Homelessness is rapidly increasing in Colorado and across the country, which poses a serious challenge for both the housing and health care sectors. Supportive housing—an evidence-based model that combines permanent housing assistance with supportive services, such as intensive case management and connections to physical and behavioral health care—has consistently proven to end homelessness for people with the highest needs. Colorado’s Statewide Supportive Housing Expansion piloted the expansion of supportive housing services throughout the state, including in rural areas where providers are often more limited, using a combination of state housing vouchers and flexible state Medicaid funding. This report presents findings from the evaluation’s implementation and impact studies, which analyzed how the statewide supportive housing program housed and served eligible participants and its impacts on housing and health care utilization and costs over the first year.

Why This Matters

This evaluation underscores that supportive housing is not just a housing solution but also a health care solution that increases access to services for people with many health challenges. The program’s notable successes in a brief period serves as proof of concept that Medicaid has an important role to play in expanding supportive housing—an expansion that can scale housing and needed services for a growing number of eligible participants both in Colorado and across the country.

Key Takeaways

The SWSHE program adds to the evidence base on how to end homelessness and improve health care in a few compelling ways.

• First, it demonstrates the feasibility of rapidly expanding quality supportive housing for hundreds of Colorado residents with unmet health needs, more than half of whom were located outside of the Denver metro area where supportive housing resources are often extremely scarce.
• Second, it documents the feasibility of intentional housing and health care models, including colocation of mental health and primary care in supportive housing buildings.
• Third, it demonstrates how flexible funding allows providers to add and expand services to provide more holistic and higher-quality supportive housing without the traditional restrictions of Medicaid funding.
• Finally, the statewide supportive housing program proves that supportive housing builds connections to health care through increased primary care visits, specialist visits, mental health outpatient visits, and prescription medications, with our evaluation showing significantly different outcomes between participants and the comparison groups. For supportive housing participants who described years of distrust and disconnection from needed health care, these supportive housing results are a meaningful step toward improved health and stabilization after homelessness.

How We Did It

To understand providers’ successes and challenges during the first years of supportive housing implementation, we collected and analyzed data from supportive housing provider service reports, interviews with providers, and in-depth site visits with providers. To understand Medicaid utilization and cost outcomes, we used a propensity score matching design at the individual level to estimate the effect of supportive housing participation on housing stability and health care utilization and costs reported in state Medicaid claims. We compared supportive housing participants with similar individuals not in the program and ran regressions on the matched sample that controlled for baseline characteristics to measure the difference in outcomes that can be attributed to the supportive housing program.

Additional Materials

As part of this evaluation, Urban conducted site visits in four different communities participating in the statewide pilot and wrote in-depth case studies that offer a closer look at their supportive housing programs, including:

• Denver/Colorado Coalition for the Homeless: This case study looks at how a Denver supportive housing provider connected patients at a recuperative care center directly to housing and examines the successes and challenges with implementing a new pathway to housing for people with high medical acuity and complex needs.
• Greeley/City of Greeley: This case study features a provider that used the supportive housing program to launch one of the first major supportive housing efforts in Greeley, highlighting the successes of their strong team-based model.
• Alamosa/Adelante and San Luis Valley Behavioral Health Care Group: This case study looks at the challenges of implementing supportive housing in a frontier community through the perspectives of two different types of supportive housing provider organizations.
• Colorado Springs/Homeward Pikes Peak: This case study features a supportive housing provider that colocated physical and mental health services in a project-based supportive housing building for families.