few cases, they even put people up in hotel rooms for few days until they could find a more permanent solution, she said.
Other housing challenges
Lawrence isn’t the only city where finding permanent housing can be a challenge. Douthart said Valeo has eight interim apartments available in Topeka for stays of up to six months and four for people who need housing indefinitely. The city of Topeka also offers some housing vouchers for people who accept case management services, she said.
But about half of the landlords in Topeka aren’t interested in taking those vouchers, and it becomes even more challenging if the client has a criminal record, a history of evictions or a substance use disorder, Douthart said.
Some states have laws that forbid landlords from discriminating based on type of payment, like vouchers, but Kansas doesn’t.
Valeo uses a housing-first model, which doesn’t require people to show they aren’t using substances, but many landlords don’t want to take tenants on those terms. Sometimes, the only housing tenants can find is substandard, and the center doesn’t encourage them to take that, she said.
“The landlords that take (vouchers) only have 10 units, and they fill up quickly,” she said. “It’s very hard, in the community, to house someone with a felony” record.
Marilyn Cook, executive director of COMCARE in Sedgwick County, said Wichita has a more comprehensive care system. COMCARE has 64 apartments available with no requirements except that the client allow weekly visits from a case manager, and other organizations also have housing available, she said. Some churches shelter people during the winter and operate day centers where people can shower and take care of other needs.
Still, Cook said the system isn’t meeting everyone’s needs. The most recent point-in-time count found about 575 homeless people in Sedgwick County, she said, and waits are long for subsidized housing. COMCARE employees were able to convince 214 people to accept assistance transitioning off the street.
Despite the challenges, some people have been able to leave homelessness behind. Whitney said the Wyandot team working with chronically homeless people has found housing for 18 of them. Wyandot still is working with 29 people and another 30 are waiting to be screened, but the center only has one case manager for housing programs, she said.
At Bert Nash Center, the case manager met last year with 86 people and 41 agreed to accept services, including some people who had been homeless for long periods, Zehr said. For example, one man who had been camping at Clinton Lake for more than a year recently moved into an apartment, she said.
“We don’t give up on people,” she said.
Community approach
Kansas has a network of 26 community mental health centers that provide care, treatment and rehabilitation throughout the state.
Since community mental health centers were established in the 1960s, their role has evolved.
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