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What is Housing First?

Understanding Housing First approaches can help states as they gather evidence-based practices that yield positive health outcomes and cost savings.

Housing First is a proven approach to chronic homelessness that provides individuals and families stable, permanent housing.63 The Housing First approach is an evidence-based model for ending chronic homelessness, keeping homeless individuals and families stably housed, improving health outcomes and reducing the costs associated with avoidable emergency department (ED) visits. The approach does not require sobriety, employment or other stipulations as a condition of their housing, but makes substance use treatment and other services available for individuals if they choose. Numerous studies have demonstrated that Housing First is associated with superior housing retention, decreased substance use, longer engagement in treatment, improved quality of life, lower health system costs and decreased involvement in the justice system compared with treatment as usual.65

*Note: In a study of 250 chronically homeless individuals with severe mental illness, of whom 90 percent had a drug or alcohol problem, over half of those assigned to Housing First opted to utilize voluntary substance use services in the 24 months the study followed the tenants.68

Return on Investment

A study of chronically homeless individuals in central Florida found a total of cost of $31,065 per person per year in inpatient hospitalizations, ED visits, incarceration and other system costs compared with $10,051 per person per year to provide individuals with supportive housing.69

Case Study: Oregon

A 2016 study of Housing First for formerly homeless, high-need individuals in Portland, Oregon, found that one year after housing, residents had improved access to care, stronger primary care connections and improved self-reported health outcomes. Evaluation of Medicaid claims data showed that higher quality care was accompanied by reduced expenditures, primarily in ED and inpatient care. After one year of housing, those with Medicaid showed an average annual reduction in costs of $8,724 per person. Reduced expenditures were maintained in year two of the program.70

Case Study: Chicago

A 2009 study showed that housing and case management for the homeless with chronic medical illness reduced hospital days and ED visits compared to usual care.71