Schumann’s story is a happy one, but it’s a rare one, too. The public housing rolls in Baltimore, where Schumann lives, and other cities are hopelessly backlogged. At last count, Baltimore had 25,000 people in public housing, and another 25,000 on the waiting list. Nationally, 1.2 million households live in public housing units, and even more get vouchers from the government. But cuts to the voucher funding programs have left fewer people than ever able to access the housing.
“The broader reality is that, as a country, we’re spending roughly 40 percent of what we spent in 1979 before contemporary homelessness,” said Kevin Lindamood, the CEO of Health Care for the Homeless, a Baltimore organization that works with Schumann and provides health services to low-income people in the city. “The safety net isn’t there in the way it once was, and there’s not enough housing to go around.”
Lindamood says people like Schumann are balancing on a three-legged stool, comprised of health care, housing, and income.
“Since Jan. 1, the health care leg has gotten a lot stronger,” he said. “But the other two just aren’t there.”
Paying for housing for high-need people could save money for shelters, too, points out Adam Schneider, who also works at Health Care for the Homeless in Baltimore. A family of four costs $27 per person, per night to be housed in a shelter in Baltimore, he said. If they’re in the shelter for 60 days, the county is spending $6,480 just to house them in a shelter; it could easily take that money and find an apartment to house them for a year.
“That would be the far more human, effective, and efficient way,” he said.
Some states allow Medicaid dollars to pay for hospice care or long-term nursing facilities, said Dennis Culhane, a Penn professor who has studied housing and homelessness. But strictly speaking, Medicaid dollars can not be spent on housing alone. States are allowed to petition the federal government to use Medicaid dollars in creative ways, though, and Chicago has asked the government to use the money for housing units. New York state has built some affordable housing complexes using Medicaid money.
But that's come under criticism from some, including Bruce Vladeck, who administered Medicaid and Medicare in the Clinton administration.
"Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem," he told WNYC.
The National Alliance to End Homelessness puts out a report every year showing where homelessness has increased and where it has decreased across the country. In some states, the number of homeless people grew, and in others it declined. The states where homelessness decreased last year were also the ones that paid for supportive housing, said Nan Roman, the group's CEO. Utah saw a 7 percent decrease between 2013 and 2014; homelessness in Colorado dropped 42 percent.
Roman hopes the report will show cities that paying for housing works. But she knows that in an era of cost-cutting and financial austerity, Medicaid could be the simpler way of finding money. Not that it will be easy.
“In the housing world," she said, "getting Medicaid to pay for housing is like the golden fleece.”