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April 25, 2024 | Volume 28, No. 4 | Archives
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Cruel and Unusual Punishment,
Part 2
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| In This Issue:
- Medicaid Unwinding: Over 20 Million Now Disenrolled
- Medicaid Work Requirements (yes, these are still looming!)
- New Funding & Guidance: Health Centers and Justice-Involved Individuals
- A Closer Look: Cruel and Unusual Punishment, Part 2
- COVID Corner: Researchers In Search of People to Interview
- Substance Use in the News
- What We’re Reading
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| Take Action: Plan a Summer Site Visit
Summer is coming, and that means your Congressmembers will be spending more time at home. Contact their office and schedule a site visit to your program! This can be an informal meet-and-greet with staff and clients and a cup of coffee, or something more formal with press coverage.
With the FY2025 budget still to be determined, and critical issues of housing, homelessness, overdose deaths, and access to health care still at crisis levels, there’s plenty to talk about—and even more to show them!
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| Medicaid Unwinding: Over 20 Million Now Disenrolled
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More than 20 million people have been disenrolled from Medicaid as part of the post-COVID redeterminations as of April 11—the vast majority (69%) for procedural reasons. That has huge implications for both patients and the providers who care for them, especially as the “unwinding” process continues. Not only does this mean people are suddenly uninsured and cannot afford care, but providers aren’t getting paid—forcing some to take out loans and/or go into debt. Nearly 1 in 4 adults who were disenrolled from Medicaid are now uninsured. As with every month for the past year we’ve been reporting on this—health centers are key to preventing coverage losses as well as getting folks re-connected to coverage.
Related reading:
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Medicaid Work Requirements (Yes, These Are Still Looming!)
While the Biden Administration has refused to approve state requests to add work requirements into Medicaid programs, Georgia got a federal court to approve theirs (overriding the Biden Administration), and other states still continue to pursue these harmful, expensive, and ineffective policies (e.g, like Mississippi, which is also considering finally expanding to single adults). Importantly, it is the Republican Party’s stated policy intention to re-instate Medicaid work requirements if they regain control of the White House this fall. Don’t let this issue fall off your radar screen because it is lurking in the shadows.
Related reading:
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| New Funding and Guidance: Health Centers and Justice-Involved Individuals
HRSA released a new funding opportunity and a draft policy information notice regarding health center services for people re-entering the community from justice settings (there’s a good overview in their press release).
- Notice of Funding Opportunity: $51 million in one-time-only funding is available to make $1 million awards to 51 health centers to support transitions in care. Applications due Monday, June 10, 2024.
- Draft Policy Information Notice: Proposes policy guidance to clarify the circumstances under which health centers may provide 14 different health services to incarcerated/detained individuals who are expected to be released from carceral setting within 90 days. HRSA is encouraging health centers and members of the public to provide feedback by Friday, June 14, via the BPHC Contact Form (click on Policy > Comment on Draft Policy > Submit Draft JI-R Individuals Policy Feedback).
This funding and guidance are to complement the Medicaid guidance CMS issued last year to State Medicaid directors regarding transition-related strategies to support community reentry and improve care transitions for individuals who are incarcerated.
Related reading:
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| Cruel and Unusual Punishment, Part 2
By Barbara DiPietro, Senior Director of Policy
On Monday, April 22, the Supreme Court heard the case of Johnson v. Grants Pass — a case that determines whether it is cruel and unusual punishment for communities to ticket or fine unsheltered people for sleeping outside. For background, last month’s Closer Look blog described the key provisions of this case and outlined how to draw attention and build power around key advocacy messages.
Many organizations submitted amicus briefs (or “friends of the court” arguments) that outlined their perspectives on this issue. The Health Care for the Homeless Community participated in creating the public health amicus brief, which argued that sleep is a biological necessity, that unhoused people have no control over the factors that impact quality sleep, and that poor sleep inflicts profound negative consequences to the health of people experiencing homelessness.
While the Justices were inside hearing the case, hundreds of advocates rallied outside to protest the ongoing arrests, fines, and other measures levied against people with nowhere else to go. An impressive array of national and local leaders from across the country — including Council CEO Bobby Watts — spoke passionately about the importance of providing housing and supportive services, not enacting more punishments. (A big shout-out to the National Homelessness Law Center for organizing the advocacy around this case!)
It’s difficult to know how the Court will rule after they deliberated for more than two hours (transcript and audio recording here). Some of the questions the Justices posed during the hearing give clues to their thinking:
- You don't arrest babies who have blankets over them, and you don't arrest people who are sleeping on the beach—it’s only homeless people who sleep outdoors will be arrested, correct? (Sotomayor)
- If a homeless person had $250 [amount of the fine], don’t you think they’d stay in a hotel? (Kagan)
- Breathing is a human need and you can’t say it’s a crime to breathe, correct? (Kagan)
- Suppose the City decided that it was going to execute homeless people — that would be both cruel and unusual, wouldn't it? (Jackson and Gorsuch) [Hint: the answer is YES.]
- Where do we put them [unsheltered people] if every city, every village, every town lacks compassion and passes a law identical to this? Where are they supposed to sleep? Are they supposed to kill themselves, not sleeping? (Sotomayor)
- What's so complicated about letting someone somewhere sleep with a blanket outside if they have nowhere to sleep? (Sotomayor)
- What about someone who has a mental health problem that prohibits them from sleeping in a shelter? Are they allowed to sleep outside or not? (Gorsuch)
- Eating is a basic human function as well, that people have to do, just like sleeping. So if someone is hungry and no one is giving him food, can you prosecute him if he breaks into a store to get something to eat? (Roberts)
- What if the person is in a homeless state because of prior life choices or their refusal to make future life choices? (Alito)
- Would a backpacker who happens to be in the area for a few days be allowed to camp on public property? (Thomas)
Much of the discussion focused on legal arguments, prior cases, and definitions of terms like "homeless." Many of the justices posed hypothetical situations for attorneys to respond to, and wrestled with how — or whether — the federal courts should be deciding these issues.
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| Three Actions to Take Now
- Schedule a site visit with your elected officials: Take advantage of the attention on this issue to invite your elected officials for a site visit. Your Congressional representatives will be home in August — get on the calendar so you can discuss the vital importance of legislators dedicating more funding for housing! Also engage your local policymakers, who are often promoting these laws, so they can get a more informed understanding of an effective response.
- Write an op-ed: Use your local media outlets to educate your community about the intersection between homelessness and health, and build empathy and support for constructive solutions to homelessness (not arrests and fines). Use this toolkit to help!
- Storytelling: Engage people with lived expertise to record short videos of their story. Help connect the general public to the reality of homelessness so they better understand the challenges of living unsheltered. Have a variety of stories so that folks understand that there’s many paths to homelessness. Use the Storytelling Guide from our National Consumer Advisory Board (NCAB) to ensure consumers tell their story in an effective, trauma-informed way.
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| For further reading (no-paywall links):
Photo by Matt McClain/The Washington Post
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| COVID Corner: Researchers In Search of People to Interview
Homelessness and Substance Use During the COVID-19 Pandemic: An Environmental Scan of Promising Practices: Researchers from the NYU School of Medicine are looking to interview managers or other leaders who were involved in new programs, responses, or initiatives related to substance use for people experiencing homelessness during the COVID-19 pandemic. The purpose of this NIH-funded study is to conduct an environmental scan of promising practices related to the intersection of substance use and homelessness during the pandemic – these could include new or modified harm reduction or overdose prevention approaches, new or modified approaches to connecting people experiencing homelessness with substance use treatment, or any other new or exciting approaches used (or attempted!) during the pandemic related to homelessness/housing and substance use.
Participation in the study would involve completing a 45-60 minute interview by phone or video conferencing. Gift card compensation for participants’ time will be provided.
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| Substance Use in the News
For this month, just a smattering of news articles on important issues:
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What We're Reading (and Watching)
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