My name is Flora Brewer representing the Paulos Foundation and I have developed, studied, and managed supportive housing programs in Fort Worth for people emerging from chronic homelessness with disabilities for the past seven years. We find that clients who qualify for Medicaid have better access to care, especially to regularly see a physician, than those in our county health system for the indigent. We believe that Medicaid is crucial to the health, welfare, and housing stability of our chronically homeless neighbors. I urge you to do everything possible to expand Medicaid and make it easier for our residents who are poor with a lifetime of unaddressed health problems to qualify.
My name is Flora Brewer and I have lived in Fort Worth, Texas for 40 years. I have been developing and managing supportive housing programs and properties serving people emerging from chronic homelessness since 2016. I recently graduated from the University of Texas at Arlington with a PhD in Urban Planning and Public Policy with a dissertation studying the characteristics of persons in HUD housing programs for formerly homeless people. Between 2008 and 2012, I served as chief operating officer for a nonprofit home care company serving Medicaid clients and was also a member of the Texas state CDS work group. Today I want to share insights about our formerly homeless clients in supportive housing.
Increasingly, people in all our HUD-funded housing programs for homeless people are older adults with histories of trauma and life shocks, chronic health problems, mental health problems, little or no income, work histories limited to very low wage jobs, and weak or non-existent support systems. Health problems often contribute to poor work histories and very poor job prospects, including disabilities incurred in very physical work fields such as personal care and construction. Increasingly, clients have more barriers to housing and employment and increased intensity of health problems, including declining cognitive abilities.
While all the clients in our supportive housing programs must have a disability, most do not have SSI or SSDI. Our case managers find it very difficult to get our clients qualified for disability assistance. Without a social security determination of disability, it is impossible for our clients to qualify for Texas Medicaid. We find that many of our clients reveal undiagnosed chronic illnesses such as untreated cancer, COPD, high blood pressure, and uncontrolled diabetes when they come to live with us.
We find that clients who qualify for Medicaid have better access to care, especially to regularly see a physician, than those in our county health system for the indigent. We do not fault the quality of care in the county system, but the system is much more difficult to navigate. In our programs, we have been able to build an outstanding partnership for our Medicaid recipients with Amerigroup and their affiliate, Care More, offering home-based care and a full array of social services, mental and physical health care, and intensive services for our residents with complex combinations of conditions. We find that Medicaid offers our clients many more options and quicker access than our county health clients.
I’d like to close with a story about one of our residents who passed away a year after coming to us with stage 4 cancer. He was able to qualify for Medicaid. I became his medical power of attorney, visiting him regularly and taking him to appointments. He had poorly controlled epilepsy from childhood and found it difficult to get and keep employment. He developed severe alcoholism and lived under a bridge for many years near our downtown area. When he came to us at age 62, he was showing significant cognitive decline. Because of Medicaid, we were able to put together an array of services including personal care, hospice, and health care. I learned from a brief attempt at nursing home care, that these patients do not tolerate nursing homes well. He was pleased to have his own apartment, that a wonderful personal care attendant kept clean, enticing him to eat regularly, and looking in on him regularly. This was an incredible blessing because our on-site case manager has a case load of 24 households. When he died, he was surrounded by caring case managers and hospice staff.
We believe that Medicaid is crucial to the health, welfare, and housing stability of our chronically homeless neighbors. I urge you to do everything possible to expand Medicaid and make it easier for our residents who are poor with a lifetime of unaddressed health problems to qualify.