KAILUA-KONA — Homeless solutions, much like the population itself, often prove elusive.
Oahu Rep. John Mizuno, chairman of the state House Health and Human Services Committee, hosted an informational briefing Tuesday morning to zero in on the most viable options to combat homelessness as the 2018 legislative session approaches.
Homelessness numbers dropped in Hawaii roughly 9 percent in 2017 based on the state’s Point-In-Time-Count study. Yet the first of several presenters made the point that Hawaii — still owner of the highest per capita rate of homelessness in the nation — remains a long way from control of the situation.
“We are in a state of crisis,” Hawaii Island Mayor Harry Kim told legislators.
Aloha transition zones
Mizuno pushed the idea of safe zones as one of the state’s best options Tuesday afternoon.
Using Kim’s framework at Camp Kikaha and the permanent homeless site he intends to replace it as a template, Mizuno envisions plots of land with sturdy but transportable structures specified to an area’s homeless population, replete with transportation and wrap-around services.
The “wrench in the machine” legislators will have to navigate, he said, is the department of planning and permitting, as developing even small plots of land can take years with water and sewer line regulations, along with other requirements.
Another problem to Mizuno’s proposition is Hawaii’s executive branch, as Gov. David Ige and State Homeless Coordinator Scott Morishige have both spoken publicly in opposition of safe zones.
Morishige serves as part of the Hawaii Interagency Council on Homelessness, which was mandated to study the concept of safe zones last year.
He said Tuesday there are concerns about safe zone or tent city implementation, particularly if encampments don’t have adequate infrastructure or services. He referenced efforts on Oahu in recent years to develop safe zones, which police were forced to scrap due to health and safety concerns.
Mizuno, however, said the concept has evolved beyond the definitions to which the administration is clinging into what he’s referring to as “aloha transition zones.”
“I’m not talking about tent cities. I’ve evolved. We’re looking at a place with wrap-around services, security, transportation services and getting them ready for the next phase, affordable rental units,” he said. “So are we talking apples and oranges?”
Morishige said the Council looked at cost per person at Camp Kikaha, which was too high. Newer navigation models to transition to permanent housing is his preferred method, as he and Ige favor Housing First models backed by the U.S. Department of Housing and Urban Development and its federal homelessness budget.
“I think that there’s concern that you likely would not be able to get federal funding for a program (like safe zones),” Morishige said. “It is inconsistent with the position of HUD and the U.S. Interagency Council on Homelessness, so I think there’s a potential it could impact federal funding.”
Mizuno suggested paying for aloha transition zones with $5 million Ige has earmarked in the executive biennium budget for police sweeps, which Mizuno says simply herd homeless from one place to the next.
Morishige countered by explaining those funds also go toward agencies addressing criminal trespassing on public lands — for instance the dozens of homeless camped illegally at Old Kona Airport Park, which sparked Kim’s creation of Camp Kikaha and the resurrection of the safe zone discussion at a state level.
Expanding Medicaid
The other most talked about solution involves reclassifying homelessness as a medical condition and using Medicaid to provide housing, which many believe would cut taxpayer costs of medical and housing assistance to the homeless.
“Individuals can’t get healthy or maintain their health without access to permanent housing,” said Dr. Judy Mohr Peterson, director of Hawaii Med-QUEST. ” (And they’re) unable to obtain and retain their housing without having health needs addressed.”
Peterson said Hawaii submitted an amendment application, called the 1115 waiver amendment, to Centers for Medicare and Medicaid Services (CMS) in August. The amendment would allow for Hawaii to provide tenancy supports to the chronically homeless, as well as those in unstable living situations if they were also afflicted with mental health or substance abuse conditions.
Tenancy supports include services like housing, 24-hour crisis support and job training.
Peterson said CMS put the proposal out for public comment, which was followed by silence. She reached out again twice this winter, eventually speaking to CMS leadership who told her they had concerns about the scope of the population included in her definitions and that the program wasn’t related enough to the provision of long-term care.
She said the state is trying to address those concerns and most recently reached out to CMS leadership on Monday.
An expanded ability to utilize Medicaid funds would help some hospitals, particularly on Oahu. In 2016, the cost of unnecessary emergency room visits to The Queen’s Medical Center by homeless individuals reached nearly $100 million, roughly $90 million of which came from the Medicaid budget.
A missing piece?
Norm Baker, chief operating officer at Aloha United Way, indicated Tuesday he favors proactive solutions to reactive ones.
His organization commissioned a study in 2017 measuring the population in Hawaii that was both above the poverty level and below a level of self-sufficiency. He said the numbers showed 48 percent of the state fell into this category, including 55 percent of Big Islanders.
This group is vulnerable to homelessness if they face even a minor financial crisis, he explained.
“We believe that a homeless diversion and prevention program needs to be a part of our homeless effort going forward,” he said. “Just that little bit of assistance to help somebody through a financial crisis will work. It will actually help people to remain housed.”