Despite constraints, mainstream programs should be encouraged to collect data on living arrangement (or homeless status) at time of enrollment, and periodically, to collect more in-depth information about homeless individuals served as part of special surveys or studies. Recognizing the difficulties faced by the mainstream programs in making changes to their well-established data sets, it would be very useful to work with mainstream DHHS programs to: (1) add a single data element to data systems that would capture living arrangement or homeless status at the time of program enrollment in a consistent manner across programs; (2) provide the mainstream programs with a common definition of what constitutes homelessness and, if possible, the specific question(s) and close-ended response categories that programs should use in tracking homelessness; and (3) if mainstream programs conduct a follow-up interview or survey with participants, request that they include a follow-up question relating to homelessness or living arrangement. Two of the four mainstream programs Head Start and the Health Centers Cluster already track homeless individuals served as part of their current grantee reporting systems. These two programs demonstrate the feasibility of mainstream programs tracking homeless individuals served. In the case of these two programs, it would be beneficial if a common definition of homelessness was used and if the same question(s) and response categories were asked of program participants at the time of intake.
The other two mainstream programs Medicaid and SAPT extend considerable flexibility to grantees to track homelessness or living arrangement if they desire to do so, but do not require these data to be submitted the federal government. With respect to SAPT, it makes sense to negotiate with states to expand use of the TEDS supplemental data set, which provides an indicator of living situation at the time of enrollment. In addition, as noted above, to the extent possible, it would be desirable to use a common definition of homelessness, as well as common question(s) and response categories.
Medicaid is a special case. The sheer size of the Medicaid program and high costs associated with adding new data elements to the MMIS, may simply not make it possible to track homelessness at the time of enrollment as part of the MMIS. However, addition of an indicator of homeless status at the time of enrollment would be very useful especially given the very large number of beneficiaries of the program. As a first step, inquiries should be made to states to determine which states/localities may already be tracking homelessness as part of their intake forms or state data systems. Such an inquiry would be helpful both from the standpoint of determining the extent to which states/localities are already collecting such data, as well as determining potential advantages and drawbacks of collecting data relating to homelessness or living arrangement. Further discussions are also needed with Medicaid program officials to determine when the next round of changes to the MMIS is expected, as well as the steps required to include tracking of homeless individuals served. One of the critical advantages of adding a variable that would identify an individuals living arrangement at the time of intake is that given that the system collects individual (beneficiary) data, it would be possible to not only generate an overall count of the numbers of homeless Medicaid beneficiaries, but also to conduct more in-depth analyses of characteristics, services received, and costs of services for participants according to living arrangement at the time of entry into the program.
For all four of the mainstream programs and the four homeless-serving programs, a step beyond collecting homeless status or living arrangement at the time of enrollment would be to collect such data at the time of exit from the program or at some follow-up point following enrollment or termination from the program (e.g., 6 months, 12 months, or later). However, determining a convenient follow-up point to interact with the participant may be difficult or impossible in these programs. With regard to collecting homeless or living arrangement status at a follow-up point, it may be best to focus (at least first) on implementing such follow-up measures in the homeless-serving programs, where long-term housing stability is a critical program objective.
Finally, where collection of information about homeless status either at the time of enrollment or some follow-up point prove either impossible to obtain or too costly, DHHS should consider potential opportunities for collecting data on homelessness as part of special studies or surveys. Several of the mainstream programs (as well as the homeless-serving programs) are periodically the subject of either special studies or survey efforts. For example, the Head Start program has implemented the FACES survey, which is conducted in 3-year waves on a sample of over 3,000 children and families served by 40 Head Start centers. Working with a sample, rather than in the universe in large programs such as Head Start (nearly 1 million children) and Medicaid (about 40 million beneficiaries) has great appeal from the standpoint of reducing burden and data collection costs. In addition, such smaller survey efforts may present an opportunity for including many more specialized questions (e.g., concerning homelessness) and tracking change in housing situation over time (i.e., pre/post comparisons).
(17) Medicaid mandatory groups include: low-income families with children meeting TANF eligibility, Supplemental Security Income (SSI) recipients, infants born to Medicaid-eligible women, low-income children (under age 6) and pregnant women, recipients of adoption assistance and foster care, and certain low-income Medicare beneficiaries. Categorically needy groups include: income pregnant women, certain aged, blind or disabled adults, low-income children under age 21 that are not eligible for TANF, low-income institutionalized individuals, persons who would be eligible if institutionalized but are receiving care under community-based services waivers, recipients of state supplementary payments, and low-income, uninsured women screened and diagnosed and determined to be in need of treatment for breast or cervical cancer.
(18) RHY program similarly focuses on youth though Head Start focuses services on a much younger age cohort (3-5) and is much more focused on developmental activities and getting very young children onto the right path.
(19) The Head Start Bureau initiated a redesign of the PIR in 2001 (the PIR Redesign Project) that led to the major revamping of the PIR report for the 2002 enrollment year. As part of this redesign, three measures related to homelessness were added to the PIR.
(20) Head Start centers submit aggregate data to the federal government as part of the PIR (i.e., participant-level data are not submitted).
(21) Because homelessness is not a condition that relates to being eligible for Medicaid benefits, it is not a data element reported by states through the MMIS to the federal government.
(22) Given the very large number of beneficiaries of the Medicaid program (about 40 million), homeless individuals likely make up a relatively small proportion of total Medicaid beneficiaries.
(23) Though not shown on the exhibit, Head Start has specific targets for each goal e.g., under the objective of children demonstrate improved emergent literacy, numeracy and language skills among the targets set are achieve at least an average 34 percent gain (12 scale points) in word knowledge for children completing the Head Start program.