Physician assistant Daniel Speller, who works for the nonprofit Healthcare in Action, treats a leg wound on Robert Smith, who is unhoused in Long Beach.
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Angela Hart
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KFF Health News
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Topline:
L.A. County officials are shifting millions from LAHSA, the region's homelessness services agency, to create a new county homelessness department. They say a health-focused program called Housing for Health will be the blueprint.
What is Housing for Health? It’s a division of L.A. County’s Department of Health Services created in 2012 to offer a “prescription for housing” for unhoused Angelenos, who often show up at the emergency rooms and hospitals. The program has grown to serve 57,000 people with a budget of $875 million and more than 600 staff last year.
Why was it chosen? Supervisors leading the move say Housing for Health’s is effective at bringing people indoors. Last year, 37% of people exiting the program’s shelter sites landed in permanent housing, compared with 29% in all shelters across the region. Officials also say Housing for Health scrupulously manages its contracts with nonprofit providers.
Challenges ahead: The new department is expected to have double the staff and budget as the existing Housing for Health program and will take on many of the responsibilities that the regional Los Angeles Homeless Services Authority currently handles. Critics question whether the healthcare-focused program can effectively manage aspects of homelessness services unrelated to medical care.
Read on ... for an in-depth look at Housing for Health.
Los Angeles County is planning to shift more than $300 million in funding away from the regional homeless services agency and toward the county’s first-ever homelessness department.
The blueprint for the new department is an existing county effort known as Housing for Health, which attempts to provide homes and support to people with serious physical or behavioral conditions.
The idea is that once a person has a stable living environment, most other aspects of their lives can become more stable as well, including health.
"From the beginning at Housing for Health, we really have tried to center the people we're serving,” said Housing for Health Director Sarah Mahin. “We will walk alongside someone for as long as it takes to help bring them inside.”
And it’s been successful, county authorities say.
Of the 1,100 clients who left shelters through the Housing for Health program last year, 37% landed in permanent housing, according to the county. By comparison, 29% of those who left shelters within the county’s broader network ended up housed, according to regional data.
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LA County is walking away from LAHSA. Housing for Health is the model for what's next
Citing problems with transparency and oversight, L.A. County voted earlier this month to pull its funding out of the Los Angeles Homeless Services Authority. A series of audits found that LAHSA, which is funded by both the city and county of Los Angeles, had improperly accounted for billions in taxpayer dollars.
Those findings prompted a federal fraud investigation, launched last week.
What the supervisors say
When the Board of Supervisors voted to create a new homelessness department within the county government, they stressed that they wanted it grounded in the idea that housing was key to a person’s overall well-being.
“I want to be clear that this is not more government, it is better government,” said Supervisor Lindsey Horvath at a board meeting this month. “And the gold standard exists right here in the county's Department of Health Services. It's called Housing for Health.”
Horvath led the effort to pull county funding from LAHSA.
“The status quo needs to change,” she said. “When seven people a day die on our streets in Los Angeles County, our need is urgent.”
Supervisor Holly Mitchell, who abstained from the vote to pull out of LAHSA, said she wanted more evidence that a new department would be more effective and accountable.
“I just want us as a policymaking body to make sure that we are using every tool in our toolkit to make sure that what we've created is better than what we're trying to move away from,” Mitchell said.
A homeless person walks by a closed business in Santa Monica.
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Valerie Macon
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AFP via Getty Images
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Bringing people inside
There are more than 75,000 people experiencing homelessness across L.A. County, according to last year’s point-in-time count. The county now has billions in funds from state, federal and local sources that it’s using to address the crisis, including an influx of new sales tax dollars flowing in under Measure A, approved by voters in November.
Housing for Health began in 2012 as a “prescription for housing” for people known to make frequent trips to county-run hospitals for all their healthcare needs. The initial goal was to cut down on costly emergency room visits.
The program expanded in 2017 because of federal dollars from Medi-Cal and county dollars from voter-approved Measure H.
Last year, Housing for Health served 57,000 people with a budget of $875 million and more than 600 staff. Working with various service providers, the program operated 3,200 temporary housing beds and placed nearly 5,000 people into permanent supportive housing, according to the county.
When it comes to housing placement, the program’s performance last year is comparable to L.A. Mayor Karen Bass' Inside Safe, which has also placed 37% of clients who left interim housing into permanent homes since it launched in 2022, according to the city.
Housing authorities also say Housing for Health has shown some success at getting people who have been living on the street into housing after its outreach teams make initial contact. In 2024, the teams connected 6% of people they contacted with housing.
That compares with 2.5% in outreach programs across the region, according to LAHSA.
Many of those programs do not include clinicians — medical professionals who can assess health needs and refer patients to doctors for further treatment.
Fostering a ‘culture of care’
Housing for Health provides homeless services across a spectrum, from prevention to permanent housing.
Its prevention unit has a 90% success rate at keeping clients housed, and 94% of its permanent housing residents remain housed after one year, according to the Department of Health Services.
LAist asked for data it could use to compare those rates to other programs, but LAHSA did not provide it.
Gary Blasi, a retired UCLA law professor who has tracked homelessness policy for more than 40 years, said Housing for Health has a strong “culture of care,” meaning its staff are willing to meet people where they are.
“That’s different from a lot of the so-called human services parts of the county that are really about managing people rather than caring for them,” he said.
Ferrino Norris has experienced that approach firsthand. He said a Housing for Health social worker helped him get medication for bipolar disorder a few years ago.
“He's always supportive to everybody here," Norris said. "He's got a good attitude, personality, everything. He's ... awesome.”
The Star Apartments in Skid Row house more than 100 people with health needs. Housing for Health's offices and flagship clinic are on the ground floor.
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Aaron Schrank
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LAist
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Nearly a quarter of all homeless residents in L.A. County have serious mental illness, and 27% have a substance use disorder, according to data from the 2024 Homeless Point-In-Time Count.
In 2022, UC San Francisco conducted a massive statewide survey of people experiencing homelessness and found that 60% of participants reported having at least one chronic health condition.
Studies show that moving chronically homeless people into permanent supportive housing significantly reduces costs associated with them living on the street.
A 2017 RAND Corporation study found that Housing for Health's permanent supportive housing program saved the county 20% in costs because of fewer hospital visits and jail stays. The average cost per person decreased from about $38,000 in the year before they received housing to $15,000 in the year after.
However, researchers caution against focusing solely on savings. This kind of housing, with intensive case management and medical support, is expensive, and many clients are housed for the rest of their lives.
The RAND study didn’t look at long-term costs.
“The cost will escalate over time,” said RAND researcher Sarah Hunter, who led the study. “You don't always find huge cost savings from these programs. They're more likely to be sort of cost neutral, but you are addressing chronic homelessness, and that's what they were designed to do.”
Accountability and transparency
County supervisors say the feedback they’ve received from service providers is mostly positive. They described Housing for Health’s contracting and accounting practices as “scrupulous” and “hands-on.”
Other observers agreed.
"They follow their protocols very strictly," said Blasi. "If you don't have notes to prove that you provided those services, you're going to have to explain that. I don't think that happens with most of the contractors for the other government agencies.”
A recent audit revealed LAHSA does not monitor its contracts with service providers while those contracts are in effect. In contrast, Housing for Health actively manages each of its service contracts and reviews data continuously, said Mahin, director of Housing for Health.
“We're not just doing it annually,” she said. “We’re doing it every day. We're also on the ground with our providers. We go to their sites and see how things are operating.”
She said providers are required to document every service they provide.
“If they're not providing the minimum level of service, we actually do contractor discrepancy reports and we will recoup payments if they haven't provided the minimum level of service that we expect,” Mahin said.
An apartment building in Pomona leases through the Housing for Health program.
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Matt Tinoco
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LAist
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The road ahead
The new county homelessness department is expected to be fully operational by summer 2026.
L.A. County officials are executing a risky transition: overhauling the entire homeless service delivery system without interrupting critical services. The new department is expected to have double the staff and budget as Housing for Health and will take on many of the responsibilities that LAHSA currently handles.
“It's a monumental administrative and bureaucratic system that they are inheriting,” said Blasi. “A lot of it is not healthcare. There's no reason for administrators in [Department of Health Services] to know anything about monitoring things that have nothing to do with healthcare.”
Some L.A. city leaders, while supportive of Housing for Health, remain skeptical of the county’s move away from LAHSA and toward an entirely new county department.
“What I fear most is that we are moving the money from one bureaucracy to another,” said L.A. City Councilmember Nithya Raman.
The new funding pouring into the county’s coffers through Measure A comes with requirements that the homeless services sector work towards specific goals and allows residents to track progress. The new department will be responsible for that.
“We’re always looking at how we can do things better,” Mahin said. “We don't pretend that we have the answers for everything, or that our system is perfect.”
She continued: “I think this is an exciting step for the county, but it's not a silver bullet.”
LAist reporter Nick Gerda contributed to this report.
