N ews
In SEK, housing is treated as health care; people are getting off the streets
PITTSBURG — Stevie and Brandon Perez could not stay awake any longer. They found two chairs in Mercy Hospital’s intensive care unit waiting room, a place they knew would be open, and they drifted off.
Around 1 a.m., a hospital staff member shook them awake: “You guys gotta go.”
It was time to move again, but this time would be the last.
They were serious.
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Stevie and Brandon mostly walked around at night. They would stay with friends, sleep in people’s yards or camp in public places, sometimes in the shelter of playground equipment.
“It was,” Stevie said, then paused. “It was. It was very degrading.”
They were sick and tired of living on the streets. Cold winters. Glares and murmurs from other residents of Pittsburg. Drug addiction. It had become unbearable. It had become life-threatening.
In Southeast Kansas, which is home to the highest poverty rates in the state, collaborative solutions tailored to the needs of the community have proven successful in addressing homelessness and in shrinking uninsured rates for people like Stevie and Brandon. These programs act as safety nets for people whom traditional systems leave behind. The Community Health Center of Southeast Kansas is one of those safety nets, expanding the definition of health care to consider every aspect of a person’s life, including housing.
Stevie and Brandon, at the time they were homeless, fell into what health care advocates call the coverage gap, which includes the more than 240,000 Kansans who are uninsured because of unaffordable health insurance. The gap is especially prominent in the 10 states, including Kansas, that haven’t expanded Medicaid to include low-income adults without children or disabilities.
A parent or caretaker living in a two-person household and making more than $8,100 a year is ineligible for Medicaid in Kansas. The state spends about $10,000 on each of its roughly 427,000 Medicaid patients each year, but as congressional Republican leaders look to cut federal funding for the program, its future here is uncertain, and advocates fear more people could lose coverage.
About one-third of people in the U.S. who have experienced a bout of homelessness in their lifetime relied on Medicaid, a Kaiser Family Foundation survey found.
In Kansas, relying on Medicaid is nearly impossible. People who experience homelessness, particularly those who don’t stay in a shelter like Stevie and Brandon, often have unmet health needs and are more likely to have chronic diseases, serious mental health challenges or substance use disorders. Without housing or income, health care is often out of reach. That’s especially true when health care for those with housing and income can be unaffordable and inaccessible.
“The stability of the place came first,” Stevie said. “Then we got better physically and mentally.”
Recovering from drug addiction and a persistent pain in her side, which she suspects is from the years of drug use and living outside, only could be addressed once she had a stable place to sleep.
Then came the job, “and then it was like, sky’s the limit,” she said.
Housing as health care
Stevie, 43, was born and raised in Pittsburg, a daughter to a well-off family who took a wrong turn, as she describes it. She is a former pageant kid, which remains evident in her bouncy personality and constant smile. Optimism and gratitude are part of almost every breath, even as she confronts the side effects of homelessness, including rebuilding relationships with her three children.
The first time Becky Gray, the executive director of Building Health Inc. in Pittsburg, met Stevie was at a temporary overnight shelter.
“I was walking in and she held the door open for me,” Gray said. “I said, ‘How are you doing?’ ” “I’m three days sober,” Stevie told her. “And she hasn’t come back,” Gray said. Building Health, a subsidiary of the Community Health Center of Southeast Kansas, was designed specifically with the relationship between housing and health in mind.
“Housing is health care,” Gray said, “and oftentimes homelessness is preceded by poor health.”
Sometimes it causes it. People experiencing homelessness — particularly those living in cars, encampments or makeshift shelters — are at a higher risk of contracting infectious and noninfectious diseases, including HIV, tuberculosis and hepatitis C, according to the Centers for Disease Control and Prevention. They also often face mental illness, alcohol and substance use disorder, diabetes, and heart and lung disease. Homelessness and its side effects shorten a person’s life expectancy by more than 17 years.
Since the 2010 Affordable Care Act authorized Medicaid expansion for low-income adults, experts identified unhoused populations as a group that could benefit from expanded coverage and, in turn, improve public health outcomes. In recent years, the federal government, for the first time, allowed states to use up to 3% of their Medicaid budgets toward specific housing-related services, cementing the link between housing and health. But states have to opt to do so.
Homelessness in Kansas reached its highest number in a decade in 2024, with more than 2,500 people experiencing homelessness on any given night, according to data from the U.S. Department of Housing and Urban Development. Stagnant wages and increasing housing costs have catapulted homelessness numbers in the U.S. since the COVID-19 pandemic.
Building Health was formed in 2020 and is just beginning to get off the ground. Gray has a 15-year plan full of meaningful solutions that enable the community to track new housing units and effects on health outcomes in certain areas. With funding from the federal government and a local philanthropic foundation, the project, dubbed “The Station,” will include 10 rental units for people exiting homelessness with supportive services and an adult education center.
“Our homeless program managers are currently designing courses so that when people who are homeless come into our program, we can, in addition to their housing goals, adjust some of their education and employment goals as well,” Gray said.
That includes a model kitchen to prepare people for hospitality jobs and basic courses on how to set up an email account and create a digital calendar. The $4 million project also plans to fund street outreach and access to showers, lockers, laundry machines, telehealth visits and mental health care.
Kansas is at a point, in Gray’s mind, where large-scale change is possible. That’s because statewide organizations have shifted from competition to collaboration, Gray said. Pittsburg is operating as a pilot program, meaning its approach to addressing homelessness is set to be replicated across the state.
