Guest Commentary written by
Dalma Diaz
Dalma Diaz is a health equity fellow at the California Health Care Foundation and a public voices fellow at the OpEd Project.
Few can challenge the wisdom of prescribing medications for life-threatening health conditions. Yet many would balk at the suggestion of “prescribing” housing, even though research and lived experience show us that homelessness is a life-threatening condition in the U.S.
What might happen if we prescribed housing when supply shortages, rental costs and health emergencies push millions of adults and families to the brink of losing their homes? Through recent Medicaid reforms, California has opened the door for the growth of street medicine and recuperative care, and is now seeking a waiver to provide limited rental subsidies.
Few states have gone as far as California, which is reimagining how its Medicaid program, Medi-Cal, can expand to better meet social needs — particularly those who are older, live with behavioral health conditions or experience homelessness. CalAIM attempts to address the social determinants of health, a framework that tells us health-related behaviors (like smoking and diet), socioeconomic and environmental factors account for more than 80% of what actually impacts our health and wellbeing.
The cornerstone that supports the other social determinants: housing. Access to nutritious food, job opportunities, health coverage, social benefits and more presume each person has a physical place where they can store their food, take showers and receive mail — which is often needed to receive treatment or services.
My own life would have been very different without affordable housing. On a flight back from Guatemala, after spending our first Christmas and New Year’s in my parent’s home country, my dad experienced a life-threatening health emergency. He was hospitalized for two months and spent many more in recovery.
He was the sole breadwinner of a family of four living in Los Angeles. Yet the one thing my mom did not have to worry about was keeping a roof over our heads. Since we lived in a subsidized rental apartment, rent was capped at 30% of our family’s income — even if that was near zero.
Our housing was a lifeline. It meant that my family, which included two children under 12 — one with a developmental disability — had a stable place to live during one of the most frightening and precarious moments of our lives.
Unfortunately, this is not the case for most Californians.
A comprehensive study by UCSF found that health emergencies increase an individual’s risk of becoming homeless: Nearly one-third of people indicated that they lost their home because of a health-related reason.
Experiencing homelessness itself also takes a toll on health — about 45% of the study’s participants reportedly had fair or poor health. That means they are at a higher risk of hospitalization or death.
In the same study, most participants said that interventions such as financial assistance could have prevented their homelessness, overwhelmingly believing that modest monthly subsidies or rental assistance would have kept them off the streets.
My own experience highlights how affordable housing makes the difference during a crisis and keeps people housed and in recovery.
To be sure, in the face of high housing costs, increasing poverty rates, and physical and mental illness exacerbated by social and economic factors, solving homelessness entirely is beyond Medi-Cal’s sole responsibility or reach. But with an issue this complex and urgent, we cannot afford to dismiss any contribution to keeping individuals and families housed.
Much work remains ahead, and many of these initiatives are in their infancy. But the opportunity to write a prescription for housing could soon be possible.