With few places to self-isolate, limited access to disinfectant supplies, and overcrowded shelters that reduce residents’ ability to physically distance themselves, individuals experiencing homelessness are at unique risk for COVID-19. Recent estimates suggest that up to 40 percent of homeless individuals, many of whom have underlying health conditions, may become infected.

As COVID-19 cases increase, states, with federal support, are adopting a variety of approaches to safeguard homeless individuals, including creating temporary shelters and renting hotel and motel rooms.

Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Department of Housing and Urban Development (HUD) appropriations help states build and operate emergency shelters, provide hotel and motel vouchers, and provide essential services to people experiencing homelessness.

Additionally, some states are requesting authorization under 1135 waivers to use Medicaid funding to assist individuals experiencing homelessness.

• Illinois and Oregon have applied for 1135 waivers to create new isolation and quarantine systems for those who cannot quarantine at home.
• Massachusetts requested federal funding to use hotels as temporary housing for individuals experiencing homelessness and to help cover the cost of sanitation products to keep the temporary housing clean.
• North Carolina asked to use Medicaid dollars to cover housing-related services, including temporary housing, housing application assistance and transfers, and moving expenses for homeless individuals who are ready to be discharged from hospitals.

Other state Medicaid offices are seeking flexibility to waive administrative requirements to address homelessness during the pandemic:

• Arkansas submitted an 1115 waiver application asking for the flexibility to use federal funding to cover temporary housing assistance for its high-risk homeless population.
• Washington State proposed targeted Medicaid funding to provide temporary shelter for homeless individuals who are currently under institutional care, so that hospitals can discharge these individuals and free up more space for COVID-19 patients.

In addition to using Medicaid authority, states are employing other resources to help individuals experiencing homelessness. In California, with a homeless population of nearly 130,000, Gov. Gavin Newsom dedicated $150 million to support local efforts to house individuals living on the street. In his April 3, 2020 address, Newsom outlined a plan to move individuals experiencing homelessness into temporary shelters, including hotels, motels, and travel trailers. The first phase of the plan, involving sheltering homeless patients testing positive for COVID-19, has already begun, with the state leasing 7,000 of 15,000 rooms needed. As of April 11, 2020, 1,813 of these rooms had been filled.

Washington State, hit early and hard by the virus, is also moving to open additional housing facilities for individuals experiencing homelessness. In mid-March, the Washington Department of Commerce announced that it was allocating $30 million to support the homeless population, with each county receiving $250,000, with the remainder distributed based on the county’s number of homeless individuals. Counties are using this funding to rent motel and hotel rooms and are focusing their efforts on individuals who have tested positive for COVID-19.

Kitsap County in western Washington recently opened two facilities to shelter homeless individuals who test positive for COVID-19 and those awaiting test results. In Seattle, the city’s Human Services Department, in partnership with other local public health departments, is working to expand shelter capacity by finding new spaces, such as the Seattle Center Exhibition Hall, to house residents from the city’s most crowded shelters. The department is also working on deploying hygiene and sanitation resources, such as public toilets and hand-washing stations, throughout the city. The Seattle Navigation Team is providing outreach to high-risk individuals experiencing homelessness to connect them to housing, sanitation kits, and medical treatment.

The Maine State Housing Authority, the Maine Department of Health and Human Services (DHHS), and the University of Southern Maine have teamed up to open a temporary shelter for homeless adults in a university gym. Located in Portland, the new shelter will house 50 individuals and alleviate some of the crowding in the city’s existing shelters to allow for physical distancing during the emergency. Individuals in the shelter are required to be screened for COVID-19 symptoms regularly and they receive food from the university’s food service contractor. Funding for supplies, including beds, comes from DHHS and MaineHousing. The University of Maine System also signed a memorandum of agreement with the Maine Emergency Management Agency that allows the system’s facilities, supplies, and employees to be used as needed to address the pandemic.

As the pandemic response continues to unfold, it will be critical to highlight how states use the flexibility granted under their new waivers, and whether and to what extent these dollars are used to address homelessness. Additionally, though 1135 waivers are only available for the duration of the public health emergency, states may identify new, creative ways to appropriately use Medicaid funding for supportive housing programs that combine rental subsidies with wrap-around services to help people stay stably housed. In California, for example, the governor hopes to continue to provide homeless services at the hotels and motels the state is renting out, and the current agreements allow for individuals to extend leases after the pandemic subsides.

As safe and stable housing clearly promote health, states and the federal government have both invested in programs that help historically disenfranchised individuals find housing and access health care and supportive services to improve equity. Though temporary during the pandemic, current state initiatives may generate new and valuable partnerships between the health and housing sectors. With the rise of COVID-19 and its health and economic consequences, it is more important than ever that health and housing sectors work in tandem to break down siloes and deploy resources in a coordinated way to meet the needs of those who experience homelessness.