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‘I Am Just Waiting to Die’: Social Security Clawbacks Drive Some Into Homelessness

Fred Clasen-Kelly — Wed, 20 Dec 2023 10:00:00 +0000

More than a year after the federal government first cut off her disability benefits, Denise Woods drives nightly to strip malls, truck stops, and parking lots around Savannah, Georgia, looking for a safe place to sleep in her Chevy.

Woods, 51, said she had rented a three-bedroom house she shared with her adult son and grandson until March 2022, when the government terminated her disability payments without notice.

According to letters sent by the Social Security Administration, the agency determined it had been overpaying Woods and demanded she send back nearly $58,000.

Woods couldn’t come up with the money. So, until February 2026, the agency is withholding the $2,048 in disability she would have received each month.

“I still don’t know how it happened,” said Woods, who has requested a waiver and is seeking a hearing. “No one will give me answers. It takes weeks or months to get a caseworker on the phone. They have made my life unbearable.”

Kilolo Kijakazi, acting commissioner of the Social Security Administration, told a congressional subcommittee in October that her agency notifies recipients when they have received overpayments and works to “help those who want to establish repayment plans or who seek waiver of the debt.”

But relief from overpayments goes to only a relatively small number of people. And many others face dire consequences: Some become homeless, are evicted from rental housing, or see their mortgages fall into foreclosure.

The SSA has a painful legacy of excluding Black people from benefits. Today the agency’s own published research shows its overpayments most often hit Black and Hispanic people, the poorest of the poor, those with the least education, and those whose medical conditions are unlikely to improve.

Woods is one of millions who have been targeted in the Social Security Administration’s attempt to claw back billions of dollars it says was wrongly sent to beneficiaries. Years can pass before the agency catches a mistake, and even the little bit extra it might send each month can add up.

In reclaiming it, the government is imposing debts that can reach tens of thousands of dollars against those least able to pay.

(WHIO, Dayton)

‘Wreaking Havoc in People’s Lives’

KFF Health News and Cox Media Group reporters interviewed people who have received overpayment notices and nonprofit attorneys who advocate for them and reviewed SSA publications, policy papers, and congressional testimony.

A 64-year-old Florida man said he could no longer afford rent after his Social Security retirement payments were garnished last year because he allegedly had been overpaid $35,176 in disability benefits. He said he now lives in a tent in the woods. A 24-year-old Pennsylvania woman living with her mother and younger siblings in public housing lost the chance to buy her own home because of an alleged $6,063 overpayment that accrued when she was a child.

“Social Security overpayments are wreaking havoc in people’s lives,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia, which represents clients who have received overpayment notices. “They are asking the poorest among us to account for every dollar they get. Under their rules, some people can save up money for a funeral burial but not enough to get housing.”

Woods has lupus and congestive heart failure and struggles to walk, but she started working part-time after her benefits were rescinded. She said she makes $14 an hour transporting railroad crew members in her 2015 Chevy Equinox between Savannah and Jacksonville, Florida, when she can get assignments and her health allows it.

The SUV costs $386 a month — a large portion of her income — but without it, Woods said, she would not have a job or a place to sleep.

“My life is just survival now,” Woods said. “Sometimes I feel like I am just waiting to die.”

The Social Security Administration has said it is required by law to attempt to recover overpayments. Notices ask beneficiaries to repay the money directly. Authorities can also recoup money by reducing or halting monthly benefits and garnishing wages and federal tax refunds.

Agency officials describe an orderly process in which they explain to beneficiaries the reason for the overpayment and offer the chance to appeal the decision and have the charges waived if they cannot afford it. One way to qualify for a waiver is if “paying us back would mean you could not pay your bills for food, clothing, housing, medical care or other necessary expenses,” according to a letter sent to one recipient.

Those most impacted by Social Security’s decisions, including people with disabilities and widows receiving survivors’ benefits, paint a different picture. They talk about having their benefits terminated without explanation or warning, an appeals process that can drag on for years, and an inability to get answers from the SSA to even basic questions.

Nancy Altman, president of Social Security Works, a group that pushes for the protection and expansion of the program, recalled how stressful it was when a colleague’s mother received an overpayment notice.

“After weeks of nonstop phone calls, he was able to get the matter resolved, but not before it put his mother in the hospital,” Altman said. “One can just imagine how much worse it would be for someone for whom English is not their native language, who lacks a high school education, and who is unassisted by such a knowledgeable and caring advocate.”

Problems surrounding the Social Security Administration are aggravated by congressional actions, including funding shortages that brought agency staffing to a 25-year low by the end of fiscal year 2022. Even so, advocates for people with disabilities say the agency does far less than it could to help people who have been overpaid, often through no fault of their own.

They said challenges faced by beneficiaries underscore how overpayments disproportionately impact Black people and other minority groups even as President Joe Biden and Social Security leaders promise to fix racial inequity in government programs.

Most overpayments are linked to the Supplemental Security Income program, which gives money to people with little or no income who are disabled, blind, or at least 65. The majority of SSI recipients are Black, Hispanic, or Asian people.

“Congress has turned a blind eye to this,” said David Weaver, a former associate commissioner for research, demonstration, and employment support at the SSA. Politicians “just want to save money. It is misplaced priorities. It is completely inexcusable.”

The Social Security Administration did not make its leaders available for an interview. Spokesperson Nicole Tiggemann declined to answer questions about the cases of Woods and other beneficiaries, citing privacy laws.

In a written statement, Tiggemann acknowledged that receiving an overpayment notice can be “unsettling,” but said the agency helps beneficiaries navigate the process and informs them of their rights if they believe they were not at fault or cannot repay the debt.

“Even if they do not want to appeal or request a waiver, the notice says to contact us if the planned withholding would cause hardship,” Tiggemann said. “We have flexible repayment options — including repayment of as low as $10 per month. Each person’s situation is unique, and we handle overpayments on a case-by-case basis.”

Critics say fighting an overpayment notice is not that simple.

Beneficiaries — many challenged by physical, mental, or intellectual disabilities — often are overwhelmed by complex paperwork or unable to find financial documents that may be years old.

The Social Security Administration has the authority to waive overpayments if officials determine recovering them would violate “equity and good conscience,” or the disputed amount falls below certain thresholds. The agency’s guidance also says collecting an overpayment “defeats the purpose” when the “individual needs substantially all of their current income to meet their current ordinary and necessary living expenses.”

Advocates for people with disabilities contend most overpayments arise from delays in processing paperwork and errors by the Social Security Administration or recipients making innocent mistakes. The agency can waive overpayments when the beneficiary is found not at fault.

But in fiscal year 2023, the Social Security Administration collected about $4.9 billion in overpayments with an additional $23 billion yet uncollected, according to an agency report. Just $267 million was waived, the report said.

David Camp, the interim chief executive officer of the National Organization of Social Security Claimants’ Representatives, which advocates for improvements in federal disability programs, said the Social Security Administration is a “broken structure.”

The agency sometimes tries to claw back overpayments from people falsely accused of failing to provide required documents, Camp said.

“Dropping off forms at their field offices is not a guarantee” paperwork will be processed, he said. “Mail is slow, or it doesn’t get opened. We see it so many times you are left with the idea that has to do with the structure.”

(WFXT, Boston)

Left Destitute

Advocacy groups and others said they don’t know how many people become homeless after their benefits are terminated, but they say anecdotal accounts are common.

A study found that more than 800,000 disability applicants from 2007 to 2017 experienced homelessness. Advocates say it only makes sense that overpayments could lead more people to become homeless, since nearly 40% of people receiving disability benefits experience food insecurity and cannot keep up with their rent and utility bills, according to research.

Ronald Harrell sleeps in the woods near Wildwood, Florida, about 50 miles northwest of Orlando. He said he shelters in a tent, cooks his meals on a small grill, and showers at a friend’s house.

Harrell, 64, said he rented a room in a house for $125 a week until last year, when the Social Security Administration cut off his retirement benefits.

A letter the SSA sent him, dated Feb. 6, 2023, says his benefits are being withheld because of overpayment of $35,176 that accrued when Harrell received disability payments. The letter acknowledges he has asked the agency to lower his payments.

“I don’t know how they are doing this to me,” Harrell said. “I did everything by the law.”

Harrell said he once worked as an HVAC technician, but nerve damage left him unable to work sometime around 2002.

He said he collected disability benefits until about 2009, when rehabilitation allowed him to return to the workforce, and he said he reported the information to the federal government. Harrell said he applied for early Social Security retirement benefits last year when his health again declined.

“I started working when I was 16,” Harrell said. “I never thought my life would be like this.”

Kijakazi, the acting Social Security commissioner, and others have said overpayments stem at least partly from low staffing and budget cuts.

From 2010 to 2023, the agency’s customer service budget dropped by 17%, after inflation, according to a report by the Center on Budget and Policy Priorities, a think tank that conducts research on government programs.

At the same time, the report says, the number of Social Security beneficiaries grew by nearly 12 million people, or 22%.

Jonathan Stein, a former attorney with Community Legal Services of Philadelphia who has participated in workgroups and meetings with federal officials about access to Social Security payments for vulnerable populations, said budget cuts cannot fully account for the agency’s penchant for denying applications and terminating benefits.

Officials suspended Supplemental Security Income benefits for about 136,540 people in 2019 for “failure to furnish report,” which means they did not meet deadlines or paperwork requirements, Stein said, despite knowing many of those people were unable to contact the agency because they are homeless or have been evicted and lost access to phones and computers.

That’s more than double the number in 2010, he said.

“They have an implicit bias for denying benefits,” Stein said. “It is a very skewed view of integrity. It reinforces a culture of suspicion and prosecution of applicants.”

The 24-year-old Pennsylvania woman who received Supplemental Security Income as a child because of a learning disability described her ordeal on the condition that her name not be published. A letter from the Social Security Administration says she received an overpayment notice for more than $6,000.

“It was frustrating,” the woman said. “You are dealing with nasty people on the phone. I couldn’t get any answers.”

In November 2022, she contacted a nonprofit law firm, which helped her file an appeal. One year later, she received another letter from Social Security saying the overpayment had been waived because it was not her fault. The letter also said officials would not seek repayment because she could not afford basic needs such as food and housing without the monthly benefits.

The woman had already paid a price.

She lived in public housing and the Philadelphia Housing Authority had offered her a chance to fulfill a long-held goal of owning a house. But when the overpayment appeared on her credit report, she said, she could not obtain a mortgage.

“I was excited about getting my own home,” she said. “That’s what everybody wants. Losing it is not a good feeling.”

David Hilzenrath of KFF Health News, Jodie Fleischer of Cox Media Group, and Ben Becker of ActionNewsJax in Jacksonville, Florida, contributed to this report.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Desantis, Newsom to Tangle Over Hot-Button Health Issues

Angela Hart and Daniel Chang — Thu, 30 Nov 2023 14:12:59 +0000

Florida’s Republican presidential hopeful, Ron DeSantis,and Democratic firebrand Gavin Newsom of California square off today in a contest of governors that can best be described as the debate to determine ¿quién es más macho? — who is more manly — about protecting your freedoms.

Both men have led their respective states since 2019, and they’ve lately been engaged in an escalating feud. While Newsom isn’t running for president himself — yet — he’s a key surrogate for President Biden. Fox News is playing up the faceoff, which it’ll host, as “The Great Red Vs. Blue State Debate.”

The Health 202 is a coproduction of The Washington Post and KFF Health News.

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The debate promises to put America’s culture wars front-and-center. Abortion. Homelessness. Transgender health care. The coronavirus pandemic response. Health coverage for undocumented immigrants. Even drag shows, DEI and Disney’s First Amendment rights.

Though conservative TV host Sean Hannity is moderating the 90-minute showdown in Alpharetta, Ga., seemingly a home-field advantage for DeSantis, Newsom is relishing the confrontation after goading Florida’s governor into going head-to-head.

Both men use each other’s states as punching bags. DeSantis portrays Newsom as too liberal for America, presiding over a failed state where homelessness and crime are rampant, citizens are forced to mask up and get vaccinated, and access to abortion and public assistance like Medicaid is too easy, breaking society morally and financially.

In a fundraising video for his presidential campaign, DeSantis called California “the petri dish for American leftism,” adding that “everything Biden is doing — they would accelerate and they would cause this country to collapse. That is not the future that we need. Florida shows a model for revival, a model based on freedom.”

Newsom has blasted DeSantis as a “small pathetic man” and argues that small-d democracy itself is at stake in the presidential election. His political operation paid for an ad on Florida’s airwaves this year in which Newsom told Sunshine State residents: “Freedom — it’s under attack in your state.”

He has knocked DeSantis’s education policies that restrict teaching gender and sexuality to schoolchildren as well as laws the Florida governor pushed through the legislature banning abortion after six weeks and limiting gender transition-related health care.

“Your Republican leaders, they’re banning books, making it harder to vote, restricting speech in classrooms,” Newsom said in his ad. “Even criminalizing women and doctors. Join us in California, where we still believe in freedom.”

Newsom’s health and education policies are largely the opposite of DeSantis’s. He’s expanded access to gender-affirming care for children and adults, and is expanding Medicaid beginning Jan. 1 to cover lower-income undocumented immigrants. Backed by the Democratic-controlled state legislature, Newsom led an effort in 2022 to enshrine the right to abortion in the state constitution, and he’s fought to block local school districts from restricting access to certain books.

While DeSantis directs resources to the presidential campaign, where he’s struggling to maintain his second-place standing in the GOP primary behind front-runner Donald Trump, Newsom struck again this month with another Florida ad buy, this time centered on reproductive health and abortion access.

The ad alleges that DeSantis has criminalized doctors and women seeking an abortion after six weeks and argues that they could be arrested “by order of Governor Ron DeSantis.”

Both men face a monumental test in their debate. Newsom must demonstrate his loyalty to Biden, the Democratic Party leader and the actual candidate next November, while scoring points against DeSantis.

DeSantis, a wooden public speaker who struggles to connect with his audiences, has faced some criticism in Republican circles for a lackluster campaign. He’s got to persuade GOP voters that he’s a formidable option to Trump, without any major gaffes.

The proxy battle could shape not only next year’s presidential contest, but the 2028 field of White House contenders as well.

One other hot-button issue we’re watching for is homelessness, considering nearly one-third of all homeless Americans live in California. Expect DeSantis to hammer Newsom over Californians fleeing for cheaper living elsewhere — including to Florida. Newsom, meanwhile, will play up the unprecedented investment he’s spearheaded to combat the humanitarian crisis (without clear results as of yet).

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La atención de salud, en el centro del debate entre DeSantis y Newsom

Daniel Chang and Angela Hart — Mon, 27 Nov 2023 10:00:00 +0000

Florida

Gobernador Ron DeSantisEdad: 45Población de Florida: 22.2 million

California

Gobernador Gavin NewsomEdad: 56Población de California: 39 million

El candidato presidencial republicano Ron DeSantis y el gobernador demócrata Gavin Newsom —rivales políticos y representantes de la América roja y azul— se enfrentarán en un debate sin precedentes el 30 de noviembre en Georgia.

Newsom, un agitador liberal en su segundo mandato como gobernador de California, no se presenta a las elecciones presidenciales de 2024. Pero incitó a DeSantis, en su segundo mandato como gobernador de Florida, a un cara a cara. “Yo llevaré mi gomina. Tú trae tu laca”, bromeó en las redes sociales.

El enfrentamiento promete ser una acalorada pelea entre estrellas políticas en ascenso que lideran dos de los estados más poblados y diversos del país. Y será la primera vez que los políticos se vean las caras, a pesar de que en las últimas semanas han intercambiado insultos en videos para recaudar fondos y anuncios de campaña.

Los temas principales serán la falta de vivienda y la salud, prioridades de los votantes y cuestiones que han definido, en gran medida, las políticas y los estilos de liderazgo de los gobernadores. Desde el aborto hasta las vacunas contra covid-19, Newsom y DeSantis no podrían ser más opuestos.

A principios de este año, DeSantis criticó a California por ser demasiado generosa con los programas públicos como Medicaid, que el Estado Dorado ha ampliado a todos los residentes elegibles, independientemente de su estatus migratorio. Esa política de gran alcance entra en vigencia en enero y va mucho más allá de la expansión opcional de Medicaid que la Ley de Cuidado de Salud a Bajo Precio (ACA) ofreció a los estados. En Florida, uno de los 10 estados que se ha negado a ampliar Medicaid bajo ACA o Obamacare, DeSantis alardea de la tasa de residentes del estado sin seguro de salud, que es del 11%, como si fuera una medalla de honor.

“No vamos a ser como California y tener un número masivo de personas en programas gubernamentales sin requisitos de trabajo”, dijo DeSantis en un debate de primarias presidenciales en el sur de California a principios de este año.

DeSantis ha llevado a su estado a restringir el aborto y la atención médica de afirmación de género, y a prohibir las máscaras relacionadas con covid y los mandatos de vacunación.

Newsom, un hábil e impetuoso sustituto del presidente demócrata Joe Biden, ha arremetido contra DeSantis por poner a los floridanos en peligro y despojarlos de sus derechos.

Florida

Al tener DeSantis la inmigración como una prioridad, los legisladores aprobaron una ley estatal que obliga a todos los hospitales de Florida a preguntar en sus formularios de admisión si un paciente es ciudadano estadounidense o se encuentra legalmente en el país. Médicos, enfermeras y expertos en políticas de salud afirman que la ley afecta a personas marginadas, que ya tienen dificultades para desenvolverse en el sistema de salud, y que los disuadirá aún más de buscar atención médica.

California

A partir de enero, todos los inmigrantes que cumplan los requisitos de ingresos podrán acogerse al programa estatal de Medicaid. Antes que Newsom asumiera el cargo, California ya había ampliado la elegibilidad a los niños inmigrantes indocumentados hasta los 18 años. Newsom firmó luego leyes que ampliaron el programa a adultos jóvenes hasta los 26 años, a adultos mayores de 50 años y, más tarde, a los inmigrantes de cualquier edad que cumplieran con los requisitos de elegibilidad.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Health Care Is Front and Center as DeSantis and Newsom Go Mano a Mano

Angela Hart and Daniel Chang — Mon, 27 Nov 2023 10:00:00 +0000

Florida

Gov. Ron DeSantisAge: 45Florida population: 22.2 million

California

Gov. Gavin NewsomAge: 56California population: 39 million

Republican presidential candidate Ron DeSantis and Democratic Gov. Gavin Newsom — political rivals from opposite coasts and proxies for red and blue America — are set to square off for a first-of-its-kind debate Nov. 30 in Georgia.

Newsom, a liberal firebrand in his second term as governor of California, isn’t running for president in 2024. But he goaded DeSantis, in his second term as governor of Florida, to go mano a mano. “I’ll bring my hair gel. You bring your hairspray,” he taunted on social media.

The matchup promises to be a heated brawl between rising political stars who lead two of the nation’s most populous and diverse states. And it will mark the first time the politicians meet in person even as they have very publicly traded barbs and insults, in recent weeks attacking each other in fundraising videos and campaign ads.

Front and center will be homelessness and health care, top priorities for voters — and issues that have largely defined the governors’ policies and leadership styles. From abortion to covid-19 vaccines, Newsom and DeSantis could not be further apart.

Earlier this year, DeSantis blasted California for being too generous with public benefit programs, such as Medicaid, which the Golden State has expanded to all eligible residents regardless of immigration status. That sweeping policy takes effect in January and goes well beyond the optional expansion of Medicaid that the Affordable Care Act offered states. In Florida, one of 10 states that have refused to expand Medicaid under Obamacare, DeSantis wears the state’s 11% rate of uninsured residents as a badge of honor.

“We’re not going to be like California and have massive numbers of people on government programs without work requirements,” DeSantis said at a presidential primary debate in Southern California earlier this year.

DeSantis has led his state to restrict abortion and gender-affirming care and to ban covid-related mask and vaccine mandates.

Newsom, a slick and brash surrogate for Democratic President Joe Biden, has slammed DeSantis for putting Floridians in danger and stripping them of their rights.

Florida

With DeSantis making immigration a priority, legislators passed a state law requiring all Florida hospitals to ask on their admission forms whether a patient is a U.S. citizen or lawfully present in the country. Doctors, nurses, and health policy experts say the law targets marginalized people who already have difficulty navigating the health care system and will further deter them from seeking care.

California

Beginning in January, all immigrants who meet income qualifications will be eligible for the state’s Medicaid program. Before Newsom took office, California had already expanded eligibility to immigrant children through age 18 living in the state without authorization. Newsom then signed laws expanding the program to young adults up to age 26, adults 50 and older, and, later, immigrants of any age who otherwise meet eligibility requirements.

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Street Medicine Practitioners Are Getting Paid. Now They Want Higher Rates.

Angela Hart — Tue, 31 Oct 2023 13:10:00 +0000

Street medicine, the practice of caring for homeless people outdoors, is a burgeoning field — an unfortunate reality as America confronts a growing homelessness epidemic. But it’s at least become a little more rewarding after the Biden administration made an under-the-radar yet revolutionary change to Medicaid.

The Health 202 is a coproduction of The Washington Post and KFF Health News.

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Starting this month, doctors, nurses and other providers can bill the program for low-income people for treating the homeless anywhere they are — indoors or on the streets. Previously, Medicaid generally paid only for care delivered in traditional settings like hospitals, clinics and offices.

Now, practitioners of street medicine are asking for more: higher Medicaid payment rates to reflect the cost of their services, which they say are far more labor-intensive and time-consuming than health care delivered at hospitals or clinics.

“Rates have to reflect the difficulty of the work so this can be sustainable,” said Michelle Schneidermann, a street medicine expert who previously led homelessness initiatives at Zuckerberg San Francisco General Hospital and is now director of people-centered care at the California Health Care Foundation.

Cities around the country are grappling with a homelessness crisis that is also a health-care crisis.

People living outdoors are often addicted to hard drugs and suffer from mental illnesses and chronic diseases. At the same time, they’re notoriously difficult patients. Street medicine started gaining traction about 25 years ago, and today there are more than 150 programs across the country, according to practitioners. At least 50 are in California.

Advocates for the homeless and the people who care for them say their medical needs have long been overlooked by the conventional health-care system and the institutions that pay for care, including the government.

“The way we treat people in health care is way different than how we approach people who are outside living under bridges and in encampments,” says Jim O’Connell, who leads Boston’s Health Care for the Homeless Program, one of the first street medicine programs in the country. “This is a population that has more severe and persistent mental illness than any other group we know in America.”

O’Connell believes the new billing change could dramatically expand street medicine and integrate it into the current system of care — broadening the definition of how and where health care is delivered. Yet much work has to be done to build infrastructure and get the industry on board, he said.

Some homeless people are already enrolled in Medicaid — usually in states that expanded the program under Obamacare. But many go uninsured even in states that have embraced the Affordable Care Act, and street medicine teams are poised to sign up patients they encounter in the field. Experts in one leading program in Los Angeles, for instance, say roughly 60 percent of patients they encounter are already enrolled in Medicaid (a fraction that is probably far lower in other states). Once engaged by street medicine teams, the percentage rises to roughly 80 percent.

Now that they can consistently bill Medicaid for their work, street medicine practitioners are planning a coordinated lobbying campaign to win higher payment rates, as well as a major PR effort to entice more providers and Medicaid health insurers to participate.

But so far only a handful of practitioners are working around the country to build support. They’re advocating for new legislation in Congress that would further expand street medicine; leading training and education initiatives with professional health-care trade groups like the American Academy of Family Physicians; and spreading the word about new billing mechanisms in states such as New Mexico.

In California, a growing street medicine collaborative is pressing health insurers to contract directly with street medicine teams to make services more readily available.

“The next big thing in street medicine is boosting rates,” said Brett Feldman, a provider with USC Street Medicine, who led the charge to persuade the federal government to expand reimbursement. “In street medicine, you’re out physically looking for your patients versus them coming to you, so it just takes longer. And it takes time to build trust.”

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Watch: California and Feds Invest in Health Care for Homeless People

Thu, 26 Oct 2023 09:00:00 +0000

California Healthline senior correspondent Angela Hart appeared on Spectrum News 1’s “Los Angeles Times Today” on Oct. 24 to discuss her coverage of state and federal efforts to expand street medicine — a growing field that focuses on treating homeless people wherever they are, whether indoors or on the streets.

Pregnant and Addicted: Homeless Women See Hope in Street Medicine

Street medicine is getting a jolt in California, which was the first state to standardize payment for street medicine providers through its Medicaid program, allowing them to be paid more consistently. There are at least 50 street medicine teams in the state, with more in the pipeline as cities grapple with growing homelessness — and the widespread drug use and mental illness that often accompany it.

Other states are also embracing street medicine, as is the Biden administration, which this month began allowing public and private insurers nationally to pay street medicine providers for medical services.

Hart discussed the dearth of traditional health care services for people without housing, particularly women, and how street medicine fills a critical gap in care.

Click here to watch her on “Los Angeles Times Today.”

Read Hart’s in-depth article about street medicine providers’ work with pregnant women and her report on national street medicine payment developments.

Health Care ‘Game-Changer’? Feds Boost Care for Homeless Americans

Angela Hart — Wed, 18 Oct 2023 09:00:00 +0000

The Biden administration is making it easier for doctors and nurses to treat homeless people wherever they find them, from creekside encampments to freeway underpasses, marking a fundamental shift in how — and where — health care is delivered.

Starting Oct. 1, the Centers for Medicare & Medicaid Services began allowing public and private insurers to pay “street medicine” providers for medical services they deliver anyplace homeless people might be staying.

Previously, these providers weren’t getting paid by most Medicaid programs, which serve low-income people, because the services weren’t delivered in traditional medical facilities, such as hospitals and clinics.

The change comes in response to the swelling number of homeless people across the country, and the skyrocketing number of people who need intensive addiction and mental health treatment — in addition to medical care for wounds, pregnancy, and chronic diseases like diabetes.

“It’s a game-changer. Before, this was really all done on a volunteer basis,” said Valerie Arkoosh, secretary of Pennsylvania’s Department of Human Services, which spearheaded a similar state-based billing change in July. “We are so excited. Instead of a doctor’s office, routine medical treatments and preventive care can now be done wherever unhoused people are.”

California led the nation when its state Medicaid director in late 2021 approved a new statewide billing mechanism for treating homeless people in the field, whether outdoors or indoors in a shelter or hotel. “Street medicine providers are our trusted partners on the ground, so their services should be paid for,” Jacey Cooper told California Healthline.

Hawaii and Pennsylvania followed. And while street medicine teams already operate in cities like Boston and Fort Worth, Texas, the new government reimbursement rule will allow more health care providers and states to provide the services.

“It’s a bombshell,” said Dave Lettrich, executive director of the Pittsburgh-based nonprofit Bridge to the Mountains, which provides outreach services to street medicine teams in Pennsylvania. “Before, you could provide extensive primary care and even some specialty care under a bridge, but you couldn’t bill for it.”

Under the new rule, doctors, nurses, and other providers can get reimbursed to care for patients in a “non-permanent location on the street or found environment,” making it the first time the federal government has recognized the streets as a legitimate place to provide health care. This will primarily affect low-income, disabled, and older people on Medicaid and Medicare.

“The Biden-Harris Administration has been focused on expanding access to health care across the country,” said CMS spokesperson Sara Lonardo, explaining that federal officials created a new reimbursement code at the request of street medicine providers who weren’t consistently getting reimbursed.

The White House unveiled an ambitious strategy earlier this year to reduce homelessness in America 25% by 2025, in part by plowing health care money into better care for those living on the streets.

Legislation pending in Congress would further expand reimbursement for street medicine, taking aim at the mental health and addiction crisis on the streets. The bipartisan bill, introduced earlier this year, has not yet had a committee hearing.

Nearly 600,000 people are homeless in America, based on federal estimates from 2022, and on average they die younger than those who have stable housing. The life expectancy for homeless people is 48, compared with the overall life expectancy of 76 years in the U.S.

More than 150 street medicine programs operate across the country, according to street medicine experts. At least 50 are in California, up from 25 in 2022, said Brett Feldman, director of street medicine at the University of Southern California’s Keck School of Medicine.

Feldman spearheaded the state and national efforts to help street medicine providers get paid, alongside the Street Medicine Institute. They submitted a formal request to the Biden administration in January 2022 to ask for a new street medicine billing code.

In the letter, they argued that street medicine saves lives — and money.

“This is done via walking rounds with backpacks, usually working out of a pick-up truck or car, but is also done via horseback, kayak, or any other means to reach hard-to-reach people,” they wrote. “The balance of power is shifted to the patient, with them as the lead of their medical team.”

Street medicine experts argue that by dramatically expanding primary and specialty care on the streets, they can interrupt the cycle of homelessness and reduce costly ambulance rides, hospitalizations, and repeated trips to the emergency room. Street medicine could help California save 300,000 ER trips annually, Feldman projected, based on Medicaid data. Some street medicine teams are even placing people into permanent housing.

Arkoosh said there’s already interest bubbling up across Pennsylvania to expand street medicine because of the federal change. In Hawaii, teams are plotting to go into remote encampments, some in rainforests, to expand primary and behavioral health care.

“We’re seeing a lot of substance abuse and mental health issues and a lot of chronic diseases like HIV,” said Heather Lusk, executive director of the Hawai‘i Health & Harm Reduction Center, which provides street medicine services. “We’re hoping this can help people transition from the streets into permanent housing.”

But the federal change, undertaken quietly by the Biden administration, needs a major public messaging campaign to get other states on board and to entice more providers to participate, said Jim Withers, a longtime street medicine provider in Pittsburgh who founded the Street Medicine Institute.

“This is just the beginning, and it’s a wake-up call because so many people are left out of health care,” he said.

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Pregnant and Addicted: Homeless Women See Hope in Street Medicine

Angela Hart — Tue, 17 Oct 2023 09:00:00 +0000

REDDING — Five days after giving birth, Melissa Crespo was already back on the streets, recovering in a damp, litter-strewn water tunnel, when she got the call from the hospital.

Her baby, Kyle, who had been born three months prematurely, was in respiratory failure in the neonatal intensive care unit and fighting for his life.

The odds had been against Kyle long before he was born last summer. Crespo, who was abused as a child, was addicted to fentanyl and meth — a daily habit she found impossible to kick while living homeless.

Crespo got a ride to the hospital and cradled her baby in her arms as he died.

“I know this happened because of my addiction,” Crespo said recently, just after a nurse injected her on the streets of downtown Redding with a powerful antipsychotic medication. “I’m trying to get clean, but this is an illness, and it’s so hard while you’re out here.”

Crespo, 39, is among a growing number of homeless pregnant women in California whose lives have been overrun by hard drug use, a deadly coping mechanism many use to endure trauma and mental illness. They are a largely unseen population who, in battling addiction, have lost children — whether to death or local child welfare authorities.

She and other women are now receiving care from specialized street medicine teams fanning across California to treat homeless people wherever they are — whether in squalid encampments, makeshift shantytowns clustered along rivers, or vehicles they stealthily maneuver from one neighborhood to another in search of a safe place to park.

“This is a really impoverished community and the big thing right now is maternity care and prenatal care,” said Kyle Patton, a family doctor who leads the street medicine team for the Shasta Community Health Center in Redding, about 160 miles north of Sacramento in a largely rural and conservative part of the state.

Patton, who dons his hiking boots and jeans to make his rounds, has managed about 20 pregnancies on the streets since early 2022, and even totes a portable ultrasound in his backpack to find out how far along women are. He’s also helping homeless mothers who have lost custody of their children try to get sober so they can reunite with them.

“I didn’t expect this to be a huge part of my practice when I got into street medicine,” Patton said on a hot June day as he packed his medical van with birth control implants, tests to diagnose syphilis and HIV, antibiotics, and other supplies.

“The system is broken and people lack access to health care and housing, so managing pregnancies and providing prenatal care has become a really big part of my job.”

Street medicine isn’t new, but it’s getting a jolt in California, which is leading the charge nationally to deliver full-service medical care and behavioral health treatment to homeless people wherever they are.

The practice is exploding under Democratic Gov. Gavin Newsom, whose administration has plowed tens of billions of dollars into health and social services for homeless people. It has also standardized payment for street medicine providers through the state’s Medicaid program, called Medi-Cal, allowing them to be paid more consistently. The federal government expanded reimbursement for street medicine this month, making it easier for doctors and nurses around the country to get paid for delivering care to homeless patients outside of hospitals and clinics.

State health officials and advocates of street medicine argue it fills a critical gap in health care — and could even help solve homelessness. Not only are homeless people receiving specialized treatment for addiction, mental illness, chronic diseases, and pregnancy; they’re also getting help enrolling in Medi-Cal and food assistance, and applying for state ID cards and federal disability payments.

In rare cases, street medicine teams have gotten some of the state’s sickest and most vulnerable people healthy and into housing, which supporters point to as incremental but meaningful progress. Yet they acknowledge that it’s no quick fix, that the expansion of street medicine signals an acceptance that homelessness isn’t going away anytime soon — and that there may never be enough housing, homeless shelters, and treatment beds for everyone living outside.

“Even if there is all the money and space to build it, local communities are going to fight these projects,” said Barbara DiPietro, senior director of policy for the Tennessee-based National Health Care for the Homeless Council. “So street medicine is shifting the idea to say, ‘If not housing, how can we manage folks and provide the best possible care on the streets?’”

The expansion of street medicine and other services doesn’t always play well in communities overwhelmed by growing homeless populations — and the rise in local drug use, crime, and garbage that accompany encampments. In Redding and elsewhere, many residents, leaders, and business owners argue that expanding street medicine merely enables homelessness and perpetuates drug use.

Patton acknowledges the process of getting people off drugs is long and messy. More often than not, they relapse, he said, and most expectant mothers lose their babies.

This is true especially of homeless mothers like Crespo, who has been using hard drugs for nearly two decades but is desperate to get clean so she can reconnect with her four living children; they range in age from 12 to 24, Crespo said, and she is estranged from all of them. Two other children have died, one from lymphoma at age 15 and baby Kyle, in August 2022, primarily due to complications from congenital syphilis.

Patton is treating Crespo for mental illness and addiction and has implanted long-acting birth control into her arm so she won’t have another unexpected pregnancy. He has also treated her for hepatitis C and early signs of cervical cancer.

Although she’s still using meth — as is her boyfriend, Kyle’s father — she’s six months sober from fentanyl and heroin, which are more deadly and addictive. “You’d think I could just get clean, but it doesn’t work that way,” said Crespo. “It’s an ongoing fight, but I’m healing.”

Patton doesn’t see Crespo’s continued drug use as a failure. His goal is to establish trust with his patients because overcoming addiction — which often is rooted in trauma or abuse — can take a lifetime, he said.

“We’re playing the long game with our patients,” he said. “They’re really motivated to seek treatment and get off the streets. But it doesn’t always work out that way.”

Street Medicine Takes Off

Patton is a young doctor. At 39, he’s on the leading edge of a movement to entrench street medicine in California, home to nearly a third of all homeless people in America. He has specialized in taking care of low-income patients from the start, first as an outreach worker in Salt Lake City and, later, in a family medicine residency in Fort Worth, Texas, focused on street medicine.

In the past two years, the number of street medicine teams operating in California has doubled to at least 50, clustered primarily in Los Angeles and the San Francisco Bay Area, with 20 more in the pipeline, said Brett Feldman, director of street medicine at the University of Southern California’s Keck School of Medicine.

Teams are usually composed of doctors, nurses, and outreach workers, and are funded largely by health insurers, hospitals, and community clinics that serve homeless people who have trouble showing up to appointments. That may be because they don’t have transportation, don’t want to leave pets or belongings unattended in camps, or are too sick to make the trip.

Feldman, who helped persuade Newsom’s administration to expand street medicine, notched a critical success in late 2021 when the state revamped its medical billing system to allow health care providers to charge the state for street medicine services. Medi-Cal had been denying claims because providers had treated patients in the field, not in hospitals or clinics.

“We didn’t even realize our system was denying those claims, so we updated thousands of codes to say street medicine providers can treat people in a homeless shelter, in a mobile unit, in temporary lodging, or on the streets,” said Jacey Cooper, the state Medicaid director, who this month leaves for the Centers for Medicare & Medicaid Services to work on federal Medicaid policy. “We want to transition these women into housing and treatment to give them more hope of keeping their kids.”

The state isn’t pumping new money into street medicine, but primarily redirecting Medicaid funds that would have paid for services in brick-and-mortar facilities.

Cooper has also pushed insurance companies that cover Medi-Cal patients to contract directly with street medicine teams, and some have done so.

Health Net, with about 2.5 million Medi-Cal enrollees across 28 counties, has contracted with 13 street medicine organizations across the state, including in Los Angeles, and is funding training.

“It’s a better use of taxpayer funding to pay for street medicine rather than the emergency room or constantly calling an ambulance,” said Katherine Barresi, senior director of health services for Partnership HealthPlan of California, which serves 800 homeless patients in Shasta County and contracts with Shasta Community Health Center.

‘There’s No Accountability’

Redding is the county seat of Shasta County, which has experienced a major political upheaval in recent years, driven in part by the anti-vaccine, anti-mask fervor that ignited during the covid-19 pandemic and the Trump presidency.

Yet residents of all political stripes are growing frustrated by the surge in homelessness and open-air drug use — and the spillover effects on neighborhoods — and are pressuring officials to clear encampments and force people into treatment.

“I don’t care if you’re left, right, middle — what’s happening here is out of control,” said Jason Miller, who owns a local sandwich shop called Lucky Miller’s Deli & Market. Miller said he’s had his windows smashed three times — costing $4,500 in repairs — and has caught homeless people defecating and performing lewd acts in his doorway.

Miller moved to Redding 15 years ago from Portland, Oregon, after losing patience with the homeless crisis there, and tries to help, handing out shoes and food.

He said he also understands that many homeless people need more services — such as street medicine.

“I get what they’re trying to do,” he said of street medicine providers. “But there’s a lot of questioning in the community around what they do. There’s no accountability.”

Patton isn’t deterred by the community’s skepticism or the cycle of addiction, even among his pregnant patients. The way he sees it, his job is to provide the best health care he can, no matter the condition his patients are in.

“It’s a lot of wasted energy, judging people and labeling them as noncompliant,” he said. “My job isn’t to determine if a patient is deserving of health care. If a patient is sick or has a disease, I have the skills to help, so I’m going to do it.”

‘I Have the Willpower’

Shasta County, like much of California, is seeing its homeless population explode — and get sicker. An on-the-ground count this year identified 1,013 homeless people in the county, up 27% from 2022. Most are men, but women account for a growing share of Patton’s patients because “more and more are getting pregnant,” he said.

County welfare agencies have little choice but to separate babies from their mothers when substance use or homelessness presents a risk to the children, said Amber Middleton, who oversees homelessness initiatives at the Shasta Community Health Center.

“We are off the charts with maternal substance abuse,” said Middleton, who previously worked for Shasta County’s child welfare agency. “A lot of these women are trying to get clean so they can get their children back, but they’re also trying to give themselves the childhood that they never had.”

Crespo turned to alcohol and drugs to deal with deep emotional pain from her youth, when she was passed among family members and, she said, beaten repeatedly by one of them.

“He would give me black eyes and I would run away,” she recalled in tears, admitting she has perpetuated that cycle of violence by punching her former husband when she felt provoked.

She has overdosed “more times than I can remember,” she said, and credits naloxone, an opioid overdose reversal drug, for saving her life repeatedly.

Patton routinely tests Crespo and other patients for sexually transmitted infections, gets them on prenatal vitamins, and treats underlying conditions like high blood pressure that can lead to a high-risk pregnancy. And he’s helping women get sober, often using a drug called Suboxone, which is a combination of two medications used to treat opioid addiction. Its forms include a strip that providers snip to make the needed dose.

“A lot of these women have already had children removed, and many are pregnant again,” he said. “If I can get them on Suboxone, they’re going to have a better chance of being successful as a family when they deliver.”

On that sweltering June day, he met Tara Darby, who was on fentanyl and meth and living in a tent along a creek that feeds into the Sacramento River. Patton started her on a course of Suboxone and got her into a hotel with her boyfriend to help her deal with the initial detox.

He also administered a pregnancy test and discovered she was already a few months along. “It’s rough out here. There’s no bathroom or water. You’re nauseous all the time,” Darby, 40, said. “I want to get out of this situation, but I’m terrified about getting clean, the detox, having my baby.”

When Patton offered her support from a drug and alcohol treatment counselor, Darby promised to try. “I want to do it. I have the willpower,” she said.

Across town, Kristen St. Clair was nearly 7 months pregnant and living in a hotel paid for by Shasta Community Health Center. Patton was helping her and her boyfriend, Brandt Clifford, get off fentanyl.

“I want to have a healthy, happy life with my baby,” said St. Clair, 42, who already had one baby taken from her due largely to her drug use. “I’m worried it’s too late now.”

But the prospect of getting clean felt daunting. Clifford, the father of her child, and an Iraq War veteran with a traumatic brain injury, had overdosed the previous day and needed five doses of naloxone to come back. “We saved your life, man,” Patton told Clifford.

Patton snipped a strip of Suboxone, explaining that addiction is complicated. “Science is showing that, for whatever reason, certain people were born with the right mix of genetic predisposition and then have had various things happen to them in their lives, which are unfair,” he said.

“And then when you tried opioids for the first time, your brain said to you, ‘This is the way I am supposed to feel.’ It takes very little to get hooked.”

Despite their desperation to kick their drug habit, St. Clair and Clifford have since relapsed, Patton reported. St. Clair delivered in early September, and her little boy was taken into custody to “withdraw in a neonatal abstinence program,” Patton said. Darby, who was evicted from her hotel room after relapsing, was in residential treatment to get sober as of early October.

Crespo is making headway, Patton said. She and her boyfriend, Andy Gothan, 43, are staying at a hotel while Patton’s team helps her hunt for a landlord who will accept a low-income housing voucher.

“I’m so close. They’ve helped me so much,” Crespo said. Meth is “always around, always available. If I can get inside, it’ll help me deal with the stress of getting clean without all those triggers.”

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Legislature Passes Newsom’s Proposal to Retool Mental Health Services Act

Molly Castle Work — Fri, 15 Sep 2023 13:40:00 +0000

The California Legislature passed a pair of bills greenlighting Gov. Gavin Newsom’s campaign to build 10,000 new beds and housing units and increase drug addiction treatment as part of his response to the state’s homelessness and drug crises. The Democratic governor is expected to sign the bills, which received bipartisan support.

The first bill, SB 326, is designed to transform the state’s Mental Health Services Act into the Behavioral Health Services Act, using an existing tax on millionaires to treat the most seriously mentally ill and to increase programs for substance use disorders. The second, AB 531, authorizes the state to issue $6.38 billion in bonds to build more housing for homeless people and treatment beds for those with the most severe needs.

Newsom will now ask voters to approve the changes on the March primary ballot.

“This reform will bring much needed accountability currently lacking at the local and state level, increased transparency and visibility into the whole mental health and addiction treatment system, and a modernized focus to address today’s crises,” Newsom said in a statement.

According to a June statewide study on homelessness by the University of California-San Francisco, more than 171,000 Californians experience homelessness daily, representing 30% of the nation’s homeless population. The majority of participants in the study reported high lifetime rates of mental health and substance use challenges; 82% reported a period in their life in which they experienced a serious mental health condition, and nearly two-thirds reported the use of illicit drugs or heavy drinking.

The mental health act was passed as Proposition 63 by voters in 2004 and levied a tax of 1% on income above $1 million, known as the “millionaire’s tax.” That money then flowed from the state to counties for use in five mental health areas, including community support, prevention, and facilities. Funding changes year to year, but the tax generated $3.3 billion in the 2022-23 fiscal year, according to the nonpartisan Legislative Analyst’s Office.

However, the program has been criticized over the years for falling short of its initial promise. Last year, the Los Angeles Times highlighted several reasons, including revenue swings, consistent underfunding of social and mental health programs, tension between state and county officials, and a shortage of mental health clinicians.

Newsom pledged that the newly renamed Behavioral Health Services Act would build 10,000 new beds and housing units for people experiencing homelessness who have behavioral health needs. It would also focus on diversifying the workforce and improving accountability — tracking outcomes in a more detailed way — so the government can understand what’s working and what’s not.

However, counties that administer this money at the local level have raised concerns. A letter from the California State Association of Counties and other organizations representing local government interests expressed fear that Newsom’s proposal would result in counties receiving significantly less funding for core services, little protection from fluctuation in funds, and less flexibility in spending.

The governor’s office emphasized that new requirements still provide flexibility.

Assembly member Jacqui Irwin (D-Thousand Oaks), who was the lead author of the bond bill and served for seven years as the chair of the body’s Military and Veterans Affairs Committee, is particularly proud of a provision that will reserve $1.07 billion for housing for veterans. California has the largest number of veterans experiencing homelessness — 31% of the nation’s homeless veteran population — according to a 2021 homelessness report by the U.S. Department of Housing and Urban Development.

“Getting veterans experiencing homelessness off the streets has long been a priority for California, but getting some of our most vulnerable veterans into needed treatment for behavioral health challenges will be transformative,” Irwin said.

Sen. Susan Talamantes Eggman (D-Stockton), who co-authored the bond bill and was the lead author of the other bill, said the bills are critical to the state’s continuum of care. “Together they will build out voluntary housing, reprioritize resources to those with the greatest needs, and provide a true safety net to prevent the many people falling through the cracks that we see today,” she said.

Legislatura aprueba la propuesta de Newsom para reformar la Ley de Servicios de Salud Mental

Molly Castle Work — Fri, 15 Sep 2023 13:30:00 +0000

La Legislatura de California aprobó un par de proyectos de ley que dan luz verde a la iniciativa del gobernador Gavin Newsom para construir viviendas, sumar 10,000 nuevas camas, y aumentar el tratamiento para adicciones como parte de su respuesta a la crisis de las personas sin hogar y de drogas en el estado. Se espera que el gobernador demócrata firme estos proyectos, que recibieron apoyo bipartidista.

El primer proyecto de ley, el SB 326, está diseñado para transformar la Ley de Servicios de Salud Mental del estado en la Ley de Servicios de Salud Conductual, al utilizar un impuesto existente a los millonarios para tratar a los enfermos mentales más graves y aumentar los programas para los trastornos por consumo de drogas.

La segunda, la AB 531, autoriza al estado a emitir bonos por valor de $6,380 millones para construir más viviendas para personas sin hogar y camas para tratamiento para los más necesitados.

Newsom pedirá ahora a los votantes que aprueben los cambios en las boletas de las primarias de marzo.

“Esta reforma aportará la tan necesaria rendición de cuentas que actualmente falta a nivel local y estatal, una mayor transparencia y visibilidad en todo el sistema de salud mental y tratamiento de adicciones, y un enfoque modernizado para hacer frente a las crisis actuales”, dijo Newsom en un comunicado.

Según un estudio estatal sobre los sin techo realizado en junio por la Universidad de California-San Francisco, más de 171,000 californianos sufren diariamente la falta de vivienda, lo que representa el 30% de la población sin hogar del país.

La mayoría de los participantes en el estudio declaró haber padecido a lo largo de su vida problemas de salud mental y de consumo de drogas; el 82% dijo haber sufrido algún trastorno mental grave en algún momento de su vida, y casi dos tercios indicó haber usado drogas ilícitas o haber bebido en exceso.

La ley de salud mental fue aprobada como Proposición 63 por los votantes en 2004 e imponía un impuesto del 1% sobre los ingresos superiores a un millón de dólares, conocido como el “impuesto de los millonarios”. Ese dinero pasaba del estado a los condados para su uso en cinco áreas de salud mental, entre ellas el apoyo comunitario, la prevención y las instalaciones. La financiación cambia año a año, pero el impuesto generó $3,300 millones en el año fiscal 2022-23, según la Oficina del Analista Legislativo, que no es partidista.

Sin embargo, el programa ha sido criticado a lo largo de los años por no cumplir su promesa inicial. El año pasado, Los Angeles Times destacó varias razones, incluidos los cambios en los ingresos, la subfinanciación constante de los programas sociales y de salud mental, la tensión entre los funcionarios estatales y del condado, y la escasez de médicos de salud mental.

Newsom prometió que la recién rebautizada Ley de Servicios de Salud Mental construiría 10,000 nuevas camas y viviendas para personas sin hogar con necesidades de salud mental. También se centraría en diversificar la mano de obra y mejorar la rendición de cuentas —mediante un seguimiento más detallado de los resultados—, para que el gobierno pueda saber qué funciona y qué no.

Sin embargo, los condados que administran este dinero a nivel local han expresado su preocupación. En una carta de la Asociación de Condados del Estado de California y otras organizaciones que representan los intereses de los gobiernos locales, expresaron el temor de que la propuesta de Newsom diera lugar a que los condados recibieran muchos menos fondos para servicios básicos, poca protección frente a la fluctuación de los fondos y menos flexibilidad en el gasto.

La oficina del gobernador hizo hincapié en que los nuevos requisitos siguen siendo flexibles.

La asambleísta Jacqui Irwin (demócrata de Thousand Oaks), autora principal del proyecto de ley de bonos y presidenta durante siete años de la Comisión de Asuntos Militares y de Veteranos, está especialmente orgullosa de una disposición que reservará $1,070 millones a viviendas para veteranos. California tiene el mayor número de veteranos sin hogar —el 31% de la población de veteranos sin hogar del país—, según un informe de 2021 del Departamento de Vivienda y Desarrollo Urbano de Estados Unidos.

“Sacar de las calles a los veteranos sin hogar ha sido durante mucho tiempo una prioridad para California, pero conseguir que algunos de nuestros veteranos más vulnerables reciban el tratamiento necesario para los problemas de salud conductual será transformador”, dijo Irwin.

La senadora estatal Susan Talamantes Eggman (demócrata de Stockton), quien es coautora del proyecto de ley de bonos, y fue la autora principal del otro proyecto de ley, dijo que estas propuestas legislativas son fundamentales para la continuidad de la asistencia que provee el estado. “Juntos construirán viviendas, reasignarán los recursos a los más necesitados y proporcionarán una verdadera red de seguridad para evitar que muchas personas caigan en las fisuras que vemos hoy en día”, afirmó.

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