In 2000, HUD, in recognition that any solution to homelessness must emphasize housing, targeted its McKinney-Vento Act homeless competitive programs towards housing activities. This policy decision presumed that programs such as Medicaid, TANF and General Assistance could pick up the slack produced by the change. This study examines how 7 communities sought to improve homeless people¿s access to mainstream services following this shift away from funding services through the Supportive Housing Program. Provides communities with models and strategies that they can use. Highlights the limits of what even the most resourceful of communities can do to enhance service and benefit access by homeless families and individuals.

The U.S. Department of Housing and Urban Development (HUD) has been funding transitional housing, permanent supportive housing, and related supportive services projects for homeless people since 1988, under the authority granted by the Stewart B. McKinney Homeless Assistance Act of 1987 and its subsequent modifications. When HUD began funding these projects under its Supportive Housing Program (SHP) as competitive grants, and later (starting in 1996) through the Continuum of Care (CoC) process, it gave applicants discretion to use HUD homeless funds for whatever mix of eligible activities they preferred. As a result, by 2000, nearly 60 percent of HUD homeless funds were being used by communities for services such as daycare and drug treatment, while the remaining funds were used for housing.

Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.