The Economic Consequences of Homelessness in The US

accounting for added expenses due to ED use and contact with law enforcement. As a
result, increasing housing stability and ending homelessness are critical factors in
reducing health system costs.
However, the lack of affordable housing and high rent costs are barriers to achieving
housing stability. HUD defines households with incomes 30% or more below their area
median as “extremely low income,” and in 2016 the National Low Income Housing
Coalition found that only 3.2 million affordable housing units were available for the 10.4
million extremely low-income households in the United States. Without access to
affordable housing, 75% of extremely low-income households are severely cost
burdened, paying 50% or more of their income toward housing costs. These housing
shortages have a particular impact on individuals with disabling conditions. A 2014
study showed that the national average rent for a modest one-bedroom unit exceeded
100% of monthly Social Security Supplemental Security Income (SSI) payments, and
the national average rent for a studio/efficiency was equivalent to 90% of monthly SSI
payments. Housing subsidies, such as HUD’s housing choice vouchers (HCVs), are
critical to assisting individuals in accessing safe, affordable housing without being too
cost burdened to meet other basic needs such as food and transportation.
Individuals with complex health needs, particularly those with severe mental illness and
co-occurring substance use disorders, often have difficulty in maintaining housing
without appropriate supportive services, even with the provision of affordable housing.
Increased access to low-barrier, permanent housing with wraparound supportive
services is essential to meeting the needs of this population. Key supportive housing
services include medical and psychiatric treatment, case management, and resources
designed to support independent living, which are often funded through Medicaid.
Income stability is critical to retaining housing for individuals who have disabling
conditions, and cash benefits and health insurance provided by Social Security disability
programs, SSI, and Social Security Disability Insurance (SSDI) make it possible for
these individuals to access important treatment and supportive services. However,
despite high levels of disabling conditions, many individuals experiencing homelessness
never apply for benefits, and those who do have a very low chance of approval without
receiving active assistance in documenting their disabilities. Nationwide, an average of
28% of all initial SSI/SSDI applications are approved, and this figure can be as low as
10% to 15% among individuals experiencing homelessness. Denials typically result
from the Social Security Administration’s inability to contact individuals, missed
appointments, and, more generally, lack of adequate documentation. People
experiencing homelessness face many challenges when applying for disability benefits,
including inconsistent treatment, difficulty in locating medical records, lack of a stable
address or telephone number for contact with Social Security, and difficulty in
understanding complex and fragmented application processes.
Further impeding income stability is the high prevalence of unemployment (estimated to
be as high as 80% to 90%) among individuals experiencing homelessness, particularly
those with severe mental illness. Frequently cited barriers to employment include
Page 98 of 289