Portland working hard to combat homelessness, but changes to MaineCare could make problem worse anyway

PORTLAND, Maine – The city has been touting its recent efforts to combat homelessness, but some say the problem remains serious and is about to get worse.

In November, the City Council adopted the recommendations of a task force it appointed to come up with ideas for reducing and preventing homelessness. The recommendations included centralizing the intake process for emergency shelters, expanding case management services, and building new facilities to house homeless individuals.

The city is now using a seven-pronged strategy to implement the recommendations, and the results are starting to show.

For example, 300 adults who used city shelters have found stable housing this year, an increase of 30 percent over the same period in 2012, according to the city’s Department of Health and Human Services.

And after seeing steep increases year after year in the number of clients its shelters serve, the city saw a slight decrease last month: 439 people, down from a record-high 444 in July 2012.

"We’re still at an unprecedented level, but the trend is starting to reverse," said Douglas Gardner, the department’s director.

At an Aug. 15 news conference, Mayor Michael Brennan hailed the work of the 18-member task force, social service organizations such as Preble Street and United Way, city staff and others for the progress that’s been made.

"We have pulled together a diverse group of partners who are working in tandem to seek solutions. This collaboration has become the catalyst to success best demonstrated by the hundreds of men, women and families who now have a home to call their own," Brennan said.

Preble Street Executive Director Mark Swann agrees. "I think in all my years here, this has been the most focused, targeted and collaborative effort we’ve made to put a dent in the problem [of homelessness]," he said Monday.

There’s no single reason for the progress that’s been made, according to Gardner. Homelessness is a complex problem with many contributing causes, he said. But he cited a few of the seven prongs that are already helping.

The Portland Housing Authority is now providing rent vouchers so that homeless individuals can be rapidly rehoused. And case management has become a major focus. For example, clients coming into any city shelter now must meet with a case manager to develop an individualized plan to secure housing.

Services on the street have been expanded, too. Outreach workers now canvas city streets and campsites to help homeless individuals, 12 hours a day, six days a week.

"We’re really trying to meet folks where they are," Gardner said.

Other prongs will not show results immediately. For example, the city has allocated $50,000 to fund siting and other pre-development work to build additional permanent housing for homeless individuals. And city planners are working to determine how zoning regulations may need to be adjusted in order to build a housing facility.

Meanwhile, a new challenge looms on the horizon: imminent changes in MaineCare, the state’s Medicaid program.

At the end of the year, about 25,000 adults will lose their MaineCare coverage as a result of changes in eligibility made by the state in 2011. These people won’t be eligible for the expanded Medicaid benefits offered states under the Affordable Care Act – also known as "Obamacare" – because Maine has refused to accept the benefits. Nor will these individuals be eligible for ACA subsidies to purchase private health insurance.

Adding thousands of Mainers to the ranks of the uninsured can only make homelessness worse, Gardner said.

For some people, lack of coverage can set in motion a downward spiral of poor health, mounting debt and other problems that eventually result in homelessness. And for people who already are homeless, the MaineCare cutbacks could leave them without their only source of health care.

At the city’s Health Care for the Homeless clinic on Portland Street, about 30 percent of the patients are eligible for MaineCare, and the clinic receives about $800,000 a year in reimbursement from the program, Gardner said.

The city is trying to determine what the potential impact of the MaineCare cuts will be on the clinic, but Gardner is worried.

"Obviously, we’re going to stay open, but there’s going to be a major impact on access," he said. "How can we maintain the same levels of service [at the clinic] that we have for 20 years?"

Swann shares Gardner’s concern. ""Many of the [homeless individuals] we see are very ill … and we already have difficulty getting a response from the health care system," he said.

"Even with all these great efforts, there’s only so much we can do in the face of broader and bigger factors at play."