The Affordable Care Act Turns 1 

The debate over the Affordable Care Act has covered all angles, both nationally and locally. Some have decried it for reaching too far in some corners, and not far enough in others. Some have lampooned it as an administrative cluster kerfuffle, and others have praised it as a monumental tweak of a system in dire need of help. But, with all the impassioned debate over insurance exchanges, death panels and pre-existing conditions, one question flew under the local radar: Can Obamacare help solve Humboldt's homeless problem?

Local officials believe the answer to that question is yes, largely because they think newly available funding streams under Obamacare will help form one prong of a multifaceted approach to helping homeless people and mitigating their impacts on the community. The idea is to use the new funding to repurpose Eureka's Multiple Assistance Center into an intake facility that gets chronically homeless and mentally ill people off the streets and connected with services before they are ultimately placed into long-term housing.

Known as The MAC, the Multiple Assistance Center was built in 2005, erected out of a partnership between the county, the city of Eureka and the Redwood Community Action Agency. With a capacity of 100 beds, the center integrated short-term housing with case management programs designed to help homeless individuals and families get back on their feet. But the facility relied on a "patchwork quilt of funding," according to RCAA Executive Director Val Martinez, and sputtered when the agency lost a three-year grant that had been used to launch the center.

That left the MAC in a state of crisis and local officials facing the prospect of shuttering a facility they'd built just a few years earlier after an arduous and at times painful public process. The city and county ponied up a combined $200,000 from their general funds to help RCAA keep the center's doors open, but wholesale changes were necessary to put it on sustainable footing.

"That's when we stepped in," said Phil Crandall, director of Humboldt County's Department of Health and Human Services. "We didn't want to lose that brick-and-mortar structure." Working with RCAA, the department repurposed it, turning it into a transitional program solely for families. Crandall said the new MAC model relied on CalWORKs — the state's welfare-to-work program that provides cash assistance to low-income families with children while helping parents find work — a funding stream not open to single adults.

The facility that had opened promising at least 82 beds for homeless people of all types closed its doors to men and women without children. Since its repurposing in 2008, Martinez said the MAC has provided services to up to 18 families at a time, usually housing between 50 and 60 people — half of them children — at any one time. The center is almost always at capacity, she said, with families relying on parenting and life skills classes, job training, education, substance abuse resources and other services for up to two years at a time.

Though Martinez wasn't immediately able to provide data on the program's outcomes, she said it's been successful. But things — including the homeless conversation in Humboldt County — have changed markedly since the MAC repurposed in 2008.

It was just about 16 months ago that Humboldt's most recognizable businessman and political lightning rod, Rob Arkley, convened a packed meeting at Eureka's Wharfinger Building. While the discussion at the meeting meandered and darted all over the map — with some, including Arkley, arguing that Humboldt's generosity and government programs were making it a magnet for the homeless, and others saying more aid and services were the answers to getting people off local streets — there seemed to be a unity in urgency. Numerous officials have pointed to that meeting, which brought together service providers and business owners, as a kind of tipping point.

After that meeting, a group of local stakeholders, including Fourth District Supervisor Virginia Bass and Crandall, began meeting regularly to discuss the issue. The seeds of Eureka's City Homeless Improvement Project, a multifaceted approach to addressing homeless people, were sown. And, some have said it was that meeting that spurred the Eureka City Council to contract with Focus Strategies, a Sacramento-based consulting firm that specializes in helping communities shape programs aimed at ending homelessness. (Numerous officials said Bass has been integral to recent efforts to address homelessness and bring the county and Eureka together on the issue.)

Focus Strategies turned over its final recommendations to the city on Aug. 12, and they were a game changer: "Focus Strategies recommends that the city focus its efforts on solutions that will actually end homelessness, rather than attempting to better manage the problem." In other words, the consultant said Eureka should shift its focus from police sweeps of homeless encampments to developing an infrastructure and programs to get homeless people into long-term housing. It's the same housing-first approach that the U.S. Department of Housing and Urban Development began fervently pushing in 2010 with the idea that giving a homeless person a home gives him or her the stability and security needed to break the cycle of homelessness.

The Focus Strategies paper also preached evidence-based practices, which was music to Crandall's ears. "It's a pretty good document that we could support," he said. "We really need to rely on data and evidence-based practices to give us the best chance to make an impact. The data says that most people placed in rapid rehousing stick, as counterintuitive as that may seem. Most people, given a place to be and reliable access to food and managed care can change, get up and engage. They don't require long-term government intervention."

The policy paper recommended the city work with the county to find ways to tap into Mental Health Services Act funding to provide short-term housing for mentally ill homeless people who aren't being adequately served and consequently place a high burden on local emergency services. Eyes quickly turned to the MAC.

The new vision for the center is to provide short-term care for the county's most chronically and mentally ill homeless adults, filling a void in services. Eureka Police Chief Andy Mills said that, currently, when his officers come across mentally ill people causing a disturbance on the streets, they have three basic options: take them to Sempervirens Psychiatric Hospital if they think they're a danger to themselves or others, book them into jail if they've broken the law or let them go on their way.

EPD and Crandall's department recently announced a partnership that has two mental health professionals — a clinician and a caseworker — teaming up with officers in the field in what's been dubbed the Mobile Intervention and Services Team. The clinician spends a couple days a week on the beat with the officer, reaching out to mentally ill homeless people and trying to connect them with services, and remains on call the rest of the week if needed. The caseworker, meanwhile, follows up with those contacted by the clinician, helping them to develop a treatment plan that may include things like outpatient mental health counseling, medication support, shelter and drug and alcohol treatment.

Mills said his department has identified the 30 people in Eureka who are the top generators of calls for services, and the team will start with them. But for now, the work will have to be done largely on an outpatient basis. The end goal, Mills said, is to funnel these people — if they consent — into the MAC, where they can be stabilized and have their physical medical needs met before being transitioned into more stable housing, whether it be on their own or into a managed-care environment. Crandall said the idea is for folks to stay at the MAC for 30 to 60 days so they can be assessed and have their immediate needs met as a long-term treatment plan is put in place.

Crandall said the new MAC will also accept referrals from the Betty Kwan Chinn Day Center, Sempervirens and other agencies and organizations, with an eye on helping those who are chronically homeless and mentally ill work toward a better life. "It's not just going to be an off-the-street, walk-in facility," he said.

But how big of an impact can an 82-bed facility really have on Eureka's homeless situation? It's unclear, as reliable data is hard to come by. The Point-in-Time Homeless count — a census taken every other year — is fraught with problems, as it relies on volunteers to get homeless people to self-report about their situations. The count, which remains the county's best gauge, found that 600 people were "homeless" in the Eureka area on a single night in 2013, but that number includes people staying in shelters, transitional housing and on friend's couches. When it comes to those truly in the wind, camping in bushes and sleeping on sidewalks, Crandall estimated there are probably around 160, while Mills guessed about 200.

Mills said he's excited about the new partnership with DHHS, and thinks the repurposed MAC's impact could be profound. "To go through those top people who are getting calls for service all the time and get them off the streets would just reduce the visual blight in the community and help people who are truly in a needy place in their lives," he said.

Crandall agreed, but also realizes that opening the MAC's doors to this new population means they close for another. He and Martinez said both DHHS and RCAA staff are working on finding placements for the families currently housed at the center, and an intake program for homeless families seeking assistance in the future.

The plan is to move families out of the MAC but make sure services follow them into more permanent housing. "The funding will go with the family," said Barbara LaHie, DHHS' assistant director of programs. Noting that data supports a housing-first model, Crandall said the change at the MAC might also bring about better outcomes for families. "We don't want to encourage bonding to a program, we want to foster independence," he said.

But fostering independence requires that families and individuals ultimately have a space of their own that they can call home. That means Humboldt County's affordable housing stock needs some bolstering, though Crandall said DHHS will work closely with its 40 partner agencies and organizations to find housing for those who need it.

There are still many moving parts and a lot that needs to be figured out between now and when the MAC transitions this summer but officials say progress has been made and there's cause for optimism moving forward. A big part of that lies in the MAC's new promise of getting some of Humboldt's most at-risk homeless individuals off the streets and connected with services.

To that end, Crandall said DHHS will tap into a lot of funding streams, including HUD, the Mental Health Services Act, prison realignment funds and, likely, even the county general fund. But, he said, this probably wouldn't be possible without the provisions of Obamacare.

"The Affordable Care Act won't fully close the gap, but it's a powerful tool," he said.