Having a home is critical to a person's health. Medicaid dollars in Washington state are helping bridge the gap between health care and housing.

Apple Health, Washington's Medicaid program, has an initiative called Apple Health And Homes. It's among the first in the nation to provide funds to help certain people on Medicaid find and secure housing.

Matt Christie, a supervisor with the Health Care Authority's Foundational Community Supports program, explained the state is shifting the landscape on how to pay for housing support services.

"The innovative thing that our program did was bring Medicaid into the space of paying for support services as part of someone's health insurance," he said.

Apple Health and Homes is for people who qualify for the Foundational Community Supports program, including folks who are chronically homeless, have behavioral health needs or suffer from substance abuse disorder.

Foundational Community Supports has served more than 35,000 people since 2018, Christie said, and added there are a variety of reasons why health is closely linked to housing.

"If you require medication that needs specific storage, how do you maintain appointments, and even just on a really fundamental level, if you don't have a place to sleep at night, just kind of the impact that has on your physical and mental health over time," he continued.

Scott Tankersley, a program administrator with Foundational Community Supports, said Apple Health and Homes is about more than just finding someone housing, and added his organization follows evidence-based practices from the Substance Abuse and Mental Health Services Administration, ensuring that people find the right community for them.

"That's really critical to Apple Health and Homes and how we pair folks with housing of their choice - to walk forward and build a path to housing stability that's according to someone's choice and preference," he said.


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Virginia has a housing shortage of more than 200,000 units, and one legislative effort backed by a coalition of faith-based groups is trying to fill that gap. A bill introduced in the General Assembly would allow local governments to create a streamlined process for faith groups and other property-tax-exempt nonprofits to build affordable housing.

Sheila Herlihy Hennessee, director of faith organizing for the Virginia Interfaith Center for Public Policy, said congregations run into many different roadblocks when trying to build housing on their land.

"Congregations don't do this every day. A developer might do three or four big housing projects per year. A faith community might do one in a century. This is not their bread and butter, so there's a big learning curve with figuring out how to make that happen," she said.

She added that other issues include resistance from neighbors to increasing population density - and zoning laws across the state that are mostly geared toward single-family housing, and said working around those zoning laws can be arduous and time consuming.

A report by Housing-Forward Virginia and the Interfaith Center finds faith-based organizations own a substantial amount of land - more than 74,000 - in the Commonwealth. That's double the size of Richmond.

Herlihy Hennessee, who also co-authored the report, said the bill would provide the same, streamlined process now used to build affordable housing to other nonprofits.

"So, this very explicitly says, 'Yes, localities, you do have the authority to make the process easier for faith communities. Yes, localities, you can cut down on the NIMBY-ism. Yes, you can make this cost less money and move faster," she explained.

The legislation would also create a pilot program, where faith communities can apply for funds to cover pre-development costs, such as feasibility studies, site plans, architects and more.


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People are increasingly moving into the wildland-urban interface areas, where human development meets wild vegetation, like forests, according to a University of Nevada-Las Vegas expert.

Such landscapes are also notorious for wildfires.

Nicholas Irwin, associate professor of economics at the university, said it is the fastest-growing land use type in the West, which has helped to almost double the number of housing units since 1990.

How do the devastating wildfires in Los Angeles County fit into the picture? Irwin said while wildfires temporarily reduce development, they do not stop it entirely.

"As people start to rebuild, it is going to sort of recede into the background," Irwin pointed out. "The wildfire risk, the risk of building in these areas; people are going to be less concerned about it, which is partly founded in science because after the fires are extinguished and everything, the Pacific Palisades area will not re-catch fire for some time because the fuel load is no longer there."

Irwin and fellow researchers have found if fire hits an area, there is a lull in development for about five years. He argued while insurance companies do a good job thinking about the risks associated with some natural disasters, wildfires are not among them. He stated as a whole, the country is in an "infancy stage" when it comes to modeling wildfire risk, which he wants to see change.

Irwin pointed out in any given year, about 70% to 80% of new residents of Southern Nevada are coming from Southern California. He contended the latest wildfires may lead even more people to relocate and consider setting roots somewhere else.

"Las Vegas is really close and I can see a lot of folks moving here, at least temporarily, which is going to put a lot of pressure on our rental market," Irwin projected. "I could even see some folks moving here for a few years as they start the rebuilding process. We're not just talking about people losing their houses, we're talking about people losing their jobs potentially, their kids losing their schools, and I could see them wanting just sort of to reset."

Irwin emphasized he and others will continue to track the data. He added research shows the median individual who moves from out of state is about 15% wealthier than an in-state Nevada resident, which means they are better able to compete in the housing market.

As urban homelessness and drug use grab the spotlight, rural areas such as Branson are left in the shadows, with critical needs going unmet. But local community organizations are stepping up to provide much-needed support.

Branson has a growing crisis where substance use and homelessness intersect, with about 1,500 people, mostly those who are working but still considered low-income, living in extended-stay motels. An estimated 20% of the population is homeless, and motel living heightens the risk of substance-use and mental-health issues.

Marietta Hagan, project coordinator, Population Health Department with Cox Health, said there are the challenges to addressing these issues in rural areas.

"Lack of transportation in rural areas, lack of that financial and other resources. Branson is considered a rural area, even though we get 9 million visitors a year - we only have a population of 12,000 and the services to support those," she said.

Also, rural areas often have fewer homeless shelters, making it harder for people to find emergency housing or long-term support. Hagan said the good news is, people who have recovered from drug use and homelessness are working together to help those still struggling.

Hagan said it's almost like a multiplying factor - and once a person starts to struggle with issues stemming from poverty, especially in rural areas, it increases their risk of struggling with other issues such as drug use and homelessness - and this leads to stigmas and a lack of support.

"If you live in a small town that has 300 people, and you are labeled as a drug user, you're often ostracized from your community and you're not given that social support and that community that you can turn to maybe when you're struggling with something," she continued.

Between 2022 and 2023, Missouri saw a 12% increase in homelessness and a 24% rise in unsheltered homelessness.


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