There is no cure for homelessness. There are just too many causes for a single remedy to end this problem. However, we do know a lot about homelessness. And we can do a lot to treat this.

There is significant drug abuse, unemployment, legal problems with recidivism, poverty and lots of mental illness. In fact, as an emergency room physician who treats homeless patients every day, I see mental illness as either the direct cause or a major contributor to most who are homeless.

On my last shift, I treated a homeless psychotic patient out of his medications, a homeless schizophrenic woman with garbage bags she was using for shoes and a disheveled young man found down in a park due to a heroin overdose. All of these patients are homeless, all of them have significant mental illness and all of them can be helped with mental health care. None of them had a regular doctor and none of them had health insurance. These unemployed single adults do not qualify for Medicaid under current Utah Medicaid rules.

Last week, in the special legislative session, we passed a bill to authorize almost $5 million to fund the Rio Grande operation that is directed at homelessness. The money goes mostly to increased law enforcement, more jail beds and opening some residential treatment beds. Now there are noticeably fewer homeless on the downtown streets.

About 30 treatment beds are filled with new patients. So, this is a good start. However, we will need hundreds more treatment beds to address this population, many more jail beds and permanent increased law enforcement and medical care. We will need at least an additional $60 million to be funded in 2018 under the Rio Grande plan to treat the homeless. This is a huge amount of taxpayer dollars. Where will it come from?

The tentative plan is that Utah obtain about 70 percent of this from federal funding via a Medicaid waiver (expansion) now pending with the Department of Health and Human Services. Without this vital Medicaid waiver, the plan will be difficult or impossible to carry out and the homeless problem will just get worse.

I recently travelled to Washington, D.C., and met with leaders of HHS and once again emphasized our need for this Medicaid waiver. Hopefully, they will favorably rule on this and we can proceed with this vital project.

Further, the final Graham-Cassidy Senate bill on health reform has failed. Therefore, we as a nation will continue under the ACA/Obamacare for the foreseeable future. Moreover, Utah has the ongoing option to expand Medicaid. Currently, Utah pays $600 million-plus in Utah taxes annually to fund the ACA, without getting the big benefits we could have had under a Medicaid expansion. Had we expanded Medicaid previously, we would have received an additional $1.5 billion dollars already for the medical care of the poor, homeless and mentally ill Utah citizens. As a result, we have lost lives, jobs and have the growing problem of the poor and homeless. We need to reconsider our policy on this vital issue.

We need a Utah expansion of Medicaid. In March, HHS has promised us flexibility in our expansion request, so we can craft our expansion the Utah way. An expansion will provide vital health insurance to thousands of the uninsured. It will save lives and treat thousands with mental illness and substance abuse. It will treat homelessness and keep many of our fellow citizens off the streets.

Utah state Sen. Brian Shiozawa, a Salt Lake City Republican, represents the 8th District in the Utah Senate.



