[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]


                          MAKING HUD-VASH WORK
                      FOR ALL VETERAN COMMUNITIES

=======================================================================

                                HEARING

                               BEFORE THE

                  SUBCOMMITTEE ON ECONOMIC OPPORTUNITY

                                 OF THE

                     COMMITTEE ON VETERANS' AFFAIRS

                     U.S. HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                       TUESDAY, JANUARY 14, 2020

                               __________

                           Serial No. 116-51

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]       


                    Available via http://govinfo.gov
                    
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
48-956                     WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------                     
                  
                     COMMITTEE ON VETERANS' AFFAIRS

                   MARK TAKANO, California, Chairman

JULIA BROWNLEY, California           DAVID P. ROE, Tenessee, Ranking 
KATHLEEN M. RICE, New York               Member
CONOR LAMB, Pennsylvania, Vice-      GUS M. BILIRAKIS, Florida
    Chairman                         AUMUA AMATA COLEMAN RADEWAGEN, 
MIKE LEVIN, California                   American Samoa
MAX ROSE, New York                   MIKE BOST, Illinois
CHRIS PAPPAS, New Hampshire          NEAL P. DUNN, Florida
ELAINE G. LURIA, Virginia            JACK BERGMAN, Michigan
SUSIE LEE, Nevada                    JIM BANKS, Indiana
JOE CUNNINGHAM, South Carolina       ANDY BARR, Kentucky
GILBERT RAY CISNEROS, JR.,           DANIEL MEUSER, Pennsylvania
    California                       STEVE WATKINS, Kansas
COLLIN C. PETERSON, Minnesota        CHIP ROY, Texas
GREGORIO KILILI CAMACHO SABLAN,      W. GREGORY STEUBE, Florida
    Northern Mariana Islands
COLIN Z. ALLRED, Texas
LAUREN UNDERWOOD, Illinois
ANTHONY BRINDISI, New York

                 Ray Kelley, Democratic Staff Director
                 Jon Towers, Republican Staff Director

                  SUBCOMMITTEE ON ECONOMIC OPPORTUNITY

                    MIKE LEVIN, California, Chairman

KATHLEEN M. RICE, New York           GUS M. BILIRAKIS, Florida Ranking 
ANTHONY BRINDISI, New York               Member
CHRIS PAPPAS, New Hampshire          JACK BERGMAN, Michigan
ELAINE G. LURIA, Virginia            JIM BANKS, Indiana
SUSIE LEE, Nevada                    ANDY BARR, Kentucky
JOE CUNNINGHAM, South Carolina       DANIEL MEUSER, Pennsylvania

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public 
hearing records of the Committee on Veterans' Affairs are also 
published in electronic form. The printed hearing record remains the 
official version. Because electronic submissions are used to prepare 
both printed and electronic versions of the hearing record, the process 
of converting between various electronic formats may introduce 
unintentional errors or omissions. Such occurrences are inherent in the 
current publication process and should diminish as the process is 
further refined.
                         
                         C  O  N  T  E  N  T  S

                              ----------                              

                       TUESDAY, JANUARY 14, 2020

                                                                   Page

                           OPENING STATEMENTS

Honorable Mike Levin, Chairman...................................     1
Honorable Gus M. Bilirakis, Ranking Member.......................     2

                               WITNESSES

Mr. Keith Harris, National Director of Clinical Operations, VA 
  Homeless Program Office, U.S. Department of Veterans Affairs...     4

Mr. Hunter Kurtz, Assistant Secretary of Public and Indian 
  Housing, U.S. Department of Housing and Urban Development......     6

Mr. Steve Berg, Vice President for Programs and Policy, National 
  Alliance to End Homelessness...................................    21

Ms. Kathryn Monet, Chief Executive Officer, National Coalition 
  for Homeless Veterans..........................................    23

Mr. Greg Anglea, Chief Executive Officer, Interfaith Community 
  Services.......................................................    25

Ms. Tamera Kohler, Chief Executive Officer, San Diego's Regional 
  Task Force on the Homeless.....................................    26

Mr. Gary Cooper, Chairman of the Board of Directors of NAIHC, 
  Executive Director of the Housing Authority of the Cherokee 
  Nation.........................................................    28

                                APPENDIX
                    Prepared Statement Of Witnesses

Mr. Keith Harris Prepared Statement..............................    39
Mr. Hunter Kurtz Prepared Statement..............................    43
Mr. Steve Berg Prepared Statement................................    46
Ms. Kathryn Monet Prepared Statement.............................    55
Mr. Greg Anglea Prepared Statement...............................    59
Ms. Tamera Kohler Prepared Statement.............................    62
Mr. Gary Cooper Prepared Statement...............................    65

 
                          MAKING HUD-VASH WORK
                      FOR ALL VETERAN COMMUNITIES

                              ----------                              


                       TUESDAY, JANUARY 14, 2020

              U.S. House of Representatives
               Subcommittee on Economic Opportunity
                             Committee on Veterans' Affairs
                                                   Washington, D.C.
    The subcommittee met, pursuant to notice, at 10 o'clock 
a.m., in room 210, House Visitors Center, Hon. Mike Levin, 
presiding.
    Present: Representatives Levin, Brindisi, Pappas, Lee, 
Bilirakis, Bergman, Barr.

           OPENING STATEMENT OF MIKE LEVIN, CHAIRMAN

    Mr. Levin. Good morning.
    Without objection, the chair is authorized to call a recess 
at any time.
    Today's hearing is entitled, ``Making HUD-VASH Work for all 
Veteran Communities.''
    HUD-VASH is a permanent, supportive housing program jointly 
administered by The Department of Housing and Urban Development 
and the Department of Veterans Affairs.
    This hearing will focus on whether veterans around the 
country have equitable access to the housing resources and the 
wraparound services provided by HUD-VASH--so critically 
important. You know, last week, we talked about making sure 
that no veteran goes hungry. This week we will talk about 
making sure that no veteran goes without a decent place to call 
home.
    Specifically, today's hearing will examine access to HUD-
VASH in urban, suburban, rural, and tribal communities, and 
work to determine what barriers and bottlenecks exist in 
delivering resources to communities of all sizes. This hearing 
continues the work the committee conducted during field 
hearings in our districts--in the ranking member's district in 
Florida and in my district in California--during the summer of 
2019. I am sorry that we couldn't quite bring the weather from 
California or Florida, but we will have to make do.
    One of our subcommittee's goals is to end the veterans' 
homelessness epidemic plaguing our country--so critically 
important. I have said it before and I will say it again: One 
homeless veteran is one too many.
    One of the most efficient methods for reducing veterans' 
homelessness is to intervene when a veteran is at risk of 
homelessness and support them through their period of crisis. 
Right now, we are not good enough at identifying at-risk 
veterans and connecting them with services before they become 
homeless--critically important.
    When veterans do slip through the cracks and become 
homeless, it is vitally important that our Nation has an 
effective method to get them off the street and back into safe 
and reliable housing.
    Over the years, HUD-VASH has proven to be a highly 
effective tool in reducing veterans' homelessness. Since 2010, 
the number of veterans experiencing homelessness has declined 
by 46 percent and the number of unsheltered veterans had 
declined by 53 percent. Without this crucial program, we would 
not have seen such a tremendous reduction in veteran 
homelessness.
    So far, more than 11,000 veterans have found permanent 
housing and critically needed support services through the HUD-
VASH program. Each HUD-VASH voucher has increased permanent 
support of housing units and decreased the number of homeless 
veterans. Despite the effectiveness of this program and the 
perpetuation of veteran homelessness, the administration has 
not requested additional HUD-VASH vouchers in the last 2 years.
    According to the 2019 Point-in-Time count, which counts the 
number of homeless individuals on one of the coldest nights in 
the year, there were over 37,000 homeless veterans, of which 
14,000 were unsheltered.
    We must continue investing in HUD-VASH, but we also know 
there are some shortcomings to the program and that is why we 
are here today. We are here, specifically, to examine how 
staffing shortages in VA can lead to increased processing time 
before veterans receive their vouchers.
    We also want to examine the unique hurdles facing different 
communities regarding how HUD-VASH vouchers and supportive 
services are distributed. We know that densely populated areas 
tend to have higher costs of living and less-affordable housing 
stock, which can manifest in veterans struggling to find 
suitable housing.
    We know that rural areas may not have as many employment 
opportunities and adequate public transportation for veterans 
to seek and maintain gainful employment.
    We know that tribal communities face far are more 
regulatory hurdles than any other community.
    We have a responsibility to abolish chronic homelessness 
for veterans and strengthening the HUD-VASH program is an 
important first step.
    I look forward to hearing the testimony from our witnesses 
on how we can do that.
    With that, I now recognize my friend, the Ranking Member, 
Gus Bilirakis, for 5 minutes.

     OPENING STATEMENT OF GUS M. BILIRAKIS, RANKING MEMBER

    Mr. Bilirakis. Thank you, Mr. Chairman.
    I appreciate it. Thank you so much for holding this 
hearing--a very important hearing. It affects all our 
districts. I also want to thank the witnesses for testifying 
today.
    Mr. Chairman, I thank everyone, again, for joining us today 
for the very important hearing of the Subcommittee on Economic 
Opportunity--house committee--obviously the subcommittee on 
Veterans Affairs on the HUD-VASH program. While homelessness is 
an increasing problem in some communities across the country, 
and I would say in a vast majority of the communities across 
the country, there is no denying that there has been 
significant progress made nationwide in reducing homelessness 
among veterans.
    Since 2010, the number of homeless veterans that you said, 
Mr. Chairman, in the United States has declined by nearly half. 
The most recent Point-in-Time count shows that veteran 
homelessness has dropped by 2 percent since 2018. It is 
progress, but there is more work to be done.
    Several municipalities have even eliminated veteran 
homelessness altogether. While this is good news, as funding 
for homeless veterans programs at the VA and the Department of 
Labor has reached our record levels, we must--there has been 
great funding, but we have got to do more--we must ensure that 
we have a true picture of how this money is being spent.
    As the chairman mentioned, this hearing is a follow up to 
two field hearings that we held on veterans' homelessness 
programs; one in North County--San Diego--in the chairman's 
district, and one in Pasco County, Florida, in my district. 
These field hearings prove to me that while significant 
progress has been made, we still have a long way to go to 
ensure that none of the estimated 37,000 veterans who were 
homeless last year remain living on the street.
    It is important to provide veterans with immediate and 
rapid housing through the VA's HUD-VASH housing voucher 
program; however, I also believe it is even more critical for 
the long-term success of these veterans that they also receive 
the comprehensive and wraparound services that are a part of 
this voucher program, as required by law.
    Our goal should always be to help those veterans in need 
find meaningful employment that will eventually allow them--no 
longer require them government--for them to have government 
assistance, because, you know, dignity and pride--veterans are 
very proud people, and I do have some other comments off that, 
but I will reserve them until later. Without helping homeless 
veterans with wraparound services or finding meaningful 
employment, we are only providing government-funding housing 
and we are failing to set these veterans up for positive, long-
term success.
    As we heard in California and in Florida, the lack of 
affordable housing, the residents expressing the ``not in my 
backyard'' sentiment, substance abuse, and other clinical 
factors contribute to homelessness. That is why I am so glad 
that we have groups like the National Coalition for Homeless 
Veterans (NCHV) here with us today that represent innovative 
providers who offer critical wellness and clinical services for 
homeless veterans in need.
    Like the debate the full committee has been having on 
providing services to veterans in crisis who are not connected 
to the VA, we should continue to look at innovative programs 
that are providing services to veterans who are not necessarily 
in the VA system and who are not hampered by government 
regulation and barriers to success, and that is so important, 
to think outside the box.
    Additionally, I am interested to hear from VA, why they are 
not providing more widely used--using the authority they have 
to contract out the case management positions for HUD-VASH 
participants. We will hear from many witnesses today about the 
difficulty of hiring and retaining VA case managers in this 
program.
    It is clear to me that one way around the bureaucratic 
hiring process is to contract with local agencies or nonprofits 
that already know how to do this work in the first place. I 
look forward to discussing that issue with our veterans today 
and I am grateful to our witnesses for giving us an opportunity 
to hear directly from those on the ground fighting against 
veterans' homelessness.
    Today, I hope to hear what works, what is not working, and 
how we in Congress can help combat this problem. Everyone here 
shares the same common goal: To guarantee that those who have 
worn the cloth of our great nation never have to worry about 
becoming homeless.
    Once again, I thank the chairman for holding this hearing 
and I will yield back. Thank you.
    Mr. Levin. I thank the ranking member. We absolutely share 
that goal. It was great to be able to have those hearings in 
both of our districts and see the commonality, the important 
issues that exist in both places, so I am very grateful.
    With that, I would like to introduce our witnesses, and I 
am very grateful to you, also. We have got some excellent 
experts on the second panel and we will hear from them shortly, 
but before that, I look forward to hearing from the important 
and appropriate people within the administration who administer 
this program.
    On the first panel we have got Keith Harris, the national 
director of clinical operations at VA's Homeless Program 
Office.
    Thank you, Dr. Harris, for being here.
    I also want to thank HUD for joining us today to discuss 
this important topic. From HUD we have Hunter Kurtz, assistant 
secretary of Public and Indian Housing.
    Thank you Assistant Secretary Kurtz.
    Thank you--and as you know, you will have 5 minutes for 
your oral statement, but your full written statement will be 
added to the record.
    With that, Dr. Harris, you are now recognized for 5 
minutes.

                   STATEMENT OF KEITH HARRIS

    Dr. Harris. Thank you, sir.
    Good morning, Chairman Levin, Ranking Member Bilirakis, 
distinguished members of the subcommittee. Thank you for the 
opportunity to testify today on the topic of veteran 
homelessness and the HUD-VASH program.
    VA remains fully committed to the goal of preventing and 
ending veteran homelessness and we remain committed to doing 
this work, jointly and collaboratively, with our Federal, 
State, and local government partners, along with our non-
governmental partners. Several of these are here today; our 
close partner, HUD, on this panel with me.
    On the second panel, as you noted, the National Alliance to 
End Homelessness, the National Coalition for Homeless Veterans 
are important national homeless advocates, regular partners to 
us in our work. Interfaith Community Services, the Housing 
Authority of the Cherokee Nation, and the San Diego Regional 
Task Force are important local partners who provide critical 
services in their respective communities.
    We recognize that ending veteran homelessness is not a 
single event in time; rather, it is a deliberate effort made to 
achieve the goal and continued follow up efforts to make sure 
that progress is sustained. Our goal is a systematic end to 
veteran homelessness and we have collectively made significant 
progress in this respect, as you both noted.
    The most recent Point-in-Time count estimated that on a 
single night in January 2019, a little over 37,000 veterans 
were experiencing homelessness, a 2-percent reduction from the 
prior year.
    Since 2010, again, as you both noted, the number of 
homeless veterans has declined by nearly half. I think it 
should be noted, this dramatic decline of 50 percent for 
veterans comes against a backdrop where the general homeless 
population has declined 11 percent over the same time period. 
It is clear that our approach to ending veteran homelessness is 
working.
    One of VA's most important resources for ending veteran 
homelessness is the HUD-VASH program. HUD-VASH is a 
collaborative program between HUD and VA, in which HUD provides 
eligible homeless veterans with a Housing Choice rental voucher 
and VA provides case management and supportive services.
    HUD-VASH is a permanent, supportive housing program which 
helps homeless veterans move rapidly into housing without 
preconditions, while concurrently providing case management, 
supportive services, and treatment so that veterans can gain 
housing stability and recover from physical and mental health 
problems, substance use disorders, and other issues 
contributing to or resulting from homelessness.
    The program aims to help veterans and their families gain 
stable housing while promoting full recovery, independence, and 
self-sufficiency in their communities.
    HUD-VASH is a powerful tool in our efforts to end veteran 
homelessness and it has, indeed, made a dramatic impact, 
particularly, among historically vulnerable homeless 
subpopulations; this includes the chronically homeless 
veterans, aging veterans, women veterans, all in the standard 
HUD-VASH program, Native American veterans in the Tribal HUD-
VASH Program.
    Among those acutely vulnerable are chronically homeless 
veterans that HUD-VASH has long-targeted. We have seen a 22-
percent decline since 2015. Three-quarters now of Continuums of 
Care report 20 or fewer chronically homeless veterans remaining 
in their communities, yet so much remains to be done.
    With HUD's most recent voucher allocation, there are now 
over 100,000 vouchers allocated nationally and over 22,000 of 
these are currently unleased. Even after accounting for 
veterans in the voucher pipeline and vouchers dedicated to 
project-based development, there are still over 14,000 unused 
vouchers, nationally. With over 37,000 veterans still homeless 
on any given night, this is too much unused vouchers and we are 
fully committed to ensuring we maximize the use of this 
valuable resource.
    I provided explanations and examples in my written 
testimony of strategies VA and HUD are adopting to increase 
voucher utilization and I am happy to discuss those here today, 
as well. One critical strategy is increasing the number of case 
managers in HUD-VASH and I want to say here for the record, 
that VA recognizes the importance of hiring case managers and 
is committed to filling case manager vacancies wherever 
possible.
    Along with the lack of affordable housing, case management 
capacity is unquestionably one of the main rate-limiting 
factors in voucher utilization.
    As a jointly run program between two Federal agencies, HUD-
VASH receives its funding from two separate appropriations 
committees. HUD has received additional money for vouchers 
every year since the program's inception in 2008. Using medical 
services appropriations, VA has been sufficiently able to keep 
its average caseload size at 25 veterans per case manager, but 
with HUD's most recent voucher allocation, caseload sizes will 
increase.
    To this end, we remain grateful for the resources Congress 
provides VA to care for veterans; particularly, HUD-VASH 
resources which are crucial to ending veteran homelessness. We 
pledge to do all we can do ensure these resources are used as 
effectively and efficiently as possible.
    Thank you for the opportunity to appear before you today to 
discuss this invaluable program, and I look forward to your 
questions.

    [The Prepared Statement Of Keith Harris Appears In The 
Appendix]

    Mr. Levin. Thank you, Dr. Harris.
    Assistant Secretary Kurtz, you are now recognized for 5 
minutes.

                   STATEMENT OF HUNTER KURTZ

    Mr. Kurtz. Thank you.
    Good morning, Chairman Levin, Ranking Member Bilirakis, and 
members of the subcommittee.
    It was a pleasure to testify before the Subcommittee on 
Economic Opportunity this summer and I look forward to 
answering your questions that the subcommittee has today on the 
important issue of ending veterans' homelessness and the 
efforts by the Department of Housing and Urban Development, as 
well as our Federal partners, to accomplish this.
    HUD is committed to ending veterans' homelessness by 
working collaboratively with our partners and maximizing the 
effectiveness of all existing resources. Funding from Congress 
and close collaboration at the Federal and local level, that 
has pushed the Nation to continue to make progress in 
addressing veterans' homelessness, and creating sustainable 
Federal and local systems that quickly respond to homelessness.
    Together, we have made a measurable impact in reducing the 
severity of this issue. Based on the most recent Point-in-Time 
count, or PIT count, veterans' homelessness has decreased by 
2.1 percent or about 800 veterans last year; additionally, we 
are finally able to say that since 2010, veterans' homelessness 
has declined by 50 percent. This kind of reduction is historic 
and HUD-VASH has been the primary reason for this progress.
    HUD-VASH is part of the Housing Choice Voucher or HCV 
program in the Office of Public and Indian Housing. The HCV 
program currently houses over 2.2 million families nationwide. 
HUD-VASH is the only Public Indian Housing (PIH) program 
dedicated to homeless veterans; however, many formerly--excuse 
me--however, many formerly homeless families, including 
veterans' families, are assisted in the regular Housing Choice 
Voucher (HCV) and public housing programs.
    The HUD-VASH program has been very successful in its 
approach to addressing veterans' homelessness. Since 2008, over 
170,000 veterans and their families have been moved into 
housing with the HUD-VASH voucher. As of October 1st, more than 
77,000 veterans and their families are currently housed with a 
HUD-VASH voucher.
    Every year since 2008, HUD and the VA have collaboratively 
awarded new HUD-VASH vouchers based on geographic need and 
administrative capacity. In Fiscal Year 2019, HUD and the VA 
looked at the HUD-VASH utilization rate of a specific Public 
Housing Agency (PHA), when considering the entity for an award.
    In total, more than 100,000 HUD-VASH vouchers have been 
awarded to more than 600 PHAs between 2008 and 2019. HUD-VASH 
can only be used after a PHA receives a referral from its local 
Veterans Affairs medical center or a designee. HUD is very 
aware that the VA is working to address the health and well-
being of millions of veterans nationwide.
    HUD-VASH was originally designed to serve highly acute, 
chronically homeless veterans who need intensive case 
management. Over the years, the chronically homeless veterans 
population has declined, while the number of vouchers has 
continued to climb; therefore, HUD is interested in efforts by 
the VA to broaden the targeting of HUD-VASH vouchers to other 
populations beyond the chronically homeless veterans.
    We continue to fulfill our commitment to help tribes with 
veterans' homelessness, as well. The Tribal HUD-VASH 
Demonstration Program follows the same structure as the regular 
HUD-VASH program, providing rental assistance and supportive 
services to veterans who are Native Americans and experiencing 
homelessness or at risk of homelessness.
    As of the end of 2019, approximately 500 Native American 
veterans have received case management services under the 
Tribal HUD-VASH Program. A great deal of progress has been made 
in the way we work together to address veterans' homelessness; 
however, we acknowledge there is still a lot of work to be 
done.
    The HUD-VASH program continues to be a model for 
interagency collaboration and one of the best tools that we 
have for ending veterans' homelessness. We continue to find 
ways to maximize the effectiveness of HUD-VASH, while also 
assisting communities in utilizing their available homeless--
sorry--homeless resources.
    Thank you for your time and I look forward to your 
questions.

    [The Prepared Statement Of Hunter Kurtz Appears In The 
Appendix]

    Mr. Levin. Thank You, Assistant Secretary.
    With that, I recognize myself for 5 minutes to begin the 
question portion of the hearing.
    You know, after field hearings in my district, in the 
ranking member's district, in conversations with many of you 
and other discussions with experts, some of whom are here in 
the audience, it is clear to me that the HUD-VASH program is 
working, but that it can be made to work even better.
    One of the statistics that really is striking to me, which 
you referenced again, the number of unused vouchers--it is a 
stunning number. Dr. Harris, in your testimony, you acknowledge 
one key reason for this is that 16 percent of VA case 
management positions are vacant. I appreciated during your 
opening statement, your commitment to filling vacancies 
whenever possible, but I want to dig into that a little bit.
    What steps are you and VA taking to help address the 
staffing limitations, with respect to HUD-VASH case managers?
    Dr. Harris. Thank you for the question, Chairman.
    A variety of steps are being taken and the first one is 
that enterprise-wide, VA H.R. is working to modernize its 
hiring efforts and the goal is to reduce the time it takes 
through recruitment to onboarding. A big part of that is 
consolidating H.R. efforts at the network level and away from 
each medical center. Places where we have seen this already 
begin have already begun to demonstrate improvements in the 
hiring rates and the time it takes. That is a big one for us.
    Additionally, we are encouraging, and medical centers are 
free to use and are being promoted to use the 3 Rs--the 
retention, relocation, et cetera--bonuses, debt reduction. We 
are pushing sites to broaden the disciplines in the programs. A 
lot of sites have historically hired social workers for this 
program to provide the case management, and while that is an 
incredibly important case management resource, permanent, 
supportive housing can be done by a variety of people and there 
is a lot of competition for social workers right now, so 
broadening the disciplines will help, as well. As was noted in 
opening statements, we also are promoting the use of 
contracting as a vehicle to bring in case managers when VA 
cannot hire them.
    Mr. Levin. I appreciate that, and, you know, obviously, it 
is of great importance to us and I hope that we see these 
numbers of unused vouchers continue to decrease in the coming 
months.
    Another reason that I have heard for this underutilization 
is the eligibility criteria and, specifically, the exclusion of 
many veterans in need. You may be aware that yesterday, the 
House, on a broad, bipartisan basis, passed the veteran house 
act. I was thrilled to work with my friend, Scott Peters from 
San Diego on that legislation. What that would do is expand 
eligibility for HUD-VASH to veterans that received an other-
than-honorable discharge.
    My question for you is: How many more homeless veterans 
could be served if HUD-VASH eligibility were expanded to 
include veterans who were not VA healthcare eligible or have 
OTH discharges?
    Dr. Harris. Thank you for that question, as well.
    I want to say, personally, I am very excited about that 
bill passing, and in our position within the HUD-VASH program, 
we support that, as well. Those ineligible for VA healthcare 
remain one of our most important subpopulations that we really 
have not been able to reach yet in this program.
    We estimate that approximately 15 percent of the parent 
homeless veteran population is not eligible for VA healthcare. 
We have held that number constant in our modeling for a number 
of years. It happens that number is probably going up as we 
reduce homelessness among those eligible.
    At any given time, 15 percent of those on the streets, we 
assume are not eligible and would benefit from this change in 
law.
    Mr. Levin. You noted in your testimony that VA is working 
to broaden the population of homeless veterans it targets. 
Could you expand on that.
    Dr. Harris. Thank you for that question, as well, 
Congressman; yes, I am happy to.
    I do want to note that this is--the efforts are very 
preliminary, but they are, in fact, designed to address the 
very issue we are all focusing on. Today, there are so many 
unused vouchers, so many homeless veterans remaining.
    The idea here is that we are discussing pilot efforts at 
some medical centers--San Diego included, which is represented 
here today--to broaden targeting, which would mean, 
essentially, assigning HUD-VASH vouchers to those with lower 
acuity than in traditionally served by the program; the exact 
nature of that still to be determined.
    Then the key to these pilot efforts is that case management 
would be provided outside of the traditional HUD-VASH program, 
so either by other VA staff or in some cases, we are looking at 
partnerships outside VA altogether.
    Mr. Levin. Thank you.
    Assistant Secretary Kurtz, I would like to turn to you and 
apologize to my colleagues in advance for going a little bit 
over my time.
    High cost of housing--we certainly know about that in 
Southern California. Limited housing stock, that can pose 
barriers for use of HUD-VASH.
    Assistant Secretary, you suggested that public housing 
agencies can strengthen the purchasing power of their vouchers 
by increasing payment standards; however, doing so does not 
increase the amount that HUD pays a public housing agency per 
voucher, so they have to make up the difference.
    In order to increase voucher utilization, we need to 
improve the accuracy of fair market rents, as is calculated by 
the program, and during Fiscal Year 2020 appropriations, I 
offered an amendment supporting funding to study alternative 
methods for calculating fair market rents in areas with rapidly 
rising rents.
    When does HUD plan to commence and conclude the study on 
this and will you include Southern California communities in 
your analysis?
    Mr. Kurtz. The fair market rents are managed out of our 
Policy and Development Research Office. Is this is something 
that the assistant secretary for that office and I have 
discussed in the past.
    I am not sure what his timeline is for when the study is 
going to take place, but we can get back to you on that.
    Mr. Levin. That would be great. We will make sure we follow 
up with you--I assure you we will follow up on that.
    You also stress the--and this is my last question--the 
impact of landlord outreach----
    Mr. Kurtz. Uh-huh.
    Mr. Levin.--in relationships on utilization--we hear this a 
lot.
    What steps has HUD taken to incentivize are landlords and 
developers to participate in HUD-VASH?
    Mr. Kurtz. Well, it is not just HUD-VASH; we are looking at 
it holistically with our entire HCV program in ways that we can 
engage landlords.
    We have been doing symposiums--I just spoke a few weeks ago 
in Fort Wayne, Indiana, where we held a roundtable with 
landlords to try to encourage them and also find out what 
issues they are facing to see how we can address.
    We have had the task force working on this and I look 
forward to continue to working on this issue because it is 
beyond HUD-VASH; it is nation--you know, it is with my regular 
voucher program, as well, that we continue to face hurdles with 
trying to get landlords to engage.
    Mr. Levin. Thank you.
    I am watching very closely in California. As I think you 
are familiar, we discussed new legislation in California on 
this topic----
    Mr. Kurtz. Uh-huh.
    Mr. Levin.--to prohibit people--prohibit landlords from 
excluding those who want to use a voucher from being able to 
rent an apartment.
    Mr. Kurtz. Yes.
    Mr. Levin. I appreciate it.
    And with that, I will turn to the ranking member for his 
questions.
    Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it 
very much and you can go as long as you possibly can. I have no 
problem, because I am interested in this. As a matter of fact, 
I am going to follow up on what you said.
    This is not just in San Diego County; it is in Florida 
where the amount of the--well, all over the country--I am sure 
the general will agree--all over the country, the voucher is 
just not enough and they need a kicker. Even in my district in 
certain areas that really are not the most-expensive areas of 
my district, you know, veterans are having a hard time because 
it is not enough and then, also, having a hard time paying the 
electricity costs, as well, and that is a wraparound service, I 
guess.
    We are lucky. We are very fortunate. We have nonprofits 
that kick in, but if we could--you know, that study, that 
amendment was a good amendment and if we could do something 
about that, it would be--because you said, what is it, 14,000 
vouchers that are not being used?
    Well, part of the reason is because they are not helpful to 
veterans in certain areas. That is so very important.
    Then the other follow up is would it be helpful if VA was 
provided direct hiring authority for these case manager 
positions? What is your opinion on that?
    Dr. Harris. Thank you for the question, Ranking Member.
    VA actually has direct hiring authority now for these--most 
of these case manager positions are social workers, licensed 
clinical social workers, which are hired into hybrid Title 38 
positions. We have the ability to do that now and that is, in 
fact, being done in certain medical centers. It is at the 
discretion of the local medical center of whether to use it or 
not.
    Mr. Bilirakis. Okay. Thank you.
    The next question is for Dr. Harris: In 2012, Congress 
authorized VA to contract out the HUD-VASH case management 
services. The most recent report provided to Congress on this 
authority found that VA medical centers that used this 
authority found contracting out these services--and you touched 
on this--they found out that this is very helpful and liked the 
improved coordination with the local providers that occurred 
with contracted services.
    With a significant number of vacancies for the HUD-VASH 
case managers nationwide, what could be done to encourage, if 
not require, some medical centers to use this authority for--
more often--and, again, you touched on this. If you could 
elaborate, I would appreciate it.
    Dr. Harris. Sure. Thank you very much for the question, a 
very important one.
    I wanted to provide you with a couple of numbers. 
Nationally, about 5,000 veterans in HUD-VASH now are being 
provided case management through contract; that is through 21 
contracts nationwide. It is, therefore, about 5 percent of the 
vouchers completely allocated, so it is still a pretty small 
piece of the program.
    Speaking from the program office perspective, we are highly 
supportive of contracting as an option. As someone noted 
earlier--I apologize, I do not remember who it was--but this--
actually, I think it was you--this is work--contractors know 
how to do this work. They have done it for decades. They were 
doing it long before VA started doing permanent, supportive 
housing.
    We are supportive of contracting out where it can be done. 
It is not a panacea; the contracting process is laborious. It 
takes a long time. It requires a qualified provider in that 
community in order to do it.
    We have promoted it from the program office. We have 
provided as many tools as we can from the D.C. office 
nationally. We have a contracting toolkit that is available to 
medical centers. We have sample statements of work, performance 
work statements, things like that, that will help medical 
centers proceed, and we push on medical centers where we see 
hiring as a challenge and where we see contracting as an 
effective alternative. In the end, it is up to the individual 
medical centers to decide this.
    You asked the piece about requiring medical centers. We 
have actually asked general counsel about that and so far have 
been told we cannot actually require it, but we have looked 
into that, as well. I think it is a really important strategy.
    Mr. Bilirakis. Thank you.
    I guess I have time for one more--is that all right?
    Mr. Levin. Go ahead.
    Mr. Bilirakis. Okay. Thank you.
    Dr. Harris, and also Mr. Kurtz, if you will, the committee 
has recently heard from a large public housing authority that 
one approach to increasing the utilization of resources is to 
allow referrals of vouchers to not flow from VA to the public 
housing authority, but to allow on a pilot program basis for 
the public housing authority to be the conduit for these 
vouchers, and then VA comes in, you know, with the wraparound 
services.
    What is your view on this proposal?
    Dr. Harris. Would you like me to----
    Mr. Bilirakis. Yes, whoever would like to go first.
    Dr. Harris. Thank you, Ranking Member. I am happy to do 
that.
    I believe you are speaking to one of the pilots that we 
have in very early stages of development right now. It has not 
begun and, actually, we are all still working out the details.
    Since I have been part of those conversations, I can tell 
you, personally, I support the idea. There is just a lot of 
work still to be figured out.
    Mr. Bilirakis. You got to make it work, yes.
    Dr. Harris. Yes.
    Mr. Bilirakis. I understand.
    Dr. Harris. We would be very happy to come brief you or 
speak to that or provide additional information for the record, 
as we work out the details, but highly supportive of the idea.
    Mr. Bilirakis. Very good, thank you.
    Mr. Kurtz.
    Mr. Kurtz. Again, we are also supportive of this initiative 
and, you know, helping the VA in any way we can. Again, Dr. 
Harris is sort of the one leading the charge on this 
initiative.
    Mr. Bilirakis. Very good. Thank you very much.
    I yield back, Mr. Chairman.
    Mr. Levin. I thank the ranking member, and I would like to 
recognize Ms. Lee for 5 minutes.
    Ms. Lee. Thank you, Chairman, and thank you, Ranking 
Member, for allowing me to ask these questions, and I also 
thank both of you for your work on this.
    I started my career running a homeless drop-in center, so a 
lot of experience in this world. I reached out to some of my 
partners just to ask sort of how this is working on the ground. 
One of them was Arnold Stalk who runs an organization called 
Veterans Village in Nevada; it provides housing and wraparound 
services to homeless veterans.
    One of the issues that was raised is that during the 
housing inspection on part of the VA, landlords are required to 
have a full kitchen in order to receive the voucher. It has 
been an issue for this organization, in particular, in reaching 
its mission, because not all of its units have full kitchens; 
they have a hot plate and a microwave, but they have a full 
kitchen onsite, as well as a program where they work with 
restaurants, the local food bank, and they provide nutritious 
USDA-sanctioned meals each and every day.
    One of the issues that Arnold Stalk had raised with me is, 
because of this requirement, he actually now houses more 
veteran or non-veterans, which then takes away from his ability 
to meet his mission.
    I am happy to report is that in Las Vegas, we have seen a 
decrease in homeless veterans, but the most recent point, you 
know, data point, is that there is still 559 homeless veterans. 
Clearly, just refining this process is something that I hope we 
can learn from this hearing.
    One of the questions I wanted to ask both of you is, is 
having a full kitchen necessary in helping prevent veteran 
homelessness?
    Mr. Kurtz. We--because HUD-VASH is part of our Housing 
Choice Voucher program, we have a set of standards for all 
Section 8 vouchers and we are actually in the process of 
reviewing all of those standards right now for the physical 
inspections through a process--our new process, we are calling 
Inspire. This is--it is not actually an issue that I have heard 
of before where the voucher--but it makes sense. I am happy to 
take a look at that as we continue this effort.
    Ms. Lee. Okay. Great.
    Dr. Harris. Thank you for the question.
    Inspections are, in fact, overseen by Housing Authority, so 
I am not going to speak to that piece.
    I actually just wanted to let you know we have corresponded 
with Mr. Stalk before from our program office and we are happy 
to continue to do so.
    Ms. Lee. Great. No, absolutely, I would love to continue to 
work on this. I think, you know, obviously we want to encourage 
innovation. We want to encourage on-the-ground providers to 
meet these challenges head on, and anything we can do to work 
around--most importantly, making sure that we are getting 
veterans off the street and also providing them with the--you 
know, nutritious meals, obviously, is important. I appreciate 
the ability or the desire to cooperate and work on that.
    Another great organization in Nevada is U.S. VETS; again, 
they provide transitional and permanent housing.
    In conversations with their director, one of the things 
that they brought up is when they receive referrals from the 
VA, they feel like the referrals for their different programs--
the supportive service for veterans families and then the HUD-
VASH--seem to be inconsistent and sometimes them have two 
veterans with almost identical situations and they are being 
put into two different programs. They have some concerns about, 
basically, the criteria that are being used.
    Then they also have concerns with the case management 
system, where it currently stands, which I think we have all 
addressed here today. They find that veterans who are placed 
into the HUD-VASH permanent housing, they come back and ask if 
they can go eat at the U.S. VETS mess hall. The staff believes 
that there needs to be some efforts to strengthen the 
wraparound services through case managers.
    One of the questions I have for you, Dr. Harris, is: Has 
the VA considered revising its score tool to make referrals to 
veterans homeless transitioning programs more uniform?
    Dr. Harris. Thank you for that question; it is a very good 
one.
    We have talked at length, and for several years, about how 
to potentially standardize the assessment, screening, and 
referral into our program. The direct answer to that question 
is, yes, we have.
    We have--I have personally spoken with U.S. VETS frequently 
and have had these very conversations with them and the piece 
you noted about veterans in HUD-VASH coming back for meals is a 
really important aspect of this program. This is--we rapidly 
move veterans into housing without preconditions, yes, but it 
is not a housing-only program.
    Ms. Lee. Right.
    Dr. Harris. It is incredibly important to do what we can to 
help veterans who experience the isolation of suddenly going 
from congregate living, or even street living but around other 
people, to having their own apartment. It does not surprise me 
to hear anecdotes like that, and it is an important part of our 
case management to provide veterans the sort of contact and 
connections that will help with that.
    If I may, one other piece of that, over time, HUD-VASH 
early on in its evolution, focused on highly acute, chronically 
homeless veterans. The Supportive Services for Veterans 
Families program that you mentioned, which U.S. VETS is a 
grantee, focused on a group of veterans that was lower acuity 
than that. You sort of had HUD-VASH up here and Supportive 
Services for Veteran Families (SSVF) down here.
    Over time, there is been a certain blending of that, so it 
is also not surprising that there might be veterans that are 
just above or below that cut, especially in any given 
community, and that is because that population of really acute 
veterans has diminished quite a bit, in fact, in some 
communities. That is a natural piece of the evolution of these 
programs, but we want to stay thoughtful about which program 
veterans are routed to.
    Ms. Lee. Great. Thank you.
    Thank you for your willingness to really take on this 
issue, especially given--with the local perspective, because, 
obviously, that is what it is going to take to make that number 
zero.
    Thank you very much. I appreciate your work.
    Mr. Levin. Thank you, Ms. Lee.
    Now, I would like to recognize Mr. Bergman for 5 minutes.
    Mr. Bergman. Thank you, Mr. Chairman.
    I know we are all here for the same reason; try to figure 
out how to mitigate and hopefully eliminate veteran 
homelessness, especially chronic homelessness.
    Mr. Kurtz, veterans only make up a part of the total 
population of the country and a part of the homeless population 
of the country. Is there any data out there, let us say by 
State, that compares, contrasts the rate of homeless veterans 
compared to the general population homeless rate?
    Mr. Kurtz. I would assume that there is. I am not sure 
what, exactly, the statistics say, but----
    Mr. Bergman. Do we know where to find it?
    Mr. Kurtz. Yes, we could find it.
    Mr. Bergman. Could we find that?
    Mr. Kurtz. We may--do you----
    Mr. Bergman. I am guessing the VA deals with veterans. You 
are not looking at general homelessness; is that correct?
    Dr. Harris. Well, thank you for the question.
    Ironically, I have the reverse number for you and that is 
that veterans made up 8 percent of the general homeless 
population in the last PIT count. Historically, that general 
veteran population has been 9 percent or above, so this is 
actually the first Point-in-Time count that I have seen where 
the veteran proportion within----
    Mr. Bergman. Can you break that down by State or, I mean, 
is it--because, for example, some states are physically, 
geographically, smaller. Some states are larger. Some areas, as 
in--you know, some of our committee members here live in very 
urban areas--my district happens to be very, not only rural, 
but remote. For example, we have 8 tribes in our district.
    I think it is very important for us, because if we are 
trying, and are successful--which we need to be--in solving the 
veteran homeless problem, chances are some of the things that 
we are going to learn in dealing with veteran homelessness is 
going to apply to the general homeless population if we get it 
right.
    Dr. Harris, you know, in business, you can--if you need a 
certain expertise that you do not have today or maybe you have 
it, but it is not serving your needs in the business model, you 
can either recruit, train from--you know, and make it part of 
your company--or you can hire outside, already existing 
expertise.
    When we talk about contractors versus full-time equivalent 
employees, does there exist in the marketplace, individuals or 
companies who understand what we are trying to do here and, as 
we would say in the military, already a full-up round to, if 
you brought them on as a contractor, can start engaging the 
veterans or whatever is going to happen in the community right 
away.
    Dr. Harris. Thank you for the question, Congressman.
    Without question, yes, such providers do exist.
    Mr. Bergman. Why would we even think, then, if homelessness 
is here now, why would we even delay bringing on qualified 
contractors, knowing that if we hire our own full-time 
equivalents it was going to take a period of time--four months, 
6 months, whatever it happens to be--to get that employee up 
and on speed, why would--why are not we going out and hiring 
contractors right now?
    Dr. Harris. Thank you, again, and, again, such an important 
question.
    The only real reason I can say is that it takes a very long 
time to contract, also.
    Mr. Bergman. Why does it take so long?
    Dr. Harris. I would love to take that for the record and 
provide a----
    Mr. Bergman. I will tell you what. If there is a place, an 
office that the VA has or whomever has--I do not care if it is 
here in D.C.--I mean, we went out to Minneapolis to the Debt 
Management Center here about 6 months ago to get a brief from 
them--I am sure some of my colleagues would travel to that 
place that could explain to us in an hour or so what the issues 
are with the length of why it takes so long to contract. Thanks 
for taking it, you know, for the record.
    Mr. Chairman, I would like a follow up on that, because 
these are the kinds of, if you will, Congressional Delegations 
(CODELs), or whatever you want to call it, that this committee 
should be taking to understand what it is that we are trying to 
achieve. Because we still struggle with, what is our role as 
Congress?
    That is--you know, we can be part of a solution here or we 
can be exacerbating a problem, and that is--we do not want to 
be the latter.
    With that--I know we have a second panel, but I guess for 
both of you very quickly, from your perspective, do you have 
any interaction with or data on how are the tribes across the 
country doing with their outreach to eligible veterans? 
Because, as we know, as an ethnic group, tribes are the highest 
percentage of participation in the military, of any, and proud 
service, and, also, they have some unique situations--in a lot 
of cases, very positive--that they can control outcomes for 
their homeless.
    Mr. Kurtz. We are, at the Tribal HUD-VASH Program, are 
really excited about the success. We house about 500 veterans, 
currently.
    There are, as I said, a unique set of issues with outreach 
in tribal lands because of the fact that they are rural and 
other issues like that. I know the VA has worked--and I guess I 
should defer to you on the outreach issue--but, I mean, we are 
excited about where we stand with HUD on that Tribal HUD-VASH 
Program and hope to expand on it.
    Dr. Harris. Thank you, and thank you for the question.
    We are equally excited about it and supportive of the 
program. You said 500 housed; it is really 500 total, right?
    Mr. Kurtz. Yes.
    Dr. Harris. It is a little under 400 actually presently 
housed in the program, and the reason for that gap is there are 
reservations where there is just literally no housing for those 
veterans, now, as we mentioned earlier. There is work being 
done that VA is a part of, locally, to do that.
    In terms of the outreach, our Tribal HUD-VASH case managers 
are some of our most dedicated, carrying, culturally competent, 
skilled case managers and they scour the reservations and the 
lands around it for veterans. It is a very impressive group of 
people and very impressive effort.
    Mr. Bergman. Okay. I know I am over my time, I would just 
like to ask one question for the record--not an answer--but 
would it be advisable or possible to expand VA's already 
existing SSVF, the Supportive Services for Veterans Families' 
Community Grant Program for these veterans? Just, if you would 
take that for the record, I would just like a written response 
on that.
    Mr. Chairman, I yield back.
    Mr. Levin. Thank you, Mr. Bergman. I appreciate that.
    I would now like to recognize Mr. Pappas for 5 minutes.
    Mr. Pappas. Thank you to the Chairman and to the ranking 
member for conducting this hearing today, and I thank our panel 
for their commitment, one that we all share, of getting to 
zero; ensuring that everyone who has worn the uniform of this 
country does not have to worry about whether or not they have a 
roof over their head at night.
    I am curious if we could talk a little bit about rural 
homelessness. I know in my State, New Hampshire, we have made 
some tremendous progress. Just last year alone, according to 
the PIT count, the number of veteran homeless individuals has 
decreased by 21 percent, so that is a good step forward. There 
is more work to do, however.
    I am wondering how much confidence we can have in these 
Point-in-Time counts and whether or not you feel that there is 
an undercounting of rural homeless veterans.
    Mr. Kurtz. From--the PIT count is managed out of an office 
that I do not ever see at HUD, but from my understanding, there 
is a level of confidence in what the results are, but we are 
happy to--I am happy to take your question for the record and 
have that office get back to you.
    Mr. Pappas. Okay. That would be great to understand a 
little bit about, you know, how they might account for what I 
think you, Dr. Harris, indicated in your testimony, you know, a 
concern that there might be an undercounting of rural homeless 
vets.
    I know that in 2016, HUD issued 600 vouchers specifically 
that were geared toward rural individuals to make sure that 
they get into housing. That program, I guess, was scrapped 
after the first year because it was underutilized.
    I am wondering if you could talk a little bit about how 
many of those vouchers were actually used that year and whether 
or not there might be another attempt to try to reach out to 
that population, specifically.
    Dr. Harris. Thank you for the question.
    I would like, as a general statement, to take that for the 
record and get back to you. I did dig into the rural effort in 
preparation for today and did not get hard data on that. 
Anecdotally, it is, as you noted, it was actually very 
difficult to get those vouchers utilized.
    As I noted in my written testimony, homelessness can be 
somewhat invisible in rural areas. There is a distinct lack of 
both, housing and services, and as it turned out, a lot of the 
vouchers, again, anecdotally, people ended up using them in 
less-rural areas than they were intended.
    I am happy to get a more complete answer to you if you 
would like.
    Mr. Pappas. That would be helpful.
    We reached out to some community partners to understand, 
you know, exactly what they are facing on the front lines and 
one organization got back to our office--Harbor Homes in New 
Hampshire, that provides housing and wraparound services for 
veterans and other homeless individuals--and they were curious 
about the way that systems communicate, ensuring that there is 
good data-sharing across agencies and across systems. They 
specifically asked, What is being done to assist with data 
sharing between VA's system Homeless Operation Management and 
Evaluation System (HOMES) and the HUD data system, Homeless 
Management Information System (HMIS)?
    I do not know if you have any information for me on that or 
would like to get back to me?
    Dr. Harris. How much time do you have?
    Mr. Pappas. A minute 58.
    Dr. Harris. Thank you for that question.
    My office has been part of all of those conversations both, 
with HUD and internally. HOMES is our data-collection, 
information-collection system for homeless veteran programs; 
HMIS is HUD's.
    There are some deep challenges in getting those systems to 
talk to each other. Ours is a single, by-name, national 
dataset. HMIS is not; HMIS is parceled out by community. It is 
also run by, I think, the last count, 27 different software 
platforms, whereas, ours is on a single one. Those challenges 
alone make it so you cannot just digitally or on the back end, 
make those systems speak to each other.
    What we have done, instead, is to everything we can to 
allow VA staff to digitally share information on a local basis. 
We worked with IT to get an ability to encrypt emails and send 
those outside the VA system.
    I would like to note that that ability was recently 
rescinded; we have lost that and staff are actually back to 
faxing things. That is a problem we could even potentially use 
assistance with, but, certainly, we are trying to solve 
internally. It had to do with updates made to the VA IT 
systems.
    We have tried to provide staff the ability to digitally 
encrypt and protect that information. We have also worked with 
the Privacy Office to free up staff with what they can share 
about homeless veterans without requiring a signed release.
    Homelessness is considered a State of emergency and a 
threat to the veteran's health and welfare. It is in the 
veteran's best interests to share that information and not wait 
for a signed release, a certain subset of information.
    Those are some of the things that we have done to allow 
information to travel between those two systems.
    Mr. Pappas. Well, great. I appreciate your attention and 
your responses. I look forward to any further information that 
you can provide. Thank you.
    I yield back, Mr. Chair.
    Mr. Levin. Thank you, Mr. Pappas.
    Now, I would like to recognize my friend, Mr. Barr for 5 
minutes.
    Mr. Barr. Thank you, Mr. Chairman.
    Dr. Harris, Mr. Kurtz, thanks for your service; we 
appreciate you all being here today and the work that each of 
your agencies do to combat veteran homelessness across the 
United States.
    As I mentioned to this committee before, my hometown of 
Lexington, Kentucky, certified an effective end to veteran 
homelessness in our area last year, thanks in part, to the HUD-
VASH program and the services offered by each of your agencies.
    Obviously, no veteran should go to bed at night without 
somewhere to lay their head.
    When the program was originally created, the HUD-VASH 
program was designed for veterans who were chronically, 
mentally ill, or had chronic substance abuse disorders; 
however, since 2008, the requirement no longer exists and 
veterans can be housed using HUD-VASH, regardless of their 
history of criminal behavior or drug abuse.
    As with many communities across the country, opioid abuse 
is a major issue in my district. In 2017, opioid overdoses in 
Kentucky took more lives than car accidents by almost double. 
That is why I have been a fierce advocate for transitional 
housing for individuals, and particularly veterans, who are 
struggling with substance abuse.
    Phil Gray, the executive director of St. James place, an 
affordable housing facility in Lexington said this, ``We know 
that transitional housing, treatment, and helping people get 
back into the workforce works. These are the things that people 
need to get better.''
    While every veteran, regardless of history, deserves to 
have a roof over their head at night, I would like to dive into 
how the VA and local PHAs determine if HUD-VASH is really the 
best program for every veteran; particularly, those with 
substance abuse issues.
    Dr. Harris, how does the VA determine what program--whether 
it is HUD-VASH or grant per diem or SSVF--is best for the 
veteran? What information does the VA case manager have at 
their disposal before referring the veteran to a particular 
program? Then the lasting question if you could answer, if a 
veteran is already enrolled in HUD-VASH, would they ever refer 
that veteran out of HUD-VASH into a different program that 
might meet their needs better?
    Dr. Harris. Thank you, sir, for the questions. I may not 
have gotten them all--I am going to do my best to get at that.
    Mr. Barr. Sure.
    Dr. Harris. The first question, I think, was about how it 
is determined that veterans are routed to one program or 
another.
    Mr. Barr. Right. Grant per diem or HUD-VASH or SSVF.
    Dr. Harris. Part of that was what kind of information the 
clinicians have at their disposal.
    Mr. Barr. Right.
    Dr. Harris. I will start that in reverse.
    The clinicians have a tremendous amount of information at 
their disposal, particularly in cases where the veterans have 
been enrolled in VA healthcare, have been served by the VA. The 
VA medical record is nationwide, so they could have been served 
anywhere we have access to that.
    The clinicians review all of the extent of the clinical 
information in the record in coming to a conclusion about 
appropriateness for HUD-VASH, in particular. The way each 
individual medical center routes veterans to one or another can 
vary by site; it is in large part, dependent upon which 
programs are even there. Not every medical center has every 
program you listed. Not every medical center has slots in those 
programs, if they have them, at any given time. So, part of it 
is based on availability.
    Much larger, referrals to HUD-VASH are for veterans who 
need the case management and supportive services that that 
program provides.
    Mr. Barr. Okay. Let me ask you, if a veteran uses their 
HUD-VASH voucher and finds a place to stay, are they required 
to accept the wraparound services offered by the VA?
    Dr. Harris. Thank you for the question.
    The answer is yes; they are required to accept case 
management.
    Mr. Barr. Okay. This is kind of for both, Mr. Kurtz and 
you: Housing First is a policy that has been supporter imposed 
on top of HUD-VASH.
    Mr. Kurtz, does Housing First frustrate that requirement?
    Mr. Kurtz. We do not have a Housing First requirement with 
HUD-VASH.
    Mr. Barr. Oh.
    Mr. Kurtz. There is no--it is--there is not--Housing First 
and HUD-VASH are not related.
    Mr. Barr. Okay. That is news to me from our oversight on 
the financial services committee. I think some of the members 
on our committee are under the--they perceive that Housing 
First does apply to HUD-VASH.
    What you are telling me is that no--there is a 
conditionality to HUD-VASH?
    Mr. Kurtz. Well, the conditionality is up to the VA.
    Mr. Barr. Okay.
    Mr. Kurtz. I mean, we are just providing the voucher in 
this situation.
    Mr. Barr. If you have a veteran that is a recipient of a 
HUD-VASH and they decline the wraparound services, the case 
management, that is a revocable voucher; is that correct?
    Dr. Harris. Thank you for the question.
    I want to back up slightly.
    Mr. Barr. Okay.
    Dr. Harris. HUD-VASH, as a clinical model----
    Mr. Barr. Right.
    Dr. Harris.--is, in fact, a Housing First model. I think 
there may be some misunderstanding to you about exactly what we 
mean by Housing First.
    I know in HUD's--for instance, it was referenced in regards 
to the stock of housing; permanent, supportive housing versus 
transitional housing.
    That is not what we are talking about in HUD-VASH. We are 
talking about a clinical model where veterans will move rapidly 
into housing without precondition and then are provided 
wraparound services.
    They do have to agree to case management to be in HUD-VASH.
    Mr. Barr. My time has expired.
    I think the case management is critical. I think that is 
getting at the underlying issues of homelessness and so I 
applaud that feature of the program and appreciate your work 
with these veterans. Thank you.
    I yield back.
    Mr. Levin. I thank the gentleman from Kentucky and 
appreciate his comments, as well.
    With that, I would like to thank our first panel, and, you 
know, if you are available, I would like to ask our friends 
from the VA and HUD if they can stay and hear from some of the 
experts; we would appreciate that very much. I think it is 
important that you hear their perspectives.
    With that, I would like to call up our second panel. All 
right. Thank you very much. I am excited for this panel, a lot 
of experts in the field, including a couple from my neck of the 
woods--great to see you.
    We first have Steve Berg, vice president of public policy 
at the National Alliance to End Homelessness.
    Thank you for being here.
    Kathryn Monet, the chief executive officer of National 
Coalition for Homeless Veterans.
    Thank you so much.
    Also joining us is Greg Anglea, chief executive officer of 
Interfaith Community Services.
    I appreciate all the work that you do in North San Diego 
County for our veterans and for our community, at large.
    Also, Tamera Kohler, chief executive officer of the 
Regional Task Force on the Homeless, San Diego.
    Thank you so much for all your excellent work in the 
community, as well.
    Finally, we have Gary Cooper, chairman of the board of the 
National American Indian Housing Council and executive director 
of the Housing Authority of the Cherokee Nation.
    Thank you very much for joining us today.
    As you know, you will have 5 minutes for your oral 
statement, but your full written statement will be added to the 
record.
    With that, Mr. Berg, you are now recognized for 5 minutes.

                    STATEMENT OF STEVE BERG

    Mr. Berg. Thank you, Mr. Levin, and other members of the 
subcommittee. Steve Berg from the National Alliance to End 
Homelessness. We are a national organization that works with 
people all over the country on reducing homelessness and 
ultimately ending homelessness, and we have made the existence 
of homelessness among veterans one of our priorities for many 
years now.
    Since the beginning of the W. Bush administration, people 
who work on homelessness have changed the way we think about 
what it is that we are doing. We have changed from running a 
bunch of disconnected programs that are trying to do some good 
things for some good people to having a systematic approach to 
actually solving this problem of homelessness.
    During that time, we have focused on getting people into 
housing and keeping them into housing, including the range of 
supportive services that are necessary to bring that about, and 
the results have been strong. Everyone here represents a place 
where homelessness over the last decade has declined 
substantially. The people who were here before, I was hoping to 
have them, but send the message to everyone that homelessness 
is going down in this country and it is going down in 
communities that have adopted the good practices that people 
have put in place.
    This has particularly been the case when it comes to 
veterans, partly because of the leadership of the Department of 
Veterans Affairs, working with HUD in some cases, partly the 
committees that deal with this issue in Congress have been very 
strong on the issue of homelessness for veterans. We appreciate 
that a lot. It continues even in what for many parts of the 
country is a difficult time right now in terms of housing 
markets and affordability of housing for low-income people, the 
numbers on veterans' homelessness continue to get better. I 
want to talk about how the HUD-VASH program fits into this 
overall strategy of ending homelessness for veterans.
    People know, I think, that homeless people are not all the 
same, homeless veterans are not all the same, different people 
need different levels of support and care, different levels of 
permanency. In order to maximize cost-effectiveness in these 
programs, which is something people working on homelessness 
have to be conscious of--there is not enough money to do 
everything for everybody, so we have to be worried about cost-
effectiveness--to do that really requires that we understand 
that some people will thrive with a shorter incidence of help 
with less supportive services, but there are also other people 
who have very severe disabilities and medical conditions.
    The intervention known as permanent supportive housing is 
what the homeless world has developed in order to do that. It 
has gotten fantastic results, been evaluated over and over 
again, shown to be effective at getting people who have the 
worst kind of problems and have been living on the street the 
longest time out of homelessness and into housing. The HUD-VASH 
program is the VA program that funds the permanent supportive 
housing model for veterans.
    As Dr. Harris was saying before, it has historically 
targeted veterans with the most severe disabilities. The 
success of the program has been such that many of the veterans 
with the most severe disabilities aren't homeless anymore. They 
are trying to figure out, you know, who is still homeless that 
needs this level of intervention, that is an important question 
to be asking.
    A couple of challenges in the way this program is--a 
program like this is always going to run into. I think we have 
talked about the case management issues, there are a number of 
different issues with that. I think the contracting-out issue 
is important. I think it is important to recognize there are 
sort of two different functions that case managers have, one is 
a medical function, making sure people get the health care they 
need, but another is a real estate function: finding landlords 
who will rent under a program like this, making sure the 
landlords are--their needs are met, as well as the needs of the 
veteran are met, and that is a function that needs to be dealt 
with and a lot of people in the sort of regular homeless 
programs, non-veteran homeless programs are dealing with very 
well.
    I also want to say that leadership is an important part of 
this. Members of Congress can have an important role to play in 
their districts to get the medical centers involved, to get 
landlords involved, and we are happy to work with anybody who 
wants to think about how you can make these programs work 
better in your district.
    I will leave it at that and any questions I am happy to 
answer.

    [The Prepared Statement Of Steve Berg Appears In The 
Appendix]

    Mr. Levin. Thank you, Mr. Berg. I know we are working hard 
in my district to do that, I assume the same is true for the 
ranking member and for all my colleagues.
    With that, I would like to recognize Ms. Monet for 5 
minutes.

                   STATEMENT OF KATHRYN MONET

    Ms. Monet. Chairman Levin, Ranking Member Bilirakis, and 
distinguished members of the subcommittee, on behalf of NCHV's 
board of directors and members across the country, thank you 
for the opportunity to testify today.
    As of December 2019, we know that 78 communities in three 
states have actually achieved the Federal benchmarks and 
criteria for ending veteran homelessness, and we have seen that 
there has been dramatic decreases in your annual Point-in-Time 
Count of veterans experiencing homelessness. Given, though, 
that there are still 37,085 veterans experiencing homelessness 
on any given night, plus there is this natural ebb and flow of 
veterans entering and exiting housing on a day-to-day basis, we 
know that we still have much work to do across the Nation.
    We know that we have got to look at deep investments in 
affordable housing and we have got to pair them with solid 
implementation of Housing First-oriented systems in order to 
see more progress.
    There is a solid body of research pointing to the success 
of Housing First and we are clear, all of us, I think, here, 
that veterans have earned quick access to permanent housing, 
employment services, and any resources that they want in order 
to attain housing stability.
    In order to get there, though, this requires Housing First-
oriented interventions, incorporating a variety of housing 
interventions that include transitional housing options in 
communities where the facilities fill gaps in services, where 
veterans actively choose to enter into therapeutic and 
treatment-oriented environments, or where the housing crisis is 
so extreme that permanent housing placements just take too 
long.
    One of the keys to a Housing First-oriented system is the 
HUD-VASH program, which we are here to talk about today. There 
is still much unmet need across the country and we know that 
HUD's 2019 Annual Homeless Assessment Report (AHAR) indicated 
that on any given night over 8,700 veterans had chronic 
patterns of homelessness. As such, NCHV calls for increased 
investment in the HUD-VASH program to ensure that communities 
have sufficient resources for the most vulnerable veterans.
    We have a few policy recommendations relating to the 
program and I think our first major recommendation is that case 
manager funding must keep pace with increases in voucher 
funding. We appreciate the ongoing congressional support for 
this program, as evidenced by the hearing today and also by the 
continual allocations of vouchers that you all have provided 
for the program. We think they are great and we think they 
should continue; however, the funding appropriated to VA for 
case management has not always kept pace with the funding that 
is appropriated for vouchers.
    The challenging, complicated, most often uncoordinated 
appropriations process has an even more profound effect on 
interagency programs like HUD-VASH, because the program is 
basically relying on two subcommittees to appropriate funds to 
two Federal agencies, sort of in collaboration and in 
conjunction, right? The status quo right now that we are 
operating under has really resulted in unintended consequences 
that really lead to an underfunded mandate on VA or, worse, a 
mandated reduction in the standard of care for veterans.
    There are some real outcomes, right? We are seeing that 
this incentive for medical center providers to support their 
partnering PHAs requesting more vouchers. We are seeing our 
members coming to us, reporting that the medical center has 
case managers that are looking really only at the clinical 
aspects of case management and not really at housing location, 
as Mr. Berg has mentioned, or even at, you know, issues that 
focus on housing stability and I guess remaining stable in your 
housing.
    We are also seeing on the PHA side that the slowdown in 
referrals of veterans into the program can affect voucher 
allocations more broadly for both veterans and civilians across 
communities.
    We are hopeful that your leadership can really look at VA 
funding increasing and formulaic response to the increases in 
number of additional VASH vouchers.
    One of the other concerns we have heard is about the 
background check and credentialing process for employees of 
case management contractors. In certain places where Veteran 
Affairs Medical Centers (VAMCs) are contracting with local 
service providers the length of the credentialing and 
background check process is cumbersome, and can actually affect 
staff retention and recruitment. We have talked to a few of 
those providers and they have indicated that the 4-to-9-month-
long process that their staff has to go through to I guess 
complete the VetPro and Electronic Questionnaire for 
Investigations Process (eQIP) procedures make it really 
difficult to recruit and retain new staff. We are hopeful that 
you can work with VA to streamline or shorten that process, if 
possible.
    NCHV does support extending HUD-VASH to veterans with Other 
Than Honorable (OTH) discharge statuses and we were pleased to 
see that your legislation passed yesterday. We do also support 
any legislation that would expand eligibility to Guard and 
Reserve components that were not federally activated. We will 
just hold that out there for you to think about.
    The other thing that I really wanted to talk about, though, 
was using the voucher program to promote affordable housing 
development, because the affordable housing crisis, as we all 
know, is really acute in areas of the country where we have got 
a high concentration of homeless veterans and communities often 
cite the inability to locate housing as one of the single 
biggest barriers to utilizing their vouchers. In many 
communities, the only way to actually house veterans is to 
develop housing by project-basing. We are hopeful that HUD 
might consider releasing another round of project-based 
vouchers, or perhaps that VA may consider more use of its 
Enhanced Use Lease (EUL) program in order to drive down the 
cost of affordable housing and bring more housing for veterans 
online while, you know, responsibly using its capital asset 
portfolio of aging medical centers.
    Last, but not least, we do support the housing needs of 
Indian Country and we are pleased to see the great progress 
that the Tribal HUD-VASH program is making across the country. 
We think that is wonderful and support the intent of 
legislation that is out there on Tribal HUD-VASH; however, we 
do seek some clarifying language to ensure that the expansion 
does not remove any vouchers that are already in place or tied 
to, I guess, projects that are in the project-based voucher 
pipeline.

    [The Prepared Statement Of Kathryn Monet Appears In The 
Appendix]

    Mr. Levin. Thank you, Ms. Monet.
    Ms. Monet. Thank you.
    Mr. Levin. I appreciate it very much.
    I would now to recognize Mr. Anglea for 5 minutes.

                    STATEMENT OF GREG ANGLEA

    Mr. Anglea. Thank you, Chair Levin. Thank you, Ranking 
Member Bilirakis. It is a pleasure to be here. I represent a 
service provider, boots on the ground, working with the women 
and the men who have served our military and find themselves in 
times of need and times of crisis.
    I am pleased to be here today because our team outlined 
three key actions that we were asking for your consideration 
and, while I was flying here last night, you did one of them. 
You passed H.R. 2398 to expand eligibility for HUD-VASH to 
veterans with other-than-honorable discharge. Thank you for 
your support of that legislation and thank you for the actions 
that you took. It is critical that that be passed into law.
    My testimony includes personal stories. I think it is what 
I can bring of greatest value here as somebody doing the work. 
Our organization works in San Diego County and, to our 
knowledge, we are one of the only that sets a goal every year 
around how many people we will end and prevent homelessness 
for. With the support and partnership of the Federal 
Government, we were able to end and prevent homelessness for 
more than 2,000 people over the last 18 months, including 
nearly 200 veterans. There are many who still need support and 
are not eligible for certain resources.
    In my testimony, I shared the story of somebody I will call 
Mr. Brown. And Mr. Brown is an example of why other-than-
honorable discharge veterans should be entitled to access HUD-
VASH, but also a reflection of--you know, I will reach higher 
here--of the need for connection to VA health care benefits.
    Mr. Brown was discharged with an other-than-honorable 
discharge due to drug use in the military. That came at a time 
when he had not yet been diagnosed with a bipolar condition, he 
was not yet connected with behavioral health counselors to help 
him address the psychotic features that came with that bipolar 
condition. He had not yet developed the healthy coping 
mechanisms that the counselors he is working with now have 
helped him with. He had gone through years of homelessness. He 
had not maintained his sobriety during that homelessness as a 
result of support he received during a Veterans Grant & Per 
Diem transitional housing stay, and the additional services he 
connected with afterwards through community-funded supports, 
because he is not eligible for VA health care benefits and he 
is not eligible to receive the health care offered by the world 
class health care system that the VA provides.
    He is going to struggle until he is able to access HUD-VASH 
to be able to exit our transitional housing program into 
permanent housing. His condition is such that he really needs 
an ongoing housing subsidy. Whether his condition was the 
result of his military service or not is a question, what is 
not a question is the amount of veterans who are exiting with 
other-than-honorable discharges. The Department of Defense 
reports that number at 7700 veterans per year. A Government 
Accountability Office report studying more than 60,000 
misconduct discharges over a 5-year period--sorry, 90,000, 
91,764 discharges over 5 years, found that 62 percent were 
diagnosed with a traumatic brain injury or post-traumatic 
stress within just 2 years of that discharge.
    To not provide these veterans who have served our country, 
who are discharged with disabling conditions shortly 
thereafter, with access to health care is a mistake that must 
be rectified.
    I will modify slightly, thanks to your good work, my key 
action requested that we not just provide access to HUD-VASH 
for other-than-honorable-discharge vets, but that we consider 
how they can access the VA health care system.
    My second key action requested is to echo the excellent 
comments of those who have come before me that support for the 
funding of supportive services within HUD-VASH, the staffing, 
the case managers, that that be increased commensurate with 
other increases, and that also additional--that contracting be 
encouraged.
    I share the story in my written testimony of somebody who 
we call Mr. Jones who only connected with HUD-VASH because he 
was able to access outside, non-VA counseling support. Due to 
his own issues related to his military service, he is very 
hesitant to engage with the VA directly, but in partnership 
with our organization we were able to make that connection and 
get him housed. Unfortunately, the level of support he receives 
through the funded services as the program is currently 
constituted we fear are not sufficient and we fear he may 
return to homelessness in the future or struggle with 
instability.
    Increased funding to strengthen those services and 
strengthening the partnerships with community providers are 
critically needed. Our local VA is leading in that effort and 
piloting with a handful of vouchers our organization and 
another colleague organization will be linking.
    I am over my time. I will be available for questions and 
comments. I really appreciate your hard work and your 
leadership on these issues.
    Thank you.

    [The Prepared Statement Of Greg Anglea Appears In The 
Appendix]

    Mr. Levin. Well, thank you, Mr. Anglea. I am thrilled that 
the House got it right this week on your plane ride here, 
passing that legislation. You know, we hopefully will do 
something else good on your plane ride back, who knows. But 
there were only 30 Members of Congress that voted against that 
legislation and, if you pay attention around here, that is 
pretty good. We just have to keep it up, now we have to make 
sure the Senate takes it up.
    With that, I would like to recognize Ms. Kohler for her 
opening statement.

                   STATEMENT OF TAMERA KOHLER

    Ms. Kohler. Thank you. My voice has kind of given out on me 
today, so I will see if it holds.
    My name is Tamera Kohler, I am the CEO of the Regional Task 
Force in the Homeless; we are the HUD Continuum of Care for San 
Diego County. The second-largest county in the State of 
California, we have a large geography and a population of 3.4 
million people, and about 240,000 of those are veterans.
    We are one of over 400 Continuum of Cares across the 
Nation. We are designed to promote community-wide commitment to 
ending homelessness and working collectively with our partners 
to tailor a local homeless response system. Veterans experience 
homelessness in every State, but nearly a quarter reside in 
California, making the regional task force uniquely positioned 
to share data and insight on this issue.
    Without question, one of the most impactful and successful 
coordinations around ending homelessness is the partnership 
between HUD and the VA with the VASH vouchers, but in our 
region we are experiencing some bottlenecks and some 
challenges. I am going to be very specific in the two areas 
that I am going to address. One is the insufficient referrals 
to our housing authorities to fully utilize their VASH 
vouchers; and, two, the limited eligibility requirements, which 
you have taken a major step forward in with the new piece that 
you just passed, which is leaving many of our homeless veterans 
under-served and without appropriate housing resources.
    The insufficient referrals from the VA to our housing 
authorities, I collected data in coordination with our largest 
housing authority in our region, which is the San Diego Housing 
Commission. I am sharing their data and the recommendations of 
that data as is current for these hearings.
    The San Diego Housing Commission has approximately 354 un-
utilized VASH vouchers, approximately 31 percent of our total 
VASH vouchers. The challenges that they identified was through 
the VA San Diego health care system were averaging only nine 
referrals a month for these VASH vouchers in our Fiscal Year 
2019. These VA referrals are insufficient to increase the 
utilization rate that we need to keep up with our attrition 
rate, which we rarely talk about. Our attrition rate reaches 
eight households a month. When we are only getting nine 
referrals and our attrition rate is eight a month, we are 
struggling to use those VASH vouchers.
    We are also concerned about the shortage of VA referrals, 
because we have a clear need for permanent housing resources in 
the city of San Diego.
    In 2019, our regional Point-in-Time Count identified 810 
veterans experiencing homelessness. We have a high unsheltered 
population in San Diego. We had 427 were sheltered veterans and 
338 were unsheltered.
    In addition, our regional Coordinated Entry System 
Assessment showed in the last 18 months we identified over 840 
veterans who are experiencing homelessness and were in need of 
housing.
    We also did a 6-month review of the homeless veterans 
referred for VASH vouchers to the VA through our Coordinated 
Entry System through April 2019 through September. We have 192 
referrals and, sadly, we had 91 declines, a decline rate of 
nearly 50 percent.
    Understanding the challenges is a collective effort and it 
is important to understand that we worked with the VA to verify 
that it was truly a 50-percent decline rate. What the VA and 
our data showed that this was solely due to eligibility 
requirements, including the prioritization eligibility.
    Our partners at the VA, Dr. Robert Smith, said in his 
written statement from our hearing in Oceanside in August that 
they are supportive of all efforts to increase homeless veteran 
HUD-VASH prioritization eligibility.
    It is important to recognize, Combat Exposure (CES) does 
not have the ability to track the referrals once they go to the 
VA through to the housing authorities. Once we have made those 
referrals, we are very much in kind of a black box. We work 
with our housing authorities to understand the time that lapses 
from when we make a referral from Coordinated Entry to when the 
VA makes a referral for our housing authorities.
    Our housing authorities have stated that this may be due to 
staffing of supportive services and the level of care required 
by the VA. They say there is a significant gap in time in 
referrals from our numbers to what they are actually seeing. 
Second, the importance of expanding the limited eligibility for 
homeless veterans for VA assistance.
    The Housing Commission has been working with our VA 
officials and have come up with some priorities that they would 
like to see around these: reducing the barriers to expanding 
VASH eligibility, eliminating the time-served requirements, 
including the veteran discharge under conditions other than 
honorable, as Greg talked about, and eliminating the VA health 
care eligibility requirements. Also ensuring that we have the 
resources needed to maximize our utilization of VASH. We have 
heard a lot about that case management.
    Another option is using our housing authorities, who are 
really skilled at leasing up their VASH vouchers. Where our San 
Diego Housing Commission had 31 percent under-utilized VASH 
vouchers, they are over 100 percent in their other Housing 
Choice vouchers. Using their expertise in helping us lease up 
is one of the recommendations.
    Will leave that to any questions you may have. Thank you.

    [The Prepared Statement Of Tamera Kohler Appears In The 
Appendix]

    Mr. Levin. Thank you, Ms. Kohler, I appreciate that very 
much, and thanks for all your great work in the San Diego 
community.
    With that, I would like to recognize Mr. Cooper for 5 
minutes.

                    STATEMENT OF GARY COOPER

    Mr. Cooper. Good morning. My name is Gary Cooper and I am 
the Chairman of the National American Indian Housing Council 
and I am a citizen of the Cherokee Nation. I also serve as the 
Executive Director for the Housing Authority of the Cherokee 
Nation located in Tahlequah, Oklahoma.
    I appreciate the opportunity to testify before the 
subcommittee today and I would like to thank Chairman Levin, 
Ranking Member Bilirakis, and committee members for having this 
hearing and for staying engaged on tribal housing issues.
    In addition to the comments I will make today, I have 
submitted a formal written statement for the record.
    The National American Indian Housing Council is comprised 
of 289 tribal housing organizations that represent and serve 
nearly 500 tribes across the United States. National American 
Housing Council (NAIHC) was established in 1974, and our 
primary functions are to work with elected Federal officials 
here in D.C. and to build capacity among our tribal housing 
programs through our training and technical assistance program. 
As part of its mission, NAIHC has advocated for and worked with 
HUD as it launched the Tribal HUD-VASH Demonstration Program.
    I appreciate this committee's focus on supporting and 
improving the HUD-VASH program. I am particularly happy that 
tribes are now included in these discussions.
    As you may know, Native Americans have historically served 
in the U.S. Armed Forces at rates higher than any other 
demographic. That also means there are a lot of Native American 
veterans who need our help once they leave active service. Many 
of these veterans return to their home communities in some of 
the most rural parts of the country and where they can only 
rely on tribal programs for services. However, when HUD-VASH 
was first created in 2008, tribes and Native American veterans 
were largely left out of the program. The program was operated 
through other public housing organizations, but tribes were not 
included. This created a gap in service, as many Native 
veterans returned to their home communities where many of these 
groups were just simply not active in Indian Country.
    This exclusion of tribes from the original HUD-VASH program 
largely followed the trend to exclude tribes from other Federal 
housing programs. Tribes started to receive Native American 
Housing Assistance and Self Determination Act (NAHASDA) and the 
Indian Housing Block Grant in 1998, and since that time new 
Federal housing programs often excluded tribes. Almost as soon 
as the block grant started, however, it has not kept pace with 
tribal needs or even inflation. Currently, tribes receive only 
about 75 percent of inflation-adjusted funding they received in 
1998.
    I am glad to report that the trend to exclude tribes is 
starting to reverse, particular with HUD-VASH. Congress funded 
the Tribal HUD-VASH Demonstration Program starting in 2015. 
Only 26 tribes have been included in the program and it faced 
some obstacles implementing the program. The two biggest 
obstacles tribes have faced include finding qualified case 
managers within the VA that can work with tribes in their 
communities in finding affordable and available housing 
options, as Indian Country faces a severe housing shortage.
    A 2017 HUD report found that Indian Country as a whole 
needs 68,000 new units to overcome overcrowded and substandard 
housing in tribal communities. Under current funding, tribes 
are largely able to build about 1,000 new units a year, while 
the bulk of funding goes to rehab and maintenance of existing 
housing stock.
    Despite these obstacles, I think that the Tribal HUD-VASH 
program is a success and can be more successful. It is a 
success because we are now serving hundreds of Native American 
veterans who would not have received services otherwise. These 
veterans are just a small portion of the Native veterans that 
are out there needing services. There are still nearly 550 
tribes across the country who are unable to access this 
program.
    Over the past 2 years, the 26 tribes in the demonstration 
program have helped about 350 veterans each year, and HUD 
estimates that over 600 Native American, including Alaska 
Native veterans, have been helped through the program. Native 
veterans who were homeless or at risk of homelessness have 
received the housing and supportive services they need. Many of 
these Native veterans have since exited the program into 
permanent solutions, including several who have moved to full 
home ownership.
    Due to the program's success at the 26 pilot communities, 
NAIHC and tribes have been supporting full authorization of the 
program. Accordingly, Members of Congress have introduced bills 
that would make Tribal HUD-VASH permanent and we support these 
efforts. This year, S. 257 and H.R. 2999 are companion bills 
that would make the program permanent and provide a mechanism 
for all tribes to participate. It also guarantees the 
Secretaries of HUD and VA have flexibility to improve the 
program and make it as effective as it can be tribal 
communities by codifying the flexibility that has been included 
in appropriations language in past years.
    S. 257 passed under unanimous consent over in the Senate 
with full bipartisan support. NAIHC thanks the leadership of 
the Senate Indian Affairs Committee and Veterans' Affairs 
Committee, all of four which leaders sponsored the bills from 
the start. Similarly, in the House, we want to thank 
Representative Luian and 11 bipartisan cosponsors of H.R. 2999. 
Both versions of the bill are with Financial Services and we 
will work with them to move it forward.
    With that, I will end my statement, I ran up on time, and I 
look forward to answering any questions you have. Thank you 
again for focusing on veteran housing issues in Indian Country.

    [The Prepared Statement Of Gary Cooper Appears In The 
Appendix]

    Mr. Levin. Thank you, Mr. Cooper, and I appreciate your 
continued advocacy for our Native American veteran community, 
and I look forward to working with Mr. Luian and others on that 
legislation.
    With that, I would like to recognize myself for 5 minutes 
for questions, and I thought I would start with Mr. Anglea. I 
thank Mr. Anglea and Ms. Kohler for flying all the way from San 
Diego and being here. I know from my review of your written 
testimony, Mr. Anglea, that you have another anecdote that you 
would like to share. You got through two of the three. I wonder 
if you could get through the other anecdote, and the other 
priority for you and for Interfaith.
    Mr. Anglea. Thank you, Congressman Levin, for the 
opportunity.
    The third key action that I outlined in our testimony is 
around veterans who have disabling conditions and struggle to 
secure the disability benefits that in our experience they are 
entitled to, they are just not able to get through the system 
to successfully gather all of their medical records to 
demonstrate the level of their health condition disability, to 
make that case effectively to the Social Security 
Administration, and many of whom, like Mr. Brown as an example 
or Mr. Santiago, as he is referred to in my testimony, have 
other-than-honorable discharges and therefore do not have 
access to the centralized VA health care system to gather those 
records easily and, as a result, their health care records are 
disparate, spread throughout. If they are experiencing 
homelessness, they are in a State of crisis. If they have 
mental health conditions, their ability to gather all this 
information together and to successfully secure benefits of any 
kind are very limited and their rates of denial are very high. 
In many cases, north of 75 percent rates of denial.
    There is an intervention that is supported by the Substance 
Abuse and Mental Health Services Association, Substance Abuse 
and Mental Health Services Administration (SAMHSA), called 
Supplemental Security Income/Social Security Disability 
Benefits Outreach Access and Recovery (SOAR), and it is where 
you have a clinician who helps an individual gather their 
medical records and apply for disability benefits. They can 
secure a sustainable income and, when that happens, they 
usually get housed. We are proposing and would like to see a 
pilot project focused on veterans with disabling conditions who 
are not yet connected to disability benefits to support them to 
secure the income that they--we believe and in our experience 
they are entitled to.
    We will pay for these individuals' care either way. We will 
pay in hospitals, emergency departments, with first responders, 
in jails, and in shelters, or we can pay by connecting to 
health care and dignified housing. A pilot project to help with 
disability benefits is, in our experience, an excellent way to 
help people in their time of need.
    Mr. Levin. Thank you very much for that.
    In our first panel, you probably heard, you know, a few 
things that HUD-VASH potentially needs to change to improve the 
program. One is case management--potentially more money, more 
case managers, better hiring criteria--another is the 
eligibility criteria. We do have that bill that we have been 
talking about regarding the OTH discharges, but there are other 
aspects of that as well. The third is the accuracy of fair 
market rent calculation. That is a particularly important 
consideration in a place like North County San Diego, as an 
example.
    Going back to eligibility criteria, one area where I have 
been stunned to learn some of the statistics is the Coordinated 
Entry process and the challenges with that process. I heard 
that about half of veterans referred to HUD-VASH through 
Coordinated Entry System are denied services due to 
eligibility. For both Mr. Anglea and Ms. Kohler, which 
eligibility criteria do you think posed the largest hurdles to 
connecting veterans with HUD-VASH?
    Ms. Kohler. Coordinated Entry struggles in its newness and 
the fact that we do not collect a lot of the information right 
up front about an individual's disabling conditions. We do not 
have the information on their VA medical eligibility, and we 
also struggle with, especially if you have a high unsheltered 
population, meeting that chronic definition sometimes, having 
that documentation.
    The 50 percent that we saw declined, 50 percent of those 
are 100 percent associated with being ineligible for the VASH 
voucher. That may be that they do not meet the VA connection to 
health care, it may be that they are other-than-honorably 
discharged, it may be that they do not meet the chronic status 
and that is something we really need to look at.
    One of the things that Greg and I talked about is the fact 
that the referrals into CES come from our service providers in 
determining that a veteran most likely would be eligible for 
VASH. If they know that it is an other-than-honorable 
discharge, they do not refer that veteran even into CES for the 
VASH vouchers. We know that those numbers are probably under-
represented as well.
    It is also challenging with CES because, as Dr. Harris 
said, our data systems are not connected. We cannot determine 
if there is something else we could collect or more information 
we could provide with Coordinated Entry.
    We work very closely. Our local VA was an early adopter of 
using Coordinated Entry, but a 50 percent decline rate is just 
not acceptable. They understand that, we understand it, but 
most of it is eligibility of the criteria and the 
prioritization. They may not score high enough, they may not 
have a length of time homeless, or they may not have the 
disabling conditions, which is something we need to look at 
when we have unused VASH vouchers sitting in the wings as well.
    Mr. Levin. Mr. Anglea, anything to add to that?
    Mr. Anglea. Just to highlight that our local VA is piloting 
a project with the support of the central VA to award vouchers 
to our organization, Interfaith Community Services, and also 
vouchers to Veterans Village of San Diego, another organization 
serving veterans in San Diego. For our staff, our boots-on-the-
ground social workers to directly connect veterans we are 
working with to those vouchers and to get them into housing.
    We operate a recuperative care program in San Diego, it is 
the only of its kind, in partnership with the VA. 
Unfortunately, in the last year, we have not been able to 
connect any veterans from that program to HUD-VASH while they 
are in the program itself, during the 3-month stay, it takes 
longer than that. This will be an intervention to fast-track 
that process and to connect veterans who we know will be 
successful, we believe will be successful with that 
intervention, and it is an example of in a way contracting with 
community partners. It does not actually come with any funding, 
we will do this with privately funded resources to show that it 
works, but it is an example of utilizing partners that are on 
the ground and ready to go.
    Mr. Levin. Thank you both again for bringing your 
perspective from North County San Diego. And if our friend Dr. 
Smith from the VA in San Diego is watching, we appreciate all 
his hard work as well and his continued partnership to get this 
right.
    And, with that, I will recognize the ranking member for his 
questions.
    Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it. 
Thank you, all of you, participating today.
    Ms. Kohler, in your written statement you propose an idea 
that would allow public housing authorities to be the gateway 
to HUD-VASH instead of waiting on VA to provide referrals. 
Please tell us more about this proposal and how you believe San 
Diego's utilization of the non-VASH vouchers compared to 
utilization of VASH vouchers supporting this proposal. This is 
really important, so please.
    Ms. Kohler. I think this is an important piece that our 
housing commission, our housing authority looked into. They are 
experts of leasing up the Housing Choice vouchers, most of our 
housing authorities are. This is their business, they work with 
landlords, they know how to move clients between all of their 
various housing resources as well.
    As I said in my written statement, and oral as well, our 
housing authority is leasing up more than 100 percent of their 
Housing Choice vouchers, yet we are under-utilizing 31 percent 
of our VASH vouchers.
    The ability for a housing authority to not only match those 
veterans, especially if they are not eligible for VASH, maybe 
to another resource, is just playing to their strengths.
    When we talked about using other resources, contracting out 
for case management, they have that ability to contract out for 
case management as well. It is housing-focused, they know how 
to work with the landlords. We could balance that approach and 
make sure we have the right level of supportive services, but I 
think it is a really innovative way. I think it is housing 
authorities stepping up and saying this is our business, we are 
good at this, work with us to be able to do that, and the VA 
then providing the health care, the supportive services, where 
they really focus on their strength as well.
    This is something that was proposed from our housing 
commission to the VA, I think we are looking at piloting that, 
and it could be transformational in the way that we are using 
our VASH vouchers.
    Mr. Bilirakis. Okay, very good. Thank you for thinking 
outside the box, so important.
    Again, another question for you, Ms. Kohler. In your 
written statement you discuss the increased number of older 
homeless veterans. Do you believe this is a factor of an aging 
Vietnam/cold war veteran type of population or something else? 
What type of additional challenges do older veterans present 
compared to younger veterans?
    Ms. Kohler. We are seeing a challenge with older veterans, 
they need different type of services. As Greg talked about 
recuperative care, we need to think about long-term care 
housing for them as well.
    Veterans--in fact, I will read some of the information--
they have some very complex challenges as they age. They have 
age-related needs that pose significant challenges to our 
system. Long-term health care issues, independent living 
options need to be considered as we are thinking about our 
veterans. Not all of our VASH vouchers or project-based units 
are really designed for people as they age, so many of them 
cannot transition in place.
    We also saw a lot of our veterans who are ineligible for 
VASH, served with our SSVF, and we saw that age increase from 
one in five being in our senior population in 2017 to 2019 it 
is one in four. We are seeing a rapid aging and I think it is 
associated with those veterans that served in Vietnam and those 
other service-oriented processes, and they are really 
struggling with just age-related issues. Anyone who works with 
the homeless population knows they age rapidly when they are 
homeless as well. The early onset of age-related issues with 
veterans who have experienced homelessness, we are seeing it at 
much younger ages, 55, where someone 70 would be experiencing 
those challenges as well.
    It is something we need to be planning for, we need to be 
mindful of it, and we need to make sure we have the right 
services for an aging veteran population.
    Mr. Bilirakis. Yes, so you are basically saying ALFs, 
assisted living facilities; not nursing homes, but assisted 
living facilities, so they can get the proper care.
    I had one more question, if I may, Mr. Chairman?
    Mr. Levin. Of course.
    Mr. Bilirakis. How can the expanded use of project-based 
HUD-VASH vouchers help meet the continued problem of affordable 
housing in some urban communities? This is a huge problem, we 
brought this up.
    This question is for Ms. Monet, if you will. Thank you.
    Ms. Monet. I think what we have seen is that in some 
communities there is just a literal shortage of housing. You 
have got veterans wandering around with vouchers, looking for 
somewhere to rent. If you have got a project-based site you 
know that there are units that will be available, they have got 
vouchers tied to them, there is a whole community of, you know, 
individuals, and somewhat of a therapeutic milieu for the 
veterans. So it really just creates more affordable housing in 
areas where you do not have any.
    Mr. Bilirakis. Okay, very good.
    Thank you, Mr. Chairman. I appreciate it.
    Mr. Levin. Thank you, Mr. Ranking Member.
    I recognize Mr. Bergman for 5 minutes.
    Mr. Bergman. Thank you, and thank you to all here on the 
panel for being here. I think I recognize some faces, but maybe 
it is because you all travel in the same circles we do when you 
are trying all over the country to do the right thing for 
people in need.
    I am going to make a blanket statement here and just raise 
your hand if I am wrong. Okay? That all of you sitting there at 
the testimony table have experience with local entities, non-
profits, veterans' groups, faith-based organizations, et 
cetera, when it comes to dealing with the issue at hand here 
that we are talking about.
    Would any of you consider yourselves subject matter 
experts--since you have basic understanding--subject matter 
experts in the area of understanding that focuses on the 
differences between urban, suburban, rural, and remote issues, 
you know, that tie into where the veteran population is? 
Anybody want to offer yourself up as the subject matter expert 
in that arena?
    Okay, good. All I want is your business card at the end.
    Mr. Berg. Okay, great. I am happy to do it.
    Mr. Bergman. There is not a question there, but I wanted to 
know, because the point is, you know, we all have areas in 
which we know a lot about and, if we are honest, we say there 
are areas we do not know much about. The idea--we are all--you 
know, all 435 Representatives in the House have different 
demographics for where their constituents live and how they 
interact with just life. All right?
    Mr. Anglea, you went into great detail on the other-than-
honorable discharges. I voted for the bill yesterday because of 
my many decades of experience as a commander having to deal 
with disciplinary situations, whether it be violation of the 
Uniform Code of Military Justice (UCMJ) or whether it be having 
to make a decision on the characterize of service of, in my 
case, you know, Marines and sailors under my command.
    Do you have any data--and this is a really--this is a 
detailed question and I don't necessarily expect you to have 
the data at this point, but I would like to get the data, 
whatever breakdown you have, because some OTH discharges are 
handed out because of, let us say, unsatisfactory participation 
in the Reserve component. They just--you know, they went 
through boot camp, they went through their A school, and then 
just decided not to show up at their unit of assignment. The 
point is I think one of the reasons--again, I voted for the 
bill yesterday--is we need to clarify exactly why an 
individual--so the people who are not in the military system 
understand why that person got an other-than-honorable. Okay?
    Just, you know--again, not to be answered now, but I would 
really appreciate any data you have that breaks it out by 
service group; it could have been active service, it could have 
been Reserve service, it could have been, you know, various 
things.
    Mr. Cooper, how would the tribe solve the problem of the 
shortage of qualified caseworkers that we have acknowledged we 
do not--what would the tribes do?
    Mr. Cooper. That is a good question. I think that now the 
VA has caseworkers in just about--if not every, almost every 
one of those tribal communities. It took a little bit of time 
to do so. We are talking about, you know, rural America and 
remote parts of Alaska and other places.
    I like the idea of the housing part starting with the 
tribes, but I think as far as the caseworkers on the VA side 
goes, I think a lot of it is they have started--they seem to 
somewhat figure it out, but there is still an issue there.
    I do not know if it is working with tribes and Indian 
Health Service to use their caseworkers, if it is expanding it 
to require maybe some type of telemedicine part of it, or also, 
you know, not requiring--in some cases it is hard to get a 
masters of social work person, a licensed social worker to go 
out to some of these tribal areas----
    Mr. Bergman. Okay.
    Mr. Cooper.--plain and simple.
    Mr. Bergman. Do you think it would be possible to 
literally--for, again, those of us who want to--if the tribes 
would be willing to sit down and talk about that? Because if we 
can develop a model that is successful for the tribes, who 
knows where that model can be applied throughout, you know, 
other parts of the country.
    With that, Mr. Chairman, I yield back.
    Mr. Levin. I thank Mr. Bergman both for his perspective on 
these issues, as well as for his support of our legislation 
earlier this week, and look forward to working together for a 
long time to come on this.
    If there are no further questions, we can begin to bring 
this hearing to a close. I really want to thank our witnesses 
today.
    Today's hearing has touched on two of the issues that are 
most important to me and to my district, and I would imagine to 
many of my colleagues as well, one is improving services for 
veterans, the other is reducing homelessness. This particular 
program, the HUD-VASH program, touches both. I am encouraged by 
a lot of what I have heard today from you, our experts in the 
field, as well as from HUD and from the VA.
    I thank all of our witnesses again, particularly those 
coming from North County San Diego and our district, for 
providing their expertise, for the outstanding work that you 
continue to do.
    We have highlighted that while HUD-VASH is working and we 
have demonstrated results that it is working, it can be 
improved to work even better by doing some of the things that 
we spoke about today. I am very hopeful about this legislation 
that we passed earlier this week to expand eligibility to OTH 
discharges. I am very hopeful that given the broad, bipartisan 
support that that legislation had this week that we can have 
them take it up in the Senate. I am hopeful also that our 
amendment that we mentioned before will receive consideration 
as well.
    I hope that, you know, we all agree on this, I believe we 
do. It is that simple premise that even one homeless veteran is 
one too many. I will continue to work however I can to use this 
subcommittee--and I know the ranking member shares this 
objective--to use this subcommittee to find bipartisan 
solutions to address veteran homelessness and housing issues. 
We are going to work on this until we solve the problem.
    No one who sacrifices so much to serve our country should 
ever have to worry about having a place to live, and I think we 
all can agree on that.
    With that, all members have 5 legislative days to revise 
and extend their remarks and include additional materials.
    Without objection, the subcommittee stands adjourned.
    [Whereupon, at 11:49 a.m., the subcommittee was adjourned.]

?

      
      
      
      
      
      
      
      
      
=======================================================================


                         A  P  P  E  N  D  I  X

=======================================================================


                    Prepared Statement of Witnesses

                              ----------                              


                   Prepared Statement of Keith Harris

    Good Morning, Chairman Levin, Ranking Member Bilirakis, and 
distinguished Members of the Subcommittee. Thank you for the 
opportunity to testify today on the topic of Veteran homelessness, 
specifically the Department of Housing and Urban Development (HUD)-
Veterans Affairs Supportive Housing (HUD-VASH) Program and the Tribal 
HUD-VASH Program.

Introduction

    The Department of Veterans Affairs (VA) remains committed to the 
goal of preventing and ending Veteran homelessness. We can and will get 
there. No one agency or group can end Veteran homelessness alone. The 
effort to prevent and end Veteran homelessness is a collaboration 
between Federal, State, and local governments and, most importantly, 
the local community. VA works with communities to help them develop the 
solutions that work best for them and their Veterans.
    VA and other Federal, State, and local governments, as well as non-
governmental organizations, recognize that ending Veteran homelessness 
is not a single event in time; rather, it is a deliberate effort made 
to achieve the goal, and continued follow up efforts to make sure that 
progress toward achieving the goal is maintained. Our goal is a 
systemic end to Veteran homelessness, which means communities across 
the country:

      Have identified all Veterans experiencing homelessness;

      Can provide shelter immediately to any Veteran 
experiencing unsheltered homelessness who wants housing;

      Provide service-intensive transitional housing in limited 
instances;

      Have the capacity to help Veterans swiftly move into 
permanent housing; and

      Have resources, plans, and systems in place should any 
Veteran become homeless or be at risk of homelessness in the future.

    The goal is to make sure that every Veteran has permanent, 
sustainable housing with access to high-quality health care and other 
supportive services and that Veteran homelessness in the future is 
prevented whenever possible or is otherwise rare, brief, and 
nonrecurring.

State of Veteran Homelessness


    Significant progress has been made in preventing and ending Veteran 
homelessness. The number of Veterans experiencing homelessness in the 
United States declined by nearly half since 2010. The most recent HUD 
Point-in-Time (PIT) Count estimated that on a single night in January 
2019, 37,085 Veterans were experiencing homelessness; a 2-percent 
reduction from the 37,878 reported in January 2018.
    Since 2010, more than 800,000 Veterans and their family members 
have been permanently housed, rapidly rehoused, or prevented from 
falling into homelessness through HUD's targeted housing vouchers and 
VA's homelessness programs. In addition to the national snapshot 
provided by the 2019 PIT Count, as of December 4, 2019, 81 
communities--which includes three States--have effectively ended 
Veteran homelessness, based on criteria established by VA, HUD, and the 
U.S. Interagency Council on Homelessness. This progress illustrates 
what can be achieved when government agencies work with citizens and 
community leaders to tailor the delivery of services in a manner that 
meets the needs and expectations of the community.

Preventing and Ending Veteran Homelessness Is Possible

    To achieve our goal of preventing and ending Veteran homelessness, 
we need continued leadership, collaboration, commitment, and a sense of 
urgency from communities across the country. No one entity on its own 
can prevent and end homelessness among Veterans.
    There has been unprecedented support from every branch of 
government; State and local leaders; and agencies to provide both the 
funding and human resources needed to end Veteran homelessness. 
Communities continue to align those resources with the most effective 
practices to ensure rapid, safe, and stable housing for Veterans who 
need it.
    Progress comes when community leaders implement proven practices 
that are reducing homelessness among Veterans nationwide and ending it 
community by community. Common practices developed and implemented 
locally that have achieved an effective end to Veteran homelessness 
include:

      Identifying all homeless Veterans by name and sharing 
those names across systems so that no one is forgotten;

      Using and sharing data to find and serve every Veteran 
who needs homeless services;

      Creating coordinated assessment and entry systems to make 
sure there is no wrong door for Veterans seeking help, and coordinating 
people and services at every level to create integrated systems of 
care;

      Setting concrete and aspirational monthly and quarterly 
goals and engage the community and associated systems to meet them. 
This requires the direct involvement of community leaders and focused 
political will and can be used as a benchmark progress against specific 
criteria;

      Synchronizing programs to coordinate outreach and target 
the right type of resource to the right Veteran at the right time;

      Making sure outreach and engagement efforts are 
coordinated across service providers; law enforcement personnel, 
prisons and jails; hospitals; libraries; and job centers to proactively 
seek Veterans in need of assistance with housing; and

      Focusing on creating connections from homeless services, 
housing organizations, and VA medical centers (VAMC) to employment 
support services such as those provided by the Department of Labor's 
Homeless Veterans Reintegration Program grantees, Workforce Development 
Boards, and employers so that Veterans can be quickly connected to 
jobs.

HUD-VASH Program

    One of VA's most important resources for ending Veteran 
homelessness is the HUD-VASH program. HUD-VASH is a collaborative 
program between HUD and VA, in which HUD provides eligible homeless 
Veterans with a Housing Choice rental voucher, and VA provides case 
management and supportive services so that Veterans can gain housing 
stability and recover from physical and mental health problems; 
substance use disorders; and other issues contributing to or resulting 
from homelessness. The program goals are to help Veterans and their 
families gain stable housing while promoting full recovery and 
independence in their community.
    HUD-VASH currently has more than 100,000 vouchers allocated 
nationally to Public Housing Authorities (PHA). As of October 31, 2019, 
80 percent of these vouchers were leased up, leaving approximately 
20,000 vouchers unleased. This unleased number of 20,000 breaks down 
further as follows: approximately 2,500 are shelved for project-based 
voucher (PBV) development and thus not available for use; over 4,500 
are in the hands of Veterans seeking housing; and over 1,300 are 
reserved for Veterans recently referred to PHA. This leaves 
approximately 11,000 vouchers unleased and available for use. With over 
37,000 Veterans still homeless on any given night, 11,000 unused 
vouchers are far too many, and VA is dedicated to ensuring we maximize 
the utilization of HUD-VASH vouchers and assist as many homeless 
Veterans as possible with obtaining and sustaining housing.
    There are several key reasons for the current voucher utilization 
rate in HUD-VASH. The reasons include: 1) the allocation strategy 
employed by VA and HUD over the past few years; 2) market factors, 
particularly low vacancy rates and high rents in communities with large 
numbers of vouchers; 3) vacancies in VA case management positions; and 
4) reductions in the chronically homeless Veteran population.

      Allocation Strategy: For many years, vouchers were 
allocated to PHAs based on a complex formula that considered multiple 
indicators of need and performance and utilization data for the local 
PHA and VAMC. This approach fostered a broad distribution of vouchers 
where they could be used (e.g., high performers received more 
vouchers). In more recent allocations, HUD and VA strategically shifted 
this approach and allocated vouchers purely based on need (e.g., those 
with the largest numbers of homeless Veterans received more vouchers). 
This shift provided enough vouchers were on the ground in high-need 
areas in the long term but resulted in surpluses of vouchers in the 
short term. To address this problem, HUD established a utilization 
threshold that PHAs must meet to be eligible for vouchers. This will 
help avoid continuing to push vouchers to communities that already have 
a short-term surplus and will help avoid exacerbating the low 
utilization rates we see nationally.

      Market Factors: A significant obstacle to higher voucher 
utilization is a lack of safe and affordable housing for Veterans 
holding a HUD-VASH voucher. Rents are skyrocketing in many of the same 
cities with the largest number of homeless Veterans and largest number 
of vouchers allocated. Veterans holding vouchers in these communities 
are finding it very difficult to find housing. To address this problem, 
VA and HUD are promoting all strategies that will either increase 
housing stock dedicated to Veterans or make the HUD-VASH voucher more 
competitive. The primary strategy for increasing housing stock is 
through the use of PBVs, where vouchers are tied to units that are 
dedicated to HUD-VASH Veterans or make vouchers more competitive by 
increasing the payment standard for HUD-VASH vouchers.

      Vacancies in VA Case Management Positions: VA is required 
by statute to ensure that Veterans in HUD-VASH are provided case 
management and seen as needed by a case manager. Because HUD-VASH is a 
permanent supportive housing program originally designed for 
chronically homeless Veterans with acute service needs, VA adopted a 
clinical model of 1 case manager for every 25 Veterans in HUD-VASH. It 
is not possible to provide intensive case management with caseloads 
significantly higher than 25. Of the 4,156 HUD-VASH positions 
nationally, 3,497 (84 percent) were filled as of October 31, 2019, 
leaving 659 positions vacant. VA aims for a filled rate of 90 percent 
staffing, to account for inevitable turnover related to retirements, 
changing positions, etc., which would yield an additional 243 case 
management positions. If each of these additional positions carried a 
caseload of 25 Veterans, HUD-VASH could house over 6,000 additional 
Veterans, improving voucher utilization to 88 percent of active 
vouchers. VA is employing multiple strategies to address its HUD-VASH 
vacancies. VAMCs are continually reminded of the prioritization of 
ending Veteran homelessness, and the importance of HUD-VASH positions 
in supporting this effort. Where staffing is a long-term challenge, VA 
is promoting the use of contracting or other alternative forms of case 
management. In the upcoming HUD-VASH voucher allocation from HUD, VA 
will require that VAMCs fill current vacancies before requesting any 
new positions to support the new vouchers.

    Reduction in the Number of Chronically Homeless Veterans 
Nationally: HUD-VASH targets chronically homeless Veterans, those who 
need the most intensive support in order to obtain and sustain housing. 
This approach has been very successful, and the HUD-VASH program has 
directly and markedly reduced the population of chronically homeless 
Veterans over the past few years. In the early years of HUD-VASH, 
chronically homeless Veterans comprised as much as 33 percent of the 
homeless Veteran population. As of the most recent PIT count, that 
percentage dropped to an estimated 22 percent. In order to fully 
utilize the remaining HUD-VASH vouchers, Federal agencies are reviewing 
ways to broaden the population of homeless Veterans it targets for HUD-
VASH by targeting specific Veteran subpopulations previously not 
targeted.

Tribal HUD-VASH

    In Fiscal Year 2015, Congress authorized HUD to set aside funds 
from the HUD-VASH program to expand the program into Indian Country. On 
March 2, 2016, HUD made $5.9 million in awards to 26 Tribes and 
tribally designated housing entities (TDHEs). The amount of the award 
was based on the number of housing units requested by the Tribe or 
TDHE, the rents established by the Tribe or TDHE, and a flat 
administrative fee per housing unit. Tribal HUD-VASH, therefore, 
accounts for less than 1 percent of the total HUD-VASH program 
nationally.
    To ensure that Native American Veterans served by this program 
receive case management and supportive services, VA funded one case 
manager for each of the 26 Tribes that received grant awards. Given the 
unique nature of working with the Tribes and on tribal land, the Tribal 
HUD-VASH case manager must develop cultural competence specific to the 
Tribe(s) being served. Currently, 23 of these positions are filled, 
with three remaining vacant. In all three vacancies, the local VAMC has 
a temporary case manager providing Tribal HUD-VASH coverage until these 
positions can be permanently filled.
    As of October 28, 2019, 387 Native American Veterans are being 
assisted under this program. Additionally, 111 Native American Veterans 
who previously received housing assistance and case management services 
have subsequently exited the program. Of these, 52 have moved into 
permanent housing, including 22 who went on to rent their homes without 
any public assistance and three who have purchased a home. Moreover, 
despite initial delays, all of the grantees have a VA case manager to 
provide case management. The Tribal HUD-VASH program is an important 
addition to the overall HUD-VASH program, bringing valuable permanent 
supportive housing resources to tribal lands.

HUD-VASH Funding

    As a jointly run program between two Federal agencies, HUD-VASH 
receives its funding from two separate appropriations committees. HUD 
has received incremental voucher assistance each year since 2008. Using 
the Medical Services appropriations, VA was sufficiently able to keep 
its average caseload size at 25 Veterans per case manager for the 
100,000 vouchers currently allocated; however, if HUD allocates new 
vouchers at the end of the first quarter of Fiscal Year (FY) 2020 as 
planned with Fiscal Year 2019 funds, average caseload sizes will 
increase to 27 Veterans per case manager without reallocation of funds 
internally. The target of 25 Veterans per case manager is considered 
high in permanent supportive housing programs. If HUD continues to 
allocate new vouchers, VA will require a proportional increase in its 
budget for case managers to support those vouchers.

Rural Homelessness

    Rural homeless individuals are often referred to as the ``hidden 
homeless.'' It is difficult to accurately estimate the size of the 
problem of rural homelessness due to its invisibility; the limited 
availability in rural areas of services intended to respond to 
homelessness; limitations in the definition of homelessness and the 
counting methods better suited for use in urban environments; and the 
migration of people experiencing housing instability from more to less 
rural areas. Rural areas often do not have sufficient resources to 
address housing crises, and the rural environment makes it difficult to 
implement evidence-based responses, such as rapid rehousing.
    Because of the difficulties in accurately estimating the number of 
homeless individuals in rural areas, it is generally assumed that the 
PIT count underrepresents the need in these areas. This is important, 
because homeless resource allocation and distribution is based heavily 
on the PIT count. Thus, it is also generally assumed that rural areas 
are under-resourced. To address this, in Fiscal Year 2016, HUD 
allocated 600 vouchers specifically for rural areas. VA funded 34 case 
manager positions to provide supportive services and case management. 
It should be noted that 34 Full-time Equivalent to support 600 vouchers 
yields an average caseload size of 17 Veterans, which is smaller (i.e., 
more service rich) than the target of 25 in the general program. This 
was done to address known challenges in providing case management in 
rural areas, such as large geographical catchment areas, lengthy 
transportation times, and scarcity of resources. Despite these targeted 
vouchers and dedicated rich case management support, these rural 
vouchers were significantly underutilized, especially compared to the 
general program at the time, which ended Fiscal Year 2016 at over 92 
percent vouchers utilized. Fiscal Year 2016 was the only year in which 
HUD allocated vouchers specifically to rural areas.
    VA remains committed to serving Veterans in all areas, including 
those in rural areas, and we will continue to promote strategies and 
innovations that will ensure that these Veterans have access to the 
housing and services they need.

Conclusion

    Across VA, we are committed to providing the high-quality care our 
Veterans have earned and deserve. We continue to improve access and 
services to meet the needs of Veterans. We are grateful for the 
resources Congress provides VA to care for Veterans, particularly HUD-
VASH resources which are crucial to ending Veteran homelessness. We 
pledge to do all we can to ensure these resources are used as 
effectively and efficiently as possible. Thank you for the opportunity 
to appear before you today to discuss this invaluable program.

                   Prepared Statement of Hunter Kurtz

Introduction

    Good afternoon Chairman Levin, Ranking Member Bilirakis and members 
of the subcommittee. It was a pleasure to testify before the 
Subcommittee on Economic Opportunity this past summer, and I look 
forward to updating you on the efforts of the Department of Housing and 
Urban Development (HUD) and our Federal partners to end veteran 
homelessness across the United States.
    HUD is committed to ending veteran homelessness by working 
collaboratively with our partners and maximizing the effectiveness of 
all existing resources. Thanks to funding from Congress and close 
collaboration among Federal and local partners, the Nation has 
continued to make progress in addressing veteran homelessness and 
creating sustainable Federal and local systems that quickly respond to 
homelessness.
    I am honored to serve as HUD's Assistant Secretary for Public and 
Indian Housing (PIH). The HUD Veterans Affairs Supportive Housing (HUD-
VASH) program, jointly administered by HUD, within PIH, and the 
Department of Veterans Affairs (VA), within the Veterans Health 
Administration Homeless Program Office, provides homes to veterans who 
are homeless or at risk of homelessness. HUD staff, local housing 
authorities, Continuums of Care, and local Veterans Affairs Medical 
Centers (VAMCs) work in tandem to provide homes and services to 
homeless veterans. I can attest that this program has been successful 
in providing a home - not just a house - to our Nation's veterans and 
their families.

General HUD Homeless Assistance Programs

    HUD's Office of Community Planning and Development (CPD) provides 
about $2.4 billion annually to communities to help end homelessness. 
Funding is primarily used for permanent supportive housing, which 
successfully houses people with long histories of homelessness and 
significant disabilities. Permanent supportive housing can reduce 
hospitalization and emergency room utilization while dramatically 
improving the well-being of the people it serves. HUD also provides 
funding for rapid re-housing, a cost-effective strategy that helps 
people move quickly into housing, provides short-term financial 
assistance, and provides supportive services to help the homeless 
stabilize in their housing, increase their employment and income, and 
connect them to community supports. HUD also supports emergency 
shelter, transitional housing, and many other types of assistance 
dedicated to ending homelessness.
    In 2017, approximately 17,000 homeless veterans were served using 
$97 million through HUD's Continuum of Care (CoC) program. Most of that 
funding is for permanent supportive housing that houses approximately 
10,000 homeless veterans with disabilities. Thousands more homeless 
veterans are served with rapid re-housing, emergency shelter, and other 
assistance. Additionally, CoCs continue to work closely with VA and 
Public Housing Authorities (PHAs) to effectively use HUD-VASH 
resources.

Housing and Urban Development - Veterans Affairs Supportive Housing 
    (HUD-VASH)

    HUD-VASH is part of the Housing Choice Voucher (HCV) program in the 
Office of Public and Indian Housing. The HCV program currently houses 
over 2.3 million families and had an annual budget of more than $20 
billion in 2019. HUD-VASH is the only PIH program dedicated to homeless 
veterans; however, many formerly homeless families, including veteran 
families, are assisted through the regular HCV program.
    The HUD-VASH program has been very successful in its approach to 
addressing veteran homelessness. The program provides long-term housing 
assistance to the most vulnerable veterans experiencing homelessness by 
combining HCV rental assistance for homeless veterans with case 
management and clinical services provided by VA. VA provides these 
services for participating veterans at various locations, including 
VAMCs and community-based outreach clinics.
    In the HUD-VASH program, the local VA case managers screen and 
determine veteran eligibility for the program. These HUD-VASH eligible 
veterans are then referred to the partnering PHA to receive their 
housing voucher assistance. By agreeing to administer the HUD-VASH 
program, the PHA is relinquishing its authority to determine the 
eligibility of families in accordance with regular HCV program rules 
and PHA policies with two exceptions: PHAs are required to prohibit 
admission of any member of the household subject to a lifetime 
registration requirement under a State sex offender registration 
program and income limits.
    A total of $795 million has been appropriated in new HUD-VASH 
funding to date. HUD-VASH vouchers are renewed based on actual leasing, 
as is the case for the HCV program generally. When a household leaves 
the program, their voucher is typically reissued to another eligible 
household. Since 2008, over 170,000 veterans and their families have 
moved into housing with a HUD-VASH voucher. As of the last day of 
Fiscal Year 2019, more than 77,000 veterans and their families were 
housed with a HUD-VASH voucher.
    HUD-VASH vouchers are specifically targeted to communities based on 
geographic need, meaning the size of the eligible population. Every 
year since 2008, HUD and VA have collaboratively awarded new HUD-VASH 
vouchers based on geographic need and administrative capacity. Using 
HUD metrics of how we calculate housing, a total of more than 100,000 
HUD-VASH vouchers have been awarded to more than 600 PHAs between 2008 
and 2019. In addition to the HUD-VASH vouchers specifically awarded as 
project-based voucher (PBV) assistance, PHAs, with the support of their 
local VA partners, have the ability to convert any of their existing 
HUD-VASH vouchers to PBV.
    The Housing Opportunity Through Modernization Act of 2016 (HOTMA) 
streamlined this process for PHAs. PHAs can now convert any of their 
existing HUD-VASH portfolio without additional approval by HUD, subject 
to statutory and regulatory requirements of the PBV program. Because 
the landscape of veteran homelessness across the country has changed 
since 2008, HUD and VA are working collaboratively to ensure that all 
HUD-VASH resources are being used as efficiently and effectively as 
possible.
    These efforts around HUD-VASH demonstrate HUD's commitment to 
optimize the effectiveness of the HUD-VASH program and allow for local 
flexibility in addressing the homeless veteran population.

Tribal HUD-VASH

    The Tribal HUD-VASH demonstration program provides rental 
assistance and supportive services to veterans who are Native American 
and experiencing homelessness, or at risk of homelessness, while living 
on or near a reservation or other Indian areas. Veterans participating 
in this program are provided housing assistance through HUD and 
supportive services through VA to foster long-term stability and 
prevent a return to homelessness.
    The pilot was first authorized in the Consolidated and Further 
Continuing Appropriations Act, 2015 (Public Law 113-235, approved 
December 16, 2014) and Congress has continued its support in subsequent 
years by enacting funds for renewal grants and modest expansion. Thirty 
tribes or tribally designated housing entities were invited to 
participate in the program based on their level of need and 
administrative capacity. Ultimately, 26 of those invited submitted 
applications and were awarded grants totaling $5.9 million to fund 
approximately 500 units of rental assistance for veterans and their 
families, and to fund associated administrative costs. HUD has renewed 
these grants annually and will fund additional grants or units of 
assistance using funding provided in the Consolidated Appropriations 
Act of 2019.
    Implementation of the program is overseen by PIH's Office of Native 
American Programs (ONAP) and VA is responsible for providing case 
management services and referring eligible veterans for housing 
assistance. As of the end of 2019, 500 veterans have received case 
management service under this program. Additionally, since the 
inception of the program, almost 150 additional veterans that were 
previously housed under the program subsequently found permanent or 
temporary housing or graduated from case management. The program is 
producing tangible results, housing Native American veterans and their 
families who were living in severely inadequate units - without running 
water, heat or electricity - or in overcrowded living conditions.

Continued Collaboration with VA and USICH

    HUD has worked closely with VA for many years administering HUD-
VASH. Together, HUD, VA, and the U.S. Interagency Council on 
Homelessness (USICH) have implemented a joint decisionmaking structure 
known as ``Solving Veterans Homelessness as One'' (SVHO) that assists 
in coordinating agency efforts and develops and implements a range of 
strategies for preventing and ending veteran homelessness. This 
structure allows us to jointly review data on HUD-VASH and other 
programs and to coordinate policymaking to ensure our assistance is 
integrated and impactful.
    This collaboration has also helped us troubleshoot any issues and 
improve utilization in the HUD-VASH program, coordinate the 
implementation of the Tribal HUD-VASH program, better target available 
assistance to those with the highest needs, and ensure all resources 
across agencies are prioritized for communities with greater numbers of 
veterans experiencing homelessness.
    HUD, VA, and USICH have also used the structure of SVHO to work 
together to create a set of standards to evaluate whether communities 
have ended veteran homelessness. Since 2014, more than 880 mayors, city 
and county officials, and Governors have set a goal of ending veteran 
homelessness in their communities. As of January 7, 2020, 78 
communities and 3 States have achieved the goal.
    The agencies also collaborate on the implementation of Coordinated 
Entry Systems. Coordinated Entry ensures that a person experiencing 
homelessness has simple access to housing and other homelessness 
resources. The collaboration between HUD and VA helps to ensure that 
veterans have access to all the resources in a community, including VA 
dedicated resources, no matter where and how they access assistance.

Technical Assistance for Communities

    Because the ability of any community to meet the goal of ending 
veteran homelessness depends on the strength of each community's 
leadership and successful implementation of proven strategies, HUD and 
its Federal partners are committed to helping communities get there. In 
addition to providing funding for homeless assistance, HUD supports 
several technical assistance initiatives that have helped reduce 
veteran homelessness. The Built for Zero and Vets@Home initiatives help 
communities implement best practices and learn from the success of 
other communities. Both initiatives were designed with the explicit 
goal of helping communities reach the goal of ending veteran 
homelessness.
    Some best practices have included incorporating HUD-VASH in a 
larger coordinated entry system to ensure there are multiple access 
points for veterans seeking help, coordinated outreach efforts to 
locate all veterans in need of assistance, and better data sharing 
across systems to ensure veterans do not fall through the cracks.
    HUD has worked with its partners to identify specific strategies 
for utilizing HUD-VASH vouchers in high-cost, low-vacancy communities. 
These are often the communities with the greatest need. In addition to 
converting HUD-VASH to PBV, PHAs have used their flexibility to 
increase their payment standard, including the adoption of exception 
payment standards, to be competitive in the private market. Another 
strategy has been intensive landlord outreach and maintaining landlord 
relationships. PHAs have also been able to connect with local service 
providers that are able to assist veterans in their housing search.
    In an effort to improve the utilization of existing HUD-VASH 
resources and ensure maximum impact of new vouchers, in Fiscal Year 
2019, HUD instituted a utilization threshold for PHAs to be eligible 
for additional HUD-VASH vouchers. HUD set this threshold at 70 percent 
current HUD-VASH leasing, with some exceptions.

Results

    Each year, communities across the country conduct Point-in-Time 
(PIT) counts of people experiencing homelessness. The PIT count, held 
at the end of January 2019, includes people living in shelters as well 
as people sleeping on sidewalks, in parks, in cars, or in other places 
not meant for human habitation. Based on that count, veteran 
homelessness decreased by 2.1 percent (793 veterans) in 2019 and has 
declined by nearly 50 percent since 2010. This kind of reduction is 
historic, and HUD-VASH has been a primary reason for this progress.
    A robust body of evidence shows that the combination of permanent 
supportive housing, rapid re-housing, and other targeted interventions 
can indeed end homelessness. Although there was a 2.7 percent increase 
in general homelessness in 2019, that was largely driven by the 16.4 
percent increase in one state: California. The trend in the other 49 
states shows a significant decrease in homelessness. The long-term 
national trend and the results in the many communities that have ended 
veteran homelessness show the positive results of a coordinated effort.

Conclusions

    A great deal of progress has been made in the way we work together 
to address veteran homelessness. However, there is still a lot of work 
to be done. The HUD-VASH program continues to be a model for 
interagency collaboration and one of the best tools we have for ending 
veteran homelessness. We must continue to find ways to maximize the 
effectiveness of the HUD-VASH program, while also assisting communities 
in utilizing all available homeless assistance resources.
    Thank you again for this opportunity to update you on HUD's efforts 
to end veteran homelessness.
                                 ______
                                 

                    Prepared Statement of Steve Berg

Introduction

    Chairman Levin, Ranking Member Bilirakis, and other distinguished 
members of the House Veterans' Affairs Subcommittee on Economic 
Opportunity, thank you for inviting the National Alliance to End 
Homelessness (hereinafter referred to as ``the Alliance'') to testify 
at this January 14th hearing entitled ``Making HUD-VASH Work for all 
Veteran Communities''. I am Steve Berg, and I am the Alliance's Vice 
President for Programs and Policy. The Alliance is a nonpartisan, 
evidence-based, and mission-driven organization committed to preventing 
and ending homelessness in the United States.
    Because of our mission, the Alliance views the veteran homelessness 
programs as a vital part of a larger national effort to eliminate 
homelessness. The Department of Housing and Urban Development (HUD) is 
responsible for the administration of the Continuum of Care (CoC) and 
Emergency Solutions Grant (ESG) programs, the two Federal programs that 
attempt to address the needs of homeless Americans generally. In Fiscal 
Year 2020, more than $2.8 billion will be awarded by HUD through the 
CoC and ESG programs to State and local governments as well as 
nonprofit organizations. The CoC program, which is the larger of the 
two, funds rapid re-housing (RRH), permanent supportive housing (PSH), 
and transitional housing (TH); the coordinated entry system; and 
initiatives to improve systems, including the Youth Homelessness 
Demonstration Program. These programs balance local control with an 
insistence on evidence-based practices and results. HUD uses research 
and data to establish criteria for the CoC competition based on cost-
effectiveness and performance, while States and localities determine 
which evidence-based interventions are most needed, and which entities 
in the community should be funded to carry them out. Approximately $290 
million will be awarded by HUD in Fiscal Year 2020 through formula 
grants to State and local governments for the ESG program, which funds 
shelters, RRH, and homelessness prevention (HP).
    The Department of Veterans Affairs (VA) is responsible for three 
different housing programs designed to assist veterans and their 
families with ending their homelessness. The Homeless Providers Grant 
and Per Diem (GPD) program will provide $250 million in Fiscal Year 
2020 in funding for community-based TH and supportive services. The 
Supportive Services for Veterans Families (SSVF) program, which 
provides both RRH and HP services, will receive $380 million in funding 
for Fiscal Year 20. The three components of RRH, a Housing First 
program, are identifying housing, providing short-term rent and move-in 
financial assistance, and offering case management and employment 
services. The historically well-funded HUD-VASH program, an 
interdepartmental collaboration which will receive an additional $40 
million from HUD for Fiscal Year 20, provides homeless veterans with 
PSH through HUD vouchers as well as VA services to help enrollees find 
and sustain permanent housing. PSH, another Housing First program, 
combines housing subsidies and support services that are designed to 
build independent living and tenancy skills and connect people with 
community-based health care, treatment, and employment services. HUD-
VASH is reserved for chronically homeless and highly vulnerable 
veterans who have a high level of housing and service needs, such as 
those with barriers to employment and self-sufficiency. A demonstration 
project to provide HUD vouchers and VA supportive services to homeless 
American Indian veterans (Tribal HUD-VASH) will receive an additional 
$1 million for Fiscal Year 20.
    The Alliance asks members of the Subcommittee to keep two important 
points in mind during their efforts to oversee and improve the veteran 
homelessness programs:

        1. The veteran homelessness programs are widely considered by 
        providers and academics to be the gold standard in preventing 
        homelessness and housing people experiencing homelessness. 
        These programs, which are designed and implemented with proven, 
        evidence-based practices, are significantly better-resourced 
        than programs which serve the general homeless population. The 
        amount of money available for each newly homeless veteran each 
        year is as much as six times that for each homeless non-
        veteran. Moreover, homeless veterans also benefit from their 
        access to VA's world-class health care system. Finally, because 
        VA is an integrated health care system, the department can 
        continuously disseminate and implement best practices across 
        its far-flung network of medical centers.

        This doesn't mean that VA's homelessness programs are above 
        criticism. Certainly not. If anything, we should hold VA's 
        dedicated, conscientious, and hard-working managers, health 
        care professionals, and caseworkers to even higher standards. 
        But it does mean that non-veteran homelessness services 
        providers look to VA for inspiration and innovation. Non-VA 
        providers follow the department's homelessness initiatives--
        including newer initiatives like Rapid Resolution and Shallow 
        Subsidy--with as much interest as the Department's authorizers 
        and appropriators on Capitol Hill. Consequently, please 
        understand that what you do and don't do as lawmakers on this 
        Subcommittee with respect to veteran homelessness programs has 
        broader implications for homelessness programs generally and 
        establishes precedents for your congressional colleagues who 
        set the rules and funding levels for non-veteran homelessness 
        programs.

        2. The veteran homelessness programs are strong because they 
        enjoy bipartisan support. That's not to say there aren't 
        reasonable differences of opinion between the two parties, but 
        there is a bipartisan consensus in support of an evidence-based 
        approach toward the reduction and even the elimination of 
        homelessness among veterans, the programs used to achieve those 
        goals, and adequately resourcing those programs. No lawmaker 
        blames homeless veterans for their plight, advocates for 
        criminalization of the conduct of homeless veterans, or insists 
        we can't adequately resource veteran homelessness programs 
        until states and localities have reformed their zoning and 
        housing regulations. Unfortunately, even though non-veteran 
        homelessness programs are pursuing the same policies and 
        approaches, albeit with less funding, they do not enjoy the 
        same level of support. The Alliance commends this Subcommittee 
        for its bipartisan approach toward veteran homelessness, 
        putting principle before party, and urges other lawmakers to 
        learn from the example set by Chairman Levin and Ranking Member 
        Bilirakis.

    I attach to the end of my testimony a chart which illustrates re-
housing capabilities for individuals, families, and veterans. The 
Alliance calculates that we could re-house more than three-fifths of 
veterans who entered a shelter in 2017, one out of every three families 
(which is a significant improvement from one out of every eight 
families several years earlier), and less than one-tenth of 
individuals. I would be happy to discuss the conservative assumptions 
used in the creation of the chart as well as provide the Subcommittee 
with an updated version when more recent information becomes available.

Housing First

    Integral to the success of the veteran homelessness programs has 
been the use of Housing First, an approach which prioritizes quickly 
providing permanent housing to people experiencing homelessness, thus 
ending their homelessness and serving as a platform from which they can 
improve their quality of life. The provision of wrap-around services--
to support housing stability, promote employment, and recovery - is an 
integral part of Housing First, and the effectiveness of all these 
services depends on the recipients living in stable housing. Housing 
First starts with housing, with no preconditions, including those 
related to religion, employment, income, absence of criminal record, 
and sobriety.
    Why should housing (with services) come first? People who 
experience homelessness may have a myriad of other challenges, 
including a mental health or substance use disorder, limited education 
or work skills, scant credit history, or a history of domestic violence 
and trauma. Would people experiencing homelessness be better off if we 
helped them to deal with other problems they are struggling with first 
and only addressed their housing needs later? Housing First, some have 
argued, allows people to avoid addressing severe challenges, such as a 
substance use disorder, so that people will quickly return to 
homelessness.
    But this argument is based on a false premise. In fact, services 
are part of Housing First interventions. Under Housing First, people 
are offered or connected to services that are tailored to the needs of 
their households. But those services are not mandated: and people are 
not coerced into accepting them because client choice is a fundamental 
tenet of Housing First.
    Housing First-informed interventions such as PSH and RRH 
demonstrate again and again that when people who have experienced 
homelessness have help paying for their housing, and when they receive 
services tailored to their individual needs, they will escape 
homelessness and they will stay housed. Not only are Housing First 
interventions effective in ending homelessness, but many and sometimes 
all of their cost is offset by reductions in the public spending that 
inevitably results from allowing people to remain homeless and reliant 
on shelters and other services.
    Practitioners experienced with serving long-term homeless adults 
know that withholding housing help until people ``get better'' or 
change in some way can perversely result in people spending years on 
the streets as their health declines. People with severe mental 
illnesses cycle frequently between jails, hospitals, shelters, and 
streets without ever achieving stable homes. Those that have seen this 
heartbreaking cycle, unfortunately still too common given inadequate 
resources, understand this fundamental truth: withholding housing 
assistance doesn't help people, it hurts them.
    Instead of requiring people to stabilize before receiving housing, 
Housing First interventions focus on helping people to achieve 
stability in housing. This is often a prerequisite to other 
improvements in their lives. People with the foundation of a home are 
in better positions to take advantage of supportive services. They have 
the stability with which to engage in a job search. They have the 
platform they need to provide care and continuity for their young 
children. The safety housing affords allows those who want to address 
traumatic experiences with a skilled practitioner to do so at a pace 
that is unthreatening and makes sense to them. They have a safe place 
to store medication and address their physical and mental health needs. 
The absence of housing, on the other hand, makes attaining those 
personal goals so much more difficult.
    Housing First focuses on providing the housing assistance and the 
supportive services that people require to sustain housing and avoid 
future homelessness. Study after study demonstrates that housing has 
many curative benefits for people experiencing homelessness. It is true 
that Housing First does not fulfill every need; people still require 
additional supports to attain personal goals and continue to thrive. 
But there is one thing that housing clearly does solve: homelessness.
    One criticism of Housing First is that it has led to a loss of 
temporary beds for people experiencing homelessness. There has been an 
increase in the number of emergency shelter beds in the period from 
2007 to 2018. Long-term TH beds have declined but they have been 
replaced by a much larger increase in permanent housing opportunities 
for people who are homeless, based on greater cost-effectiveness and 
greater demand, thus leading to long-term decreases in the number of 
people homeless, including dramatic decreases for veterans. TH 
continues to be available for homeless veterans through the GPD program 
in appropriate cases.
    During two field hearings, the Chairman and the Ranking Member of 
this Subcommittee listened carefully to the concerns of many groups and 
individuals who care deeply about veteran homelessness programs, and I 
am pleased that their testimonies included much praise of Housing First 
and reaffirmed its importance in the success of those programs. Housing 
First has enjoyed strong bipartisan support since the Administration of 
President George W. Bush--and if the approach is judged on the merits 
that should not change. The Alliance urges the Subcommittee to continue 
to support Housing First--and, if necessary, aggressively reaffirm its 
importance for the veteran homelessness programs.
    The Appendix at the end of my testimony summarizes research on the 
effectiveness of Housing First.

Point-in-Time Counts

    HUD's annual point-in-time (PiT) count is what it is--a snapshot in 
time of the sheltered and unsheltered homeless populations based on one 
or several days of diligent searching by small armies of experts and 
volunteers across the length and breadth of a CoC. A PiT count does not 
include everyone who experiences homelessness in a particular year. The 
count of the sheltered homeless population is obviously more accurate 
than the count of the unsheltered population. A CoC that is 
sufficiently funded to employ an aggressive outreach effort throughout 
the year is more likely to know where more of the unsheltered 
population is during a count. The Alliance believes that for the last 
several years communities across the Nation have worked hard to ensure 
greater accuracy in the documentation of homelessness. I understand 
there are fears that the integrity of the count might be undermined by 
schemes to over-count or under-count. However, it is our impression 
that too many conscientious people from too many different entities are 
involved, many of them governmental, to prevent such conspiracies.
    There are concerns about who is to be counted--a family which 
spends the night in a car would be counted, while a family which sleeps 
in a relative's house (doubled-up) would not. There are other sources 
of data, including the Bureau of the Census, to make estimates about 
the doubled-up population. However, the PiT count is the only 
comprehensive source of data about people sleeping in places not 
intended for human habitation.
    Conducted over time and in a consistent manner, the counts can be 
helpful tools to identify trends, both generally and with respect to 
specific subpopulations, and allocate very finite resources, 
particularly when used in conjunction with Housing Inventory Counts 
(HIC) and other helpful data tracked by HUD's CoC Homeless Management 
Information Systems (HMIS).
    The nation's affordable housing crisis has created three distinct 
populations: the rent-burdened, those several million low-income 
households paying a large and unsustainable percentage of their income 
toward housing; the unstably housed, often referred to as the doubled-
up, who, according to the Alliance's analysis of the census are more 
than 4.4 million people; and the more than one half-million people who 
experience homelessness on a particular day. Thanks to the PiT and HIC 
counts as well as HUD's HMIS systems, we know far more about the 
homeless population than the much larger rent-burdened and doubled-up 
populations.
    In our view, the biggest flaw of a PiT count is that it doesn't 
account for the productivity of homelessness programs. For example, 
casual readers might have read HUD's November 12 press release on the 
2019 veterans PiT count (``Trump Administration Announces Continued 
Decline in Veterans Homelessness--Since last year, 793 more veterans 
now have a roof over their heads'') and failed to appreciate how hard 
the veterans homelessness programs had to work in order to achieve that 
increase. Because of the constant churn--veterans continuing to become 
homeless due to the lack of affordable housing or for their own 
personal reasons--those programs managed to house tens of thousands of 
homeless veterans in 2019, in addition to the 793 for which they were 
accorded public credit. In Fiscal Year 2018, for example, I understand 
the total number of homeless veterans permanently housed by veteran 
homelessness programs was in excess of 50,000--which does not include 
family members and dependent children, let alone veterans prevented 
from becoming homeless.
    There is a similar churn in the non-veteran homelessness programs. 
The increase in homelessness in California is much discussed. However, 
it is easy to lose sight of the productivity of homelessness programs 
in the Golden State. Los Angeles County manages to house 133 homeless 
persons per day, a remarkable accomplishment; unfortunately, 150 
persons become homeless in Los Angeles County every day. In San 
Francisco, for every homeless person housed, three more become 
homeless. We should be wary of judging the success or failure of anti-
homelessness efforts entirely on PiT counts. In most instances with bad 
PiT counts, if we dig a little deeper, we'll learn that it is not that 
the programs aren't working, it is that the programs aren't adequately 
resourced to meet extraordinary demands for services, which are largely 
caused by the Nation's affordable housing crisis.
    The Alliance supports both the effort led by the United States 
Interagency Council on Homelessness (USICH) to identify communities 
making progress toward ending veteran homelessness through the 
establishment of benchmarks developed by USICH, HUD, and VA, as well as 
another interagency initiative known as the Mayor's Challenge to End 
Veteran Homelessness. Public recognition is a cheap but powerful 
incentive for our leaders to show us their best selves and for their 
staffs to overcome parochial concerns that might otherwise divide them 
and work together to achieve this goal.
    Most importantly, both efforts remind us that ending homelessness 
is possible, that we do have the right programs in place, and that we 
just need to work better together to fund and implement them. When one 
looks at the list of the states and localities that have been 
determined, consistent with the USICH benchmarks, to have ``ended'' 
veteran homelessness, it is difficult to generalize about them--because 
it's happening in cities, suburbs, and the countryside; it's happening 
in all regions--north, south, east, and west; it's happening in red 
states and blue states; it's happening in areas with lots of people as 
well as less populated areas; and it's happening in wealthy localities 
as well as more modest localities. Ultimately, the list shows we can 
end homelessness, veteran and otherwise, in all areas of the United 
States if our Federal, State, and local leaders make that objective a 
higher priority--and in doing so, it is clear from the experiences of 
these three states and 78 communities that we won't break the bank.

Prevention

    The best way to keep the number of homeless veterans low is to 
prevent veterans from becoming homeless in the first place. The 
Alliance appreciates the leadership shown by this Subcommittee in 
ensuring a successful transition for military personnel to civilian 
life, particularly as shown by H.R. 2326, the Mulder Transition 
Improvement Act, by enhancing job prospects.
    The VA has been justifiably lauded for devising a set of questions 
to ask veterans which can help to identify which ones are at risk of 
becoming homeless. It would be helpful if a version of those questions 
were asked by the Department of Defense of departing personnel prior to 
discharge as well as part of a proactive follow up by VA soon after 
discharge, rather than wait until a medical center's initial 
interaction, in order to identify potential referrals to the veteran 
homelessness programs. The Alliance commends the House and Senate 
Appropriations Committees for the inclusion of a report requirement in 
the Fiscal Year 2020 funding measure for VA that will help us to 
understand how much more needs to be done to ensure ``servicemembers 
identified through the Transition Assistance program process'' develop 
viable post-transition housing plans.
    Similarly, it would be helpful if more military personnel received 
instruction in basic life lessons prior to discharge. Military service 
requires many sacrifices, including a significant loss of personal 
autonomy. Financial responsibility, including buying a home or leasing 
an apartment, can be daunting and difficult for anyone, let alone 
someone for whom housing was largely determined by her or his employer.
    The potentially problematic transition out of controlled 
environments is also a challenge for non-veteran homelessness programs. 
People emerging from incarceration and hospitalization are 
disproportionately vulnerable to homelessness for several reasons, 
including diminished job prospects, skeptical landlords, inadequate 
health care, and lack of family support, in addition to being 
unprepared to make basic life decisions.

HUD-VASH: Case Management

    The single biggest complaint the Alliance hears about the HUD-VASH 
program is the difficulty the VA has in recruiting and retaining 
caseworkers. Apparently, caseworkers can find jobs with comparable work 
but better pay outside of VA. Too often, we hear, vouchers that might 
be used to house chronically homeless veterans are sitting idle because 
of a shortage of caseworkers. This is not a problem everywhere, but it 
is enough of a problem that it is important to address.
    Why should helping chronically homeless veterans be less attractive 
than other casework? We need to change this culture so that HUD-VASH 
casework is sought after by the very best caseworkers because of the 
challenge of the work and the prestige of the clients. Perhaps the VA, 
in consultation with its own caseworkers and their union 
representatives as well as recognized leaders in social work, should 
devise a new pay scale that more adequately compensates this workforce, 
endows it with a higher status, and invests it with more prestige. 
Other VA positions can receive additional pay if it can be shown there 
are recruitment and retention problems--but has the necessary pay 
survey been conducted for caseworkers? Are hiring or performance 
bonuses appropriate? Should VA caseworkers be made eligible for 
performance pay? Does VA's personnel staff need to be specially trained 
to expedite at least for caseworkers the infamously lengthy Federal 
hiring process? The Alliance commends the House and Senate 
Appropriations Committees for the report language included in the 
Fiscal Year 2020 funding measure for VA on the department's staffing 
for HUD-VASH and the program's management of vouchers.
    Until a more robust in-house casework capability can be 
established, medical centers should be directed to at least consider 
outsourcing HUD-VASH casework and be required to publicly explain why 
they failed to do so if vouchers are not being used because of an 
absence of Federal caseworkers. Perhaps a little transparency is all 
that is needed to induce medical centers to staff up their caseworker 
positions.
    Finally, HUD-VASH casework should be limited to supporting a 
veteran's recoveries from physical and mental illnesses and substance 
use disorders in order to allow her or him to live independently in the 
affordable permanent housing of her or his choosing. Identifying 
landlords who will accept HUD-VASH vouchers, negotiating with those 
landlords, and then cultivating them so that they will remain receptive 
to the program's enrollees are functions which should be performed by 
experienced housing navigators, who are usually locally grown and need 
not be Federal employees. Congress and VA should work together to make 
housing navigation a regular part of the HUD-VASH program. Allowing VA 
caseworkers to focus exclusively on recovery, rather than real estate, 
may ultimately allow them to take on more cases and make their work 
more rewarding.

HUD-VASH: Cooperative Landlords

    Another complaint the Alliance hears about the HUD-VASH program is 
the difficulty in getting landlords to accept vouchers. Although there 
are obviously outliers, the Alliance believes that landlords are just 
as appreciative of the service of our veterans as other Americans and 
that they genuinely want to do right by veterans enrolled in HUD-VASH. 
Consequently, we favor the use of the carrot, rather than the stick. 
Experienced housing navigators who actively seek out and cultivate 
cooperative landlords can open up a lot of doors for veterans enrolled 
in HUD-VASH. Should VA reward every landlord who houses, say, fifty 
HUD-VASH veterans with a commemorative coin? Why not? Such landlords 
are private actors doing their part in the promotion of a cherished 
public interest. Should congressional lawmakers single out for praise 
every year in one of their town hall meetings landlords who 
consistently serve HUD-VASH veterans? Why not? Landlords are almost as 
much a part of the recovery process for HUD-VASH veterans as VA 
caseworkers and HUD vouchers. There are no doubt other ways to earn 
goodwill from landlords at minimum expense. Similarly, if landlords 
know that the HUD-VASH veterans they are asked to house are being 
served by effective caseworkers the more likely they will be to honor 
the program.
    This could be an area where Members of Congress can play a 
leadership role in their local communities. Members of Congress could 
work with local Mayors and VA leadership to invite landlords to 
participate in the program and thus be accorded public recognition.
    If there continues to be problems generating support from landlords 
in a particular area, we may need to look more closely at the payment 
standard established by the local Public Housing Authority.

Additional Improvements VA Homelessness Programs

    Allow HUD-VASH to serve more chronically homeless veterans: The 
Alliance thanks the House Veterans Affairs Committee--no doubt because 
of the bipartisan leadership shown by the Economic Opportunity 
Subcommittee--for being the first congressional panel to mark-up H.R. 
2398, legislation introduced by Representative Scott Peters (D-CA) to 
allow military personnel who are discharged under the category of 
``other-than-honorable'' (OTH) to be eligible for HUD-VASH benefits. We 
continue to hear concerns from providers that there are homeless 
veterans in their communities who need the more intense treatment 
provided by HUD-VASH but who are denied access to that program because 
of the status of their discharge. Given that OTH veterans are already 
eligible for the GPD and SSVF homelessness programs, H.R. 2398 breaks 
no precedents, and the legislation commands the strong support of 
homelessness and veteran groups. Enactment of this legislation will 
allow a small group of veterans, but one that is disproportionately 
vulnerable to chronic homelessness, to enroll in a program that can 
actually help them.
    Rebuild confidence in HUD-VASH through greater transparency: HUD-
VASH is immensely popular, but it seems just about every congressional 
office with whom we consult has its own administrative concerns about 
the program, particularly how many vouchers are actually available in 
their states and districts. The Alliance does not necessarily share all 
of those concerns, but we believe that H.R. 2399, another bill 
introduced by Representative Peters, would help to rebuild trust in the 
program. HUD-VASH is a fine program, a shining example of how the 
Federal Government can help deserving Americans. We have nothing to 
fear from learning more about how HUD-VASH works. The Alliance thanks 
this Subcommittee for its bipartisan leadership on H.R. 2399.
    Target HUD-VASH to chronically homeless veterans: The Alliance 
understands that there are homeless veterans enrolled in the program 
who aren't actually chronically homeless, and that these veterans might 
be more efficiently served by the less expensive SSVF program. In the 
non-veteran context, the Alliance encourages providers of services to 
those experiencing homelessness to employ ``Moving On'' strategies for 
clients in PSH who may no longer need or want the intensive services 
offered but continue to need help to maintain their housing. Any 
savings generated can be used to serve more homeless veterans.
    If a community has housed all or nearly all of the veterans 
experiencing chronic homelessness, then additional vouchers should be 
targeted at homeless veterans with severe medical conditions that 
require intensive treatment (including behavioral health treatment) and 
which make employment an unrealistic, short-term goal.
    The Alliance does hear concerns about HUD-VASH not covering 
important incidental costs, e.g., repair of a car needed for transport 
to health care. Co-enrollment in SSVF and HUD-VASH should address most 
of those concerns, assuming the former program is sufficiently funded.
    Better serve veterans in high-cost areas: The VA is to be commended 
for its ambitious Shallow Subsidy pilot program to serve homeless 
veterans enrolled in SSVF who live in high cost areas through the 
provision of longer housing subsidies. We are concerned about the 
adequacy of funding in the program's second year. However, the Alliance 
is convinced that this program enjoys strong, bipartisan support, and 
that any financing concerns will be satisfactorily addressed by 
Congress. Shallow Subsidy is a promising initiative--it's success would 
be a very favorable precedent for non-veteran homelessness programs.
    Continue to make the veterans homeless programs accessible to 
different groups of veterans: This Subcommittee is playing a leading 
role in attempting to ensure that the SSVF program continues to serve 
the needs of women veterans and their families. Native Americans have 
served in the Armed Forces in greater numbers per capita than any other 
ethnic group. The Alliance strongly supports Tribal HUD-VASH, 
particularly because this program can help to build new housing stock 
on reservations with project-based vouchers. Veterans are becoming 
older as a group and thus facing greater medical expenses. The Alliance 
supports efforts to allow veterans to age in place, which should reduce 
costs to VA and promote autonomy for veterans. And under the 
appropriate supervision of congressional authorizers and appropriators, 
the VA should be encouraged to experiment with its homelessness 
programs in order to devise new and better ways to help more veterans. 
As mentioned earlier, the advances achieved and the innovations 
embraced by VA managers will ultimately redound to the benefit of 
homelessness programs generally.

Leadership and Accountability

    Finally, I will emphasize the importance of VAMC management in the 
exercise of strong leadership in the fight against veteran homelessness 
and holding that VAMC management accountable when it fails to exert 
such leadership. Notwithstanding variations in the housing market, it 
is the Alliance's view that an important factor in making substantial 
progress toward a reduction in veteran homelessness in a particular 
area is whether the relevant VAMC management has made veteran 
homelessness a priority and insisted on allocating finite resources 
accordingly. And it is incumbent upon public officials--at the local, 
State, and Federal levels of government--as well as veteran and 
homelessness groups to hold that VAMC leadership accountable. VAMC's 
have immense workloads and limited resources, so it can be all too easy 
for local management to give homelessness short shrift. The field 
hearings conducted earlier this year by this Subcommittee in the 
districts of the Chairman and Ranking Member were master classes in how 
to put management in the relevant VAMC's on notice that ending veteran 
homelessness must continue to be a top priority.
    The Alliance thanks the Subcommittee for consideration of its views 
as well as its bipartisan determination to end veteran homelessness.

        Appendix: Housing First is a Demonstrated Best Practice

    The Pathways to Housing program, one of the early versions of 
Housing First, has greatly informed the field of homeless services. Sam 
Tsemberis (its founder) first evaluated Pathways in 2000 and continued 
to examine its results in subsequent years. The published findings 
include:

      Pathways to Housing: Supported Housing for Street-
Dwelling Homeless Individuals with Psychiatric Disabilities (2000)

      Consumer Preference Programs for Individuals Who Are 
Homeless and Have Psychiatric Disabilities: A Drop-In Center and a 
Supported Housing Program (2003)

      Housing First, Consumer Choice, and Harm Reduction for 
Homeless Individuals with a Dual Diagnosis (2004)

    Pathways participants in New York City, many of whom had mental 
health and/or substance abuse challenges, largely experienced positive 
housing outcomes. In the 5-year longitudinal study, 88 percent remained 
housed compared to 47 percent of those in the system that required 
treatment prior to housing placements.
    Encouraged by these results, Canada implemented the housing first 
model. It conducted a massive evaluation, encompassing five cities 
(Vancouver, Winnipeg, Toronto, Montreal, and Moncton) and over two 
thousand participants. After 2 years, 62 percent of the housing first 
participants were housed the whole time compared to 31 percent of those 
who were required to participate in treatment prior to the receipt of 
housing.
    In recent years, additional evaluations of housing first were 
completed in multiple locations including California and New York City. 
These studies have consistently found greater housing stability among 
housing first participants:

      Association of Housing First Implementation and Key 
Outcomes Among Persons with Problematic Substance Use (2014)

      Fidelity to the Housing First Model and Variation in 
Health Service Use Within Permanent Supportive Housing (2015)

    Materials prepared by two relevant executive branch agencies 
support these findings.

    The United States Interagency Council on Homelessness (USICH), in a 
memorandum for local officials, describes Housing First as

        ``a proven method of ending all types of homelessness and (it) 
        is the most effective approach to ending chronic homelessness. 
        Housing First offers individuals and families experiencing 
        homelessness immediate access to permanent, affordable or 
        supportive housing. Without clinical prerequisites like 
        completion of a course of treatment or evidence of sobriety and 
        with a low-threshold for entry, Housing First yields higher 
        housing retention rates, lower returns to homelessness, and 
        significant reductions in the use of crisis service and 
        institutions...Housing First should be adopted across your 
        community's entire homelessness response system, including 
        outreach and emergency shelter, short-term interventions like 
        rapid re-housing, and longer-term interventions like supportive 
        housing.''

USICH, Housing First Checklist: Assessing Projects and Systems for a 
Housing First Orientation, Updated September 2016, pages 1-2.https://
www.usich.gov/resources/uploads/asset--library/
Housing_First_Checklist_FINAL.pdf

The Department of Housing and Urban Development (HUD) emphasizes the 
success of Housing First in treating the most difficult category of 
homelessness:

        ``While the principles of Housing First can be applied to many 
        interventions and as an overall community approach to 
        addressing homelessness, permanent supportive housing models 
        that use a Housing First approach have been proven to be highly 
        effective for ending homelessness, particularly for people 
        experiencing chronic homelessness who have higher service 
        needs. Studies such as HUD's The Applicability of Housing First 
        Models to Homeless Persons with Serious Mental Illness have 
        shown that Housing First permanent supportive housing models 
        result in long-term housing stability, improved physical and 
        behavioral health outcomes, and reduced use of crisis services 
        such as emergency departments, hospitals, and jails.''

HUD, Housing First in Permanent Supportive Housing Brief, Published 
July 2014, pages 1-2.https://files.hudexchange.info/resources/
documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf

USICH explains the evidence-based rationale behind quickly connecting 
those experiencing homelessness with housing and services, i.e., 
Housing First:

        ``Housing stability is essential for people to address their 
        challenges and pursue their goals. Housing and income are core 
        social determinants of personal health, along with the 
        circumstances under which people are born, grow up, live, work, 
        age, and access health care. Substantial evidence indicates 
        that when people--both adults and children alike--experience 
        homelessness, their prospects for future educational 
        attainment, employment growth, health stability, and family 
        preservation are significantly reduced. The lack of a safe and 
        stable home also results, for some people, in increased use of 
        crisis services, like shelter, emergency departments, detox 
        programs, and psychiatric institutions, and greater engagement 
        with other systems, like child welfare and criminal and 
        juvenile justice, creating significant, preventable costs for 
        public programs. To reduce these impacts and end homelessness 
        as quickly and efficiently as possible, communities are 
        increasingly focused on using evidence-based practices to 
        streamline connections to housing opportunities and to provide 
        people with the appropriate level of services to support their 
        long-term housing stability. This shift in focus to permanent 
        housing outcomes, driven by research on effective practices, 
        has helped reduce homelessness nationwide by 13 percent between 
        2010 and 2017, according to annual Point-in-Time counts.

        ``Shifting to Housing First: To improve housing outcomes, 
        communities are making a fundamental shift to Housing First, 
        removing as many obstacles and unnecessary requirements as 
        possible that stand in the way of people's access to permanent 
        housing . . .''

USICH, The Evidence Behind Approaches that Drive an End to 
Homelessness, Published December 2017, page 1. https://www.usich.gov/
resources/uploads/asset_library/evidence-behind-approaches-that-end-
homelessness.pdf
[GRAPHIC] [TIFF OMITTED] T8956.001

                                 ______
                                 

                  Prepared Statement of Kathryn Monet

    Chairman Levin, Ranking Member Bilirakis, and distinguished Members 
of the House Veterans' Affairs Subcommittee on Economic Opportunity.
    On behalf of our Board of Directors and Members across the country, 
thank you for the opportunity to share the views of the National 
Coalition for Homeless Veterans (NCHV) with you. NCHV is the resource 
and technical assistance center for a national network of community-
based service providers and local, State and Federal agencies that 
provide emergency, transitional, and supportive housing, food, health 
services, job training and placement assistance, legal aid and case 
management support for thousands of homeless, at-risk, and formerly 
homeless veterans each year. We are committed to working with our 
network and partners across the country to end homelessness among 
veterans.
    As of December 2019, 78 communities and three states have achieved 
the Federal benchmarks and criteria for ending veteran homelessness. 
This is important proof that building systems to end veteran 
homelessness nationwide is achievable. We have seen the annual point-
in-time (PIT) count of veterans experiencing homelessness decrease by 
nearly 50 percent since 2009. The 2.1 percent decrease between 2018 and 
2019, when compared to the 2.7 percent increase in homelessness within 
the general population in HUD's 2019 PIT Count, is largely a testament 
to the dedication and hard work of local service providers, community 
partners, Veterans Affairs Medical Center (VAMC) staff, and the 
responsiveness of this committee, its members and dedicated staff with 
regard to providing resources and oversight required to scale VA 
programs responsibly.
    Continued progress comes at a pace that is challenging to maintain, 
requiring a dedication to surpassing the status quo. Given the 37,085 
veterans experiencing homelessness on any given night according to the 
latest PIT count and the ebb and flow of veterans entering and exiting 
homelessness, we still have much work to do across the Nation. From 
NCHV's perspective, every veteran deserves safe and permanent housing, 
whether they are currently experiencing homelessness or are facing 
housing-cost burdens that put them at risk of homelessness. We must 
enhance and invest in efforts to ensure that homelessness is rare, 
brief, and nonrecurring, for veterans and all Americans. Deep 
investments in affordable housing must be paired with solid 
implementation of housing-first oriented systems and housing-first 
interventions in order to see true success. It is NCHV's position that 
Housing First should never mean housing only. It is also NCHV's view 
that shelter and services alone cannot solve this problem.
    There is a solid body of research pointing to the success of 
Housing First oriented interventions. VA must commit to continued 
implementation of Housing First oriented systems to end veteran 
homelessness and to implementing them well. Veterans have earned quick 
access to permanent housing, employment, services and any resources 
they request to attain housing stability. This requires communitywide 
partnership to create Housing First oriented systems incorporating a 
variety of housing interventions, including adequate transitional 
housing options in communities where these facilities fill gaps in 
services or where the housing crisis is so extreme that permanent 
housing placement takes longer than it should, or where veterans 
actively choose therapeutic and treatment oriented environments. We 
need to recognize that successful implementation of a Housing First 
model also includes access to health and mental health care, and 
wraparound services like benefits assistance and employment and 
training services to ensure that a placement is indeed sustainable. The 
needs of veterans must come first.

                                HUD-VASH

    Homelessness is a multifaceted and complex problem that differs for 
each veteran experiencing it. One of the cornerstones of a Housing 
First oriented system is the Housing and Urban Development--Veterans 
Affairs Supportive Housing or HUD-VASH program, which has allowed VA to 
focus resources more efficiently by pairing VA-funded case management 
with a HUD-funded Section 8 voucher for the most vulnerable veterans. 
We appreciate the commitment Congress has made to investing in the 
creation of new HUD-VASH vouchers since 2008. NCHV applauds the 
foresight entailed by this consideration, and thanks Congress for these 
vouchers on behalf of the over 100,000 veterans who have been and are 
currently being housed.
    Yet, the simple fact remains that there is still much unmet need 
across the country. A recent survey of NCHV members indicated that 86 
percent of our respondent communities still had an unmet need for 
permanent supportive housing and had a waitlist of veterans for HUD-
VASH. In addition, HUD's 2020 Annual Homelessness Assessment Report 
indicated on any given night, over 8,700 veterans experiencing 
homelessness had chronic patterns of homelessness. As such, NCHV is 
calling for an increased investment in the effective HUD-VASH program 
to ensure communities have sufficient resources for the most vulnerable 
populations.
    The affordable housing crisis in the US is widespread. It is most 
acute in urban areas, particularly, in the areas of the country with 
the highest concentration of homeless veterans: California, New York, 
and Florida. In certain areas of the country with extremely low rental 
housing vacancy rates, the ability to locate housing is the single 
biggest barrier to housing veterans. For many communities experiencing 
this crisis, the only way to find affordable housing in which to place 
formerly homeless veterans is to develop it. HUD-VASH vouchers are a 
reliable source of operating revenues that enhance a developer's 
ability to obtain project financing. Vouchers must be distributed to 
areas with the most acute needs and housing authorities should consider 
project-basing more frequently, particularly in low-vacancy, high-cost 
markets.
    NCHV appreciates the ongoing congressional support for the HUD-VASH 
program as evidenced by the addition of vouchers in the last several 
years. However; the funds appropriated to VA for case management have 
not increased in proportion to the increase in vouchers. The 
challenging, complicated, and most often uncoordinated appropriations 
process has an even more profound effect on interagency programs like 
HUD-VASH due to their reliance on two Subcommittees to appropriate 
funds to two Federal Agencies. When there is a disconnect in terms of 
timing or funding levels, veterans end up paying the price due to 
delayed distribution of vouchers and case managers who are stretched 
thin. In addition, NCHV is focusing on how to change how HUD-VASH case 
management is funded and delivered. Veterans' Affairs Medical Centers 
or VAMCs have case managers who focus solely on the clinical aspects of 
case management, such as mental health care and medication management, 
at the expense of case management that focuses on basic tenets of 
housing stability. Successful case management in permanent supportive 
housing must address both clinical and housing stability aspects to 
adequately support the client, and in too many instances, veterans are 
not able to access that standard of care, leaving affordable housing 
providers responsible for filling that gap.

    NCHV makes the following policy recommendations relating to the 
HUD-VASH program:

        1. Case managers are the lifeblood of a permanent supportive 
        housing program like HUD-VASH and we know inadequate supports 
        can lead to negative exits from a program. VA funding 
        pertaining to HUD-VASH case management should be increased in 
        formulaic response to increases in the number of additional 
        VASH Vouchers each year. This can be achieved either through an 
        appropriations trigger mechanism, or by redesignating funding 
        for HUD-VASH case management as mandatory spending, just as 
        existing vouchers are deemed in the program. The status quo has 
        resulted in the unintended consequence of an unfunded mandate 
        placed upon the VA or worse, a mandated reduction in standards 
        of care provided to those most vulnerable as case managers will 
        exceed their mandate as the number of vouchers increases and 
        the number of case managers does not. Further, this creates a 
        disincentive for VAMC directors to support their partnering 
        PHA's applications for additional vouchers in their 
        communities. This is an ongoing issue that has lingered for 
        several years.

        2. In instances where VAMCs are contracting with local service 
        providers for case management services, the exorbitant duration 
        of the credentialing and background check process can be 
        cumbersome and affects staff recruitment and retention. Several 
        service providers have indicated the four-to nine-month long 
        process their staff has to go through in order to complete the 
        VetPro and eQIP background and credentialing procedures make it 
        difficult to recruit new staff. This also makes retention 
        challenging, as staff is only able to shadow and learn until 
        the process is completed and are then provided access to CPRS. 
        We request that the Committee work with VA to see whether there 
        are any opportunities to truncate the timeline of this process.

        3. Veterans who received an ``Other Than Honorable'' type of 
        discharge from military service are in practice ruled 
        ineligible for VA health or other benefits. This is true even 
        though many studies in recent years have shown that a large 
        portion of ``Other Than Honorable'' (OTH) discharges are the 
        result of service members behavioral changes from repeat 
        deployments or unaddressed Post Traumatic Stress (PTS). The 
        Department of Defense has acknowledged PTS as a vector to OTH 
        discharges and has directed review boards for discharge status 
        upgrades to take it into account. Despite a single-digit 
        percentage of America's veterans receiving OTH discharges, they 
        are disproportionately represented, making up 15 percent of the 
        homeless veteran population nation-wide. In some urban locales 
        the percentage of OTH veterans among the homelessness 
        population can rise to nearly 30 percent. NCHV strongly 
        supports Representative Scott Peters' legislation H.R 2398 that 
        will expand HUD-VASH eligibility to veterans with ``Other Than 
        Honorable'' discharges, cited as the ``Veteran Housing 
        Opportunities and Unemployment Support Extension (Veteran 
        HOUSE) Act of 2019,'' as well as the Senate's companion bill S. 
        2061. We have committed as a nation to ending veteran 
        homelessness - these men and women are veterans, and we must 
        not leave them behind.

        4. HUD should release another round of Project Based Vouchers 
        to directly address the immediate lack of housing stock due to 
        the amount of time it takes to plan and develop those projects.

        5. The Enhanced Use Lease (EUL) program at VA is a resource for 
        developers, as land is a significant driver of affordable 
        housing development costs. VA should consider more use of its 
        EUL authority to reduce its liabilities for underutilized or 
        vacant properties while bringing more veteran housing online. 
        In addition, we recommend the Asset Infrastructure Review 
        Commission created by the MISSION Act keep the affordable 
        housing needs of veterans experiencing or at-risk of 
        homelessness at the forefront by including homeless veteran EUL 
        initiatives in any Commission Charter.

        6. The housing needs of veterans in Indian Country must not be 
        forgotten in any program that serves veterans experiencing or 
        at-risk of homelessness. NCHV recommends that Congress do 
        everything it can to support housing initiatives for Native 
        American, Alaska Native, and Native Hawaiian veterans, 
        particularly to create additional Tribal HUD-VASH vouchers. 
        While we support the intent of legislation introduced in both 
        Chambers, we are concerned that language in active legislation 
        would require HUD to shift 5 percent of the HUD-VASH vouchers 
        already allocated and in use over to Indian Country. Tribal 
        veterans deserve safe housing, but we are concerned that well-
        meaning supporters of this legislation may not have considered 
        the negative impact of removing vouchers from formerly homeless 
        veterans who are relying on them for housing stability. 
        Additional investment in Tribal HUD-VASH should not come at the 
        expense of veterans using HUD-VASH.

    While HUD-VASH remains the lynchpin of proven tried and true, data 
driven Housing First methodologies, we would be remiss not to discuss 
VA's Grant and Per Diem Program (GPD), given its interconnectedness 
with HUD-VASH and its recent changes that create a window of 
opportunity for enhancement. GPD plays a key role in providing 
transitional housing and making recovery-oriented services available 
for those veterans who indicate they would benefit from them.

      Successful Program Transitions and Adaptability (Recapture)

    Providers in several communities that have made tremendous progress 
in ending veteran homelessness have raised concerns to NCHV regarding 
barriers to changing their programs that arise from receiving a GPD 
Capital Grant in the past. There are certain communities where the 
population of veterans experiencing homelessness has decreased such 
that there are significant vacancies in local GPD programs. NCHV has 
heard from several providers in this situation, who are interested in 
transitioning away from operating a GPD grant and into operating 
permanent supportive housing, or affordable housing. They have been 
told that in order to fulfil both VA real property recapture 
requirements and the real property disposition requirements of the 
Office of Management and Budget (OMB) including ones found in 38 CFR 
61.67 / 2 CFR 200.311 / 38 USC 8136, they would need to pay the 
government a percentage of the current market value of their property 
to fulfil the requirements of their grants, many of which date back to 
the early 1990's. Obviously, real property can appreciate dramatically 
over the course of several decades and in some cases these payments are 
prohibitively expensive for nonprofit service providers.
    It is the view of NCHV that no grantee should face a financial 
penalty for their success in achieving housing stability in their 
communities. Further, grantees shouldn't be required to embark on a 
capital campaign to pay the government in order to adjust their 
operations to meet their community's most pressing need. We request 
that Congress introduce legislation to waive both VA real property 
recapture requirements and OMB real property disposition requirements 
for grantees that would like to decrease the number of beds funded by 
or leave the GPD program under certain circumstances. These would 
include, but not be limited to, making a long-term commitment to 
utilizing the property for which the grant was received to serve 
homeless or at risk individuals, especially veterans, by offering 
affordable permanent housing, permanent supportive housing via project 
based vouchers, or other services to address housing instability. NCHV 
asks for the committee's leadership on addressing this issue.

                                 Reboot

    NCHV has supported the GPD reboot, as it generated several types of 
program models service providers can implement as critical parts of a 
housing-first oriented system of care for homeless veterans. As 
grantees have shifted to utilizing these models, we have heard 
consistently that challenges have cropped up, due to the expense of 
hiring higher level clinical staff with the appropriate credentials to 
operate certain higher-intensity models such as clinical treatment, 
hospital to home, and low demand. NCHV suggests that Congress modify 
the law such that providers operating these models are eligible to 
receive 125 percent of the State home per diem amount. There is 
precedent for amending the per diem payment structure to accommodate 
the augmented needs of the Special Needs Grant population, and the 
higher costs of operating GPD Transition-in-Place beds, thus NCHV urges 
Congress to take swift action to make similar changes to ensure 
providers can afford to continue operating these models.

                   Training and Technical Assistance

    As with any major change in a large Federal program, sufficient 
training of grantees is required to ensure the most optimal outcomes 
for veterans. We urge you in Congress to amend 38 USC 2064(a) to 
expressly authorize VA to provide technical assistance to grantees on 
issues related to operating their grants, national best practices, and 
working collaboratively with key partners. We also respectfully request 
that the expired authorization of appropriations language in 38 USC 
2064(b) be modified to include $2,000,000, annually, in perpetuity for 
the training of GPD grantees and contractors through the HCHV program.

                            Data Collection

    Data is a key component of an effective community-based response to 
veteran homelessness. HUD has mandated that grantees utilize a Homeless 
Management Information Systems (HMIS) to coordinate local efforts to 
serve people experiencing homelessness and to collect client-level data 
on individuals experiencing and at-risk of homelessness, the services 
and housing interventions they utilized, and the services and housing 
interventions available in their communities. Data completeness 
improves a community's ability to coordinate services and identify and 
plan for impending trends in inflow. The SSVF program has mandated its 
use for its grantees, and providers have been able to incorporate that 
into their annual budgets. The GPD program has not yet mandated its 
grantees to do so and many do not. The per diem payment structure does 
not allow for those who may be receiving the maximum per diem payment 
per bed, to do so without decreasing the standard of service to 
veterans in their programs. NCHV recommends that the Committees 
consider a legislative change to authorize an appropriation for a 
reimbursement of reasonable HMIS user fees for GPD grantees who are 
otherwise unable to access HMIS through their SSVF, Continuum of Care, 
or other local grants received. The improvement in data quality will 
improve community responses to veteran homelessness which in turn will 
enhance outcomes and efficiencies. NCHV recommends language alterations 
to Title 38 USC Section 2012 in the form of an additional section D 
that could read, ``The Secretary may reimburse reasonable sums in 
support of efforts to access the Homeless Management Information 
Systems or HMIS for grantees that are unable to receive access through 
other grant programs or government contracts.'' These changes could 
improve programs across the Nation immediately by leveling the field 
for smaller service providers.

                              In Summation

    Thank you for the opportunity to submit this testimony for the 
record and for your continued interest in ending veteran homelessness. 
It is a privilege to work with the House Committee on Veterans' Affairs 
to ensure that every veteran facing a housing crisis has access to 
safe, decent, and affordable housing paired with the support services 
needed to remain stably housed.
                                 ______
                                 

                   Prepared Statement of Greg Anglea

Introduction

    The introduction of HUD-VASH in 2008, along with additional 
housing-focused interventions like Supportive Services for Veteran 
Families (SSVF), is directly responsible for the dramatic, nearly 50 
percent reduction in Veterans experiencing homelessness over the last 
decade, from 76,329 Veterans in 2010 to 37,085 in 2019, per the annual 
Point In Time Count.
    That's the good news. The bad news is that more than 37,000 men and 
women who sacrificed to protect our country are still struggling in 
homelessness. They answered the call to service, yet their country is 
now failing to help them in their time of crisis. This is unacceptable. 
As a Nation, we must do better.

    Key Actions Requested to Make HUD-VASH Work for All Veteran 
Communities:

        1) Pass H.R. 2398 to Expand Eligibility for HUD-VASH to 
        Military Personnel Discharged with an ``Other than Honorable'' 
        Basis

        2) Increase Funding for the Supportive Services within HUD-
        VASH, and Encourage Contracting with Local Service Providers

        3) Establish Pilot Project to Leverage HUD-VASH with 
        Sustainable Income for Chronically Homeless, Disabled Veterans

    Key Action #1: Pass H.R. 2398 to Expand Eligibility for HUD-VASH to 
Military Personnel Discharged with an ``Other than Honorable'' Basis
    The HUD-VASH program has been the most instrumental resource in 
helping disabled Veterans overcome homelessness in the last decade. But 
tragically, there are thousands of Veterans who are not allowed to 
access this resource: Veterans with Other than Honorable (OTH) 
discharges. This is despite their service to our county, and despite 
their disabling conditions, which often stem from their military 
service and/or contributed to their OTH discharge.
    It is estimated that 10 percent of Veterans experiencing 
homelessness have an OTH discharge, excluding them from accessing VA 
Healthcare services and excluding them from eligibility for HUD-VASH 
Permanent Supportive Housing.
    Veterans like ``Mr. Brown.'' Mr. Brown received an OTH discharge 
due to drug use. At the time he was in denial about his psychosis and 
mental illness. Since his discharge he has been diagnosed as having 
bipolar disorder with psychotic features. He has delusions of his 
family history and life story. These issues were not diagnosed until 
after his OTH discharge.
    As a Veteran experiencing homelessness Mr. Brown is eligible for VA 
transitional housing through the VA Grant & Per Diem program, which is 
how my organization Interfaith Community Services in Escondido, 
California met Mr. Brown during his first stay in one of our Veterans 
transitional housing programs. While Mr. Brown found stability and 
began to address his mental health conditions during that stay, he was 
unable to secure housing or stable income. Due to his OTH discharge 
status he was not eligible for HUD-VASH, and he ultimately exited to 
homelessness.
    Through a privately funded grant Interfaith Community Services is 
able to provide mental health services for any Veteran regardless of VA 
healthcare eligibility. It is through that privately funded resource we 
have continued to see and support Mr. Brown even after he was exited 
from our VA transitional housing program.
    Mr. Brown continued to work with our counsellors over the next 2 
years, maintaining sobriety despite being homeless. During that time he 
applied for disability benefits but was denied, a common response among 
the many disabled, homeless Veterans we serve.
    Nine months ago we helped Mr. Brown re-enter our VA transitional 
housing program. He actively participates in a substance abuse recovery 
group, continues his sobriety, and recently secured part-time 
employment as a cook. His path out of homelessness remains doubtful 
though, as he is only eligible for SSVF, a short-term rental assistance 
program. With his current very-limited income, multiple disabling 
conditions, inability to secure disability benefits, and ineligibility 
for HUD-VASH, he will struggle to maintain independent living without 
the longer-term housing subsidy HUD-VASH would provide.
    Sadly, Mr. Brown's story exemplifies a growing group of disabled, 
homeless Veterans falling through the gaps, living, and even dying, on 
the streets of the country they sacrificed to protect.
    Nearly 7 percent of all OEF/OIF/OND Veterans have received OTH 
discharges. According to the Department of Defense approximately 7,700 
service members are discharged OTH each year. A 2017 Government 
Accountability Office Report found that among the 91,764 service 
members who received a misconduct separation between 2011 - 2015, 62 
percent were diagnosed with Traumatic Brain Injury (TBI) or Post 
Traumatic Stress Disorder (PTSD) within 2 years. Of those, 23 percent 
received an OTH discharge, making them ineligible for VA healthcare 
benefits. That's 12,283 Veterans in just 5 years who have a diagnosed 
TBI or PTSD, received an OTH discharge, and are therefore ineligible 
for both VA Healthcare benefits and should they ever become homeless, 
HUD-VASH.
    To be clear we have the proven-effective interventions that have 
reduced homelessness nearly 50 percent nationwide, and we have the 
resources as a country to extend those interventions to Veterans 
homeless today, yet we deliberately and purposefully withhold those 
lifeline resources from Veterans who need them. This is unacceptable 
and must be changed.
    Expand eligibility for HUD-VASH to include ``Other than Honorable'' 
discharges. Support and pass H.R. 2398.

    Key Action #2: Increase Funding for the Supportive Services within 
HUD-VASH, and Encourage Contracting with Local Service Providers
    In San Diego and in other communities, a lack of supportive 
services staff result in under-utilization of HUD-VASH vouchers. 
Without the staff to work with individual Veterans to help them secure 
housing and then be successful in that housing, HUD-VASH vouchers 
cannot be assigned to Veterans in need. Housing vouchers lie dormant 
while Veterans meeting HUD-VASH qualifications sleep on our streets.
    Interfaith Community Services operates the only VA-funded 
Recuperative Care program in San Diego County for Veterans experiencing 
homelessness and being discharged from local hospitals. Despite stays 
at our Recuperative Care Center of up to 3 months, no Veteran has been 
able to qualify for and be matched with a HUD-VASH resource during 
their time in program this last year. Local staffing shortfalls 
lengthen the approval and matching process, creating wait-lists, and 
resulting in a process that takes many months and often more than a 
year to connect eligible Veterans in crisis to HUD-VASH.
    Furthermore, when Veterans are enrolled in HUD-VASH, the amount of 
supportive services provided through VA funding alone is often 
insufficient. This is the result of insufficient Federal funding to 
local VA Health Centers to provide needed supportive services staff.
    A Veteran I will call ``Mr. Jones'' entered our VA transitional 
housing program in January 2019. He had already been approved and 
enrolled in HUD-VASH, but had yet to secure permanent housing, and 
entered our transitional housing with no income and a long history of 
mental illness. He was very suspicious of the VA, so he refused to seek 
treatment or medication to address those challenges. Thankfully, his 
HUD-VASH VA case manager and Interfaith Community Services' 
transitional housing case manager communicated regularly to ensure that 
the Veteran was taking steps forward toward permanent housing. Mr. 
Jones was also willing to engage with our organization's mental health 
clinician, because that clinician was outside the VA, to address some 
of his paranoia about moving forward with VA support. Because of the 
client's mental health challenges he was unable to find employment 
while in our program, but his HUD-VASH and Interfaith Community 
Services case managers were able to help Mr. Jones move into a new 
permanent housing project that opened up in San Diego, where the client 
has been living successfully since last June. Mr. Jones still has not 
gotten mental health treatment since entering permanent housing, but he 
has the support of monthly check-ins from his HUD-VASH VA case manager 
and has been able to sustain his housing.
    Mr. Jones is a success story today. However it took local service 
provider resources contracted by the VA, in partnership with direct VA 
resources, to get him to where he is now, safe and no longer homeless. 
He would benefit significantly though from an increased level of 
support. Once a month check-ins from a VA social worker may be 
insufficient long-term.
    Increased funding to strengthen the amount of supportive services 
offered to HUD-VASH Veterans will further increase long-term success. 
Encouraging local VA Health Centers to contract HUD-VASH services with 
local, trusted and proven-effective service providers, will further 
expand care and deliver services at lower costs to taxpayers.

    Key Action # 3: Establish Pilot Project to Leverage HUD-VASH with 
Sustainable Income for Chronically Homeless, Disabled Veterans
    The following program proposes a regionally coordinated effort to 
help disabled Veterans experiencing homelessness to secure the 
Supplemental Security Income (SSI) / Social Security Disability 
Insurance (SSDI) assistance they are entitled to, expediting a very 
complicated application process, improving application approval rates, 
and through linkage to HUD-VASH, ending their homelessness.
    Interfaith Community Services proposes a pilot project to combine 
the proven-effective national SSI/SSDI Outreach, Access and Recovery 
(SOAR) program to provide sustainable revenue for disabled Veterans, 
with the stable permanent supportive housing offered by HUD-VASH. SOAR 
is a best practice supported by the Substance Abuse and Mental Health 
Services Administration (SAMHSA). SOAR case managers represent clients 
as appointed representatives and waive all monetary fees, communicate 
with local Social Security Administration field offices and Disability 
Determination Services, collect medical records to help expedite the 
decision, and summarize the client's medical records, highlighting the 
most important information through a Medical Summary Report, in 
cooperation with medical professionals from the partnering federally 
Qualified Health Centers.
    The target population for SOAR case management support are adults 
who are experiencing or at risk of homelessness and have a mental 
illness, medical impairment, and/or a co-occurring substance use 
disorder. This pilot project would focus on Veterans who meet the above 
eligibility criteria. Many Veterans are not eligible for benefits such 
as VA pension (due to era of service) or health supports (due to nature 
of discharge) and remain homeless when they are no longer able to work.
    Interfaith Community Services is currently working with a veteran 
we will call ``Mr. Santiago,'' who has an OTH discharge, PTSD, 
struggles to maintain employment, and has been homeless for many years. 
Mr. Santiago was in our VA transitional housing program three years 
ago. He was able to gain a minimum wage job that allowed him to earn 
enough to receive temporary rental assistance from the VA (via SSVF), 
and exited our program successfully with SSVF support in 2017. 
Unfortunately, about a year after his SSVF funding ran out his previous 
issues came back to the surface and he ended up homeless again, once 
again requiring the services of our transitional housing program. When 
Veterans like Mr. Santiago are not eligible for HUD-VASH or VA 
healthcare, once their SSVF funding runs out, so does the additional 
case management support to assist in emotion management and long-term 
planning. It is clear the Mr. Santiago needs ongoing support. The pilot 
project we are proposing would help him secure disability benefits to 
provide sustainable income, while also coordinating and connecting to 
primary care and mental health services. A pilot project to also 
combine HUD-VASH housing support would further demonstrate the positive 
impact and long-term community savings of safe, stable housing. Without 
these resources there is no clear mechanism to provide continuity of 
care for Mr. Santiago.
    The SOAR framework is proven to increase rates of success for 
individuals suffering with multiple disabilities, but in reality there 
are no SOAR-trained case managers with availability to help disabled 
Veterans who, like Mr. Santiago or Mr. Brown, are significantly 
disabled yet unable to secure disability benefits on their own. We 
propose and request the testing of a focused pilot project for disabled 
Veterans, providing SOAR case managers exclusively for Veterans to 
secure entitled disability income, and HUD-VASH to provide housing. We 
believe the results will demonstrate cost-savings to tax payers and 
most importantly lives saved and enriched for the disabled men and 
women who have served our country.

Conclusion and Summary

      Launch of HUD-VASH and other housing-focused VA 
interventions has reduced Veteran homelessness by nearly 50 percent in 
the last decade

      Yet more than 37,000 Veterans remain homeless in our 
country

      Some are not allowed to access the resources, like HUD-
VASH, that have proven effective for others

        o Key Action #1: Pass H.R. 2398 and expand access to HUD-VASH

      Others need a higher level of supportive services than 
HUD-VASH currently provides, and many suffer on waiting lists as a lack 
of staffing prevents awarded housing vouchers from being used

        o Key Action #2: Increase funding for HUD-VASH supportive 
        services staff, and encourage local VA Health Centers to 
        contract with community providers to overcome staffing 
        shortfalls and help Veterans who are homeless today

      Disabled homeless Veterans struggle to obtain the benefit 
income they are entitled to

        o Key Action #3: Explore the untapped possibilities of 
        leveraging SOAR disability benefits access with HUD-VASH to 
        help disabled, chronically homeless Veterans secure sustainable 
        income and safe, permanent, supportive housing

    Thank you for your time today, for inviting me to share our 
experiences and expertise helping Veterans overcome homelessness. I 
look forward to and offer anything that Interfaith Community Services 
or myself can do to help this committee in your work.
                                 ______
                                 

                  Prepared Statement of Tamera Kohler

Introduction

    My name is Tamera Kohler, I am the Chief Executive Officer of the 
Regional Task Force in the Homeless (RTFH) for the San Diego area. On 
behalf of our Board of Directors and members, I thank you for the 
opportunity to share our views with you this morning. The Regional Task 
Force on the Homeless is the Housing and Urban Development (HUD) 
Continuum of Care (CoC) for San Diego County, the second-largest county 
in the State of California. We have a large geographic area and 
population, for context the population in San Diego County is nearly 
3.5 Million, a population larger than 22 of the states in the Nation.
    We are one of over 400+ CoC across this Nation designed to promote 
a community-wide commitment to the goal of ending homelessness; provide 
funding for efforts by nonprofit providers, and State and local 
governments to quickly rehouse homeless individuals and families while 
minimizing the trauma and dislocation caused to homeless individuals, 
families, and communities by homelessness; promote access to and effect 
utilization of mainstream programs by homeless individuals and 
families; and optimize self-sufficiency among individuals and families 
experiencing homelessness.
    We work collectively with our funding partners, such as the 
Veterans Administration (VA) and local housing authorities to tailor a 
local homeless crisis response system through data-driven planning, 
purposeful collaboration, targeted aligned resources and coordination 
of efforts while providing guidance and technical assistance around 
proven evidence-based practices and emerging promising practices to 
effectively and efficiently use resources to address and alleviate 
homelessness. This includes all efforts undertaken with local, State 
and federally funded agencies, faith-based organizations, non-profit 
organizations, health organizations, and others. These programs provide 
outreach, prevention, diversion, emergency shelter, transitional 
housing, short term rental assistance, housing subsidies and permanent 
supportive housing along with food, health services, employment 
services, connection to social services, legal aid and case management 
support for thousands of homeless in our region, both sheltered and 
unsheltered, those at-risk, and formerly homeless each year.
    I appreciate the opportunity to focus on Veteran homelessness in 
this statement. Specifically, to examine access to HUD-VASH in urban, 
suburban, rural, and tribal communities and work to determine where 
bottlenecks exist in delivering resources in communities of all sizes.

    What we know about veteran homelessness nationally:
    In 2018 Point-In-Time (PIT) estimates no less than 73,878 veterans 
are experiencing homelessness on any given night, with 38 percent 
unsheltered.

    What we know about veteran homelessness in California:
    California accounted for just under 30 percent of all veterans 
experiencing homelessness in the United States (29 percent or 10,836 
veterans) and half of all unsheltered veterans (7,214 veterans) 
according to 2018 PIT estimates.

    With these numbers in mind, I will focus my statement and testimony 
on two areas around where bottlenecks tend to be present to access HUD-
VASH vouchers in our communities; referrals from VA to Housing 
Authorities and limited eligibility for homeless veterans for VA 
assistance with HUD-VASH.

Focus: Insufficient referrals from the VA to Housing Authorities

    Without question one of the most impactful and successful 
coordinated efforts to address homelessness has been the partnership 
between HUD and VA in the VASH voucher programs. This single dedicated 
resource has reduced the numbers of veterans significantly with nearly 
a 50 percent reduction since 2009. In our region we are experiencing a 
significant challenge with insufficient referrals to fully utilize the 
VASH programs.
    In coordination with our largest Housing Authority in the Region, 
San Diego Housing Commission (SDHC), I am sharing the following data 
SDHC prepared and their recommendations as of the date of this hearing. 
SDHC is strongly focused on this issue, holding discussions with both 
regional and Federal leaders at the VA as well as State and Federal 
legislators.
    SDHC has approximately 354 unutilized VASH vouchers, approximately 
31 percent of their total VASH allocation of 1,117 vouchers. Challenges 
in our jurisdiction include:

      The U.S. Department of Veterans Affairs (VA) San Diego 
Healthcare system averaged nine referrals per month to SDHC for VASH 
vouchers in Fiscal Year 2019 (July 1, 2018 - June 30, 2019). These VA 
referrals are insufficient to increase the utilization rate or keep up 
with the attrition rate, which averaged eight households per month in 
Fiscal Year 2019.

    SDHC is concerned about this shortage of VA referrals because of 
the clear need for permanent housing resources in the city of San 
Diego:

      The 2019 regional Point-in-Time Count identified 810 
veterans experiencing homelessness--472 sheltered and 338 unsheltered. 
In addition, regional Coordinated Entry System (CES) assessments in the 
past 18 months identified 840 veterans experiencing homelessness in 
need of housing.

    Currently, as the need for these resources remains, VASH vouchers 
go unutilized because of few referrals to the program. A 6-month review 
of homeless veterans referred for VASH voucher to the VA through CES 
managed by the RTFH shows from April -September 2019, 192 referrals 
were made to the VA with 91 declines or a decline rate of 50 percent. 
This data was verified by our partners at VA with over 50 percent of 
those declines solely due to VA eligibility requirements, including 
prioritization eligibility. The CES does not have the ability to track 
the referrals from the VA to the Housing Authorities (HA) such as SDHC.
    There is a gap in the time and number of referrals from CES 
referral acceptance to assignment for referral to the HA for VASH. The 
HA have cited this may be due to staffing of supportive services and 
level of care required by the VA.


Focus: Limited eligibility for homeless veterans for VA assistance with 
    HUD-VASH

    With a high concentration of homelessness among military veterans 
locally, San Diego has a more significant need to identify housing 
solutions for veterans experiencing homelessness than other 
communities.

    SDHC has recommended the following actions to Federal VA Leadership 
for SDHC to maximize the utilization and impact of VASH vouchers to 
provide housing for veterans experiencing homelessness in the city of 
San Diego:

        1. Reduce barriers to ending a veteran's homelessness by 
        expanding VASH eligibility:

                -Eliminate the time-served requirement.

                -Include veterans discharged under conditions other-
                than-honorable, but not dishonorable, in the 
                eligibility criteria.

                -Eliminate VA healthcare eligibility requirement.

        2. To ensure needed resources are available to maximize VASH 
        utilization, outsource Case Management:

                -VA outsource case management, including referrals.

                -Permit SDHC to administer and contract out supportive 
                services from community-based organizations. 
                Organizations would make referrals for VASH (in 
                coordination with Regional CES data, Supportive 
                Services for Veteran Families (SSVF) providers, and 
                outreach teams) and provide services.

        3. Allow SDHC to use VASH vouchers to provide housing for 
        veterans experiencing homelessness, regardless of the 
        supportive services they receive.

                -SDHC's voucher utilization rate for non-VASH vouchers 
                exceeds 100 percent.

                -SDHC voucher households obtain housing within 60 days, 
                on average.

                -SDHC's Landlord Engagement and Assistance Program 
                (LEAP) and other initiatives create additional 
                opportunities to identify housing for veterans with 
                VASH vouchers.

                -The average turnover rate of 60-80 households per 
                month among all SDHC voucher households will enable 
                SDHC to accommodate all of the referrals it receives 
                from the VA for VASH vouchers.

    The underutilization of VASH vouchers was specifically cited as an 
area for immediate consideration in the City of San Diego Community 
Action Plan on Homelessness, approved unanimously by the San Diego City 
Council on October 14, 2019. (On behalf of the city of San Diego, SDHC 
contracted with the Corporation for Supportive Housing to develop this 
plan).

    This Community Action Plan on Homelessness further identified that 
with more efficient use of veteran's resources, specifically VASH 
vouchers, ending veteran homelessness in San Diego is an attainable 
goal within reach in the next 3 years. SDHC, the city of San Diego and 
the Regional Task Force on the Homeless seek the support of the VA to 
achieve this goal.
    Our partner at the VA, Dr. Robert Smith, Director of VA San Diego 
Healthcare System Veteran Health Administration (VHA) stated in his 
written statement for the August 2019 field hearing that they support 
all efforts to increase Homeless Veteran HUD-VASH prioritization 
eligibility.

Additional factors in San Diego County suburban and rural areas-

Housing affordability/tight rental market:

    With rents rising much faster than wages, the burden of affording 
rent is looming larger and larger for many veterans, especially those 
that are aging and on fixed incomes, and, in some cases becoming 
insurmountable. According to the Zillow Group Consumer Housing Trends 
Report 2018, 8 out of 10 renters or 79 percent of renters who moved in 
the last 12 months experienced an increase in their monthly rent before 
moving to a new place. Over two-thirds (67 percent) said that hike was 
a factor in pushing them out the door and into another rental.
    Nearly a third (30 percent) of households nationwide, representing 
roughly 73 million adults, report they're struggling or just getting by 
financially. Most extremely low-income Americans spend greater than 50 
percent of their income on rent. Increasingly, major metro areas are 
becoming out of reach for those who aren't earning more than minimum 
wage, and this is becoming increasingly true even in markets that have 
historically been more affordable. This is especially difficult for 
those on fixed incomes. A majority of renters (79 percent) report 
living with others. This is very true in the high cost tight rental 
market in San Diego County.
    As an example, according to the National Low-Income Housing 
Coalition, San Diegans need an income of nearly $30 an hour to afford a 
1 bedroom unit at 30 percent of their income. San Diego County's 
average rent hit an all-time high in September of $1,960 a month, as 
reported from MarketPointe Realty Advisors. The lowest vacancy rate in 
the county in September was 1.5 percent for apartments costing $1,200 
to $1,299 a month. These are traditionally the units veterans are 
looking to lease with vouchers.
    In our regions Point-in-Time count survey the question was asked, 
what do you need to end your homelessness? 60 percent stated a rental 
subsidy or financial assistance. Increases in rent, tight rental 
markets and limited housing stock all contribute to the difficulty 
finding adequate and affordable housing and our Homeless Management 
Information System (HMIS) data shows higher than the national average 
returns to homelessness after housing assistance due to unaffordable 
rent without assistance.
    This high cost, tight rental market makes it extremely difficult 
for veterans with vouchers to find rental units. In this type of market 
conditions there is a need to assist veteran in navigating the market 
and working with landlords.

Aging homeless veteran population:

    Older Veterans are expected to be a majority of the population of 
Veterans who experience or are at risk of homelessness in the coming 
years. As members of this group get older, they are likely to have 
increasingly complex and age-related needs. Among participants in the 
VA's transitional housing programs, a significantly greater proportion 
of Veterans age 55 or older have serious medical problems, compared to 
younger Veterans, making them especially vulnerable to experiencing 
negative consequences related to homelessness.
    Homeless veterans are not just aging, their needs are vastly 
different than younger veterans. With the greater numbers of Elderly 
Homeless Veteran come significantly different challenges than our 
system has been designed to serve. Long term healthcare issues and 
independent living options will become greater challenges and housing 
options more limited. Attention to this emerging urgent need is needed 
by both the VA and HA as well as the HUD CoC Homeless system. This 
again speaks to efforts to increase Homeless Veteran HUD-VASH 
prioritization eligibility and consideration of level of supports 
outside of current models.
    Data from the RTFH Homeless Management Information System (HMIS) 
for the San Diego CoC shows significant increases in our population 
over the age of 62 in just 2 years. In the 1st quarter of 2017, 1 in 5 
or 20 percent of veterans were 62 or older, 2 years later in the 1st 
quarter of 2019, 1 in 4 or 26 percent of veterans are now 62 or older.
    Additionally, during this same timeframe in 2017, 12 percent of 
those served with SSVF Rapid Rehousing were 62 or older, in 2019 it has 
increased to 18 percent. We need more permanent housing resources and 
options for elderly homeless veterans who are currently being served by 
short term SSVF.

Focus: Building on Success

    A significant measure of success has been achieved through the 
impactful partnership between HUD and the VA in the VASH voucher 
programs. To address the underutilization of our VASH programs, RTFH 
supports the Expanding Access options of H.R. 2398. This proposed 
legislation will allow additional vulnerable chronically homeless 
Veterans to receive much needed HUD-VASH vouchers and case management. 
As our regional VA office noted that in expanding eligibility, VA and 
HUD will need to coordinate to ensure responsible program 
implementation in order to maintain continued quality of care and 
success of the HUD-VASH program. RTFH also supports H.R. 2399 
transparency in HUD-VASH.

Focus: Data-driven decisions

    Despite these areas of success, we are missing critical information 
on the characteristics and needs of Veterans who experience unsheltered 
homelessness to better tailor and target strategies and resources. We 
need greater data collected by outreach on the unsheltered population. 
We need to better understand the risk factors for returns to 
homelessness among Veterans being served by the HUD-VASH and SSVF 
programs and more data on the numbers of Veterans experiencing 
homelessness who have dishonorable discharges or are otherwise not 
eligible for VHA health care services.

Conclusion

    Thank you to the committee for inviting me to again speak on this 
issue. I will restate my conclusion from my previous statement in 
August 2019. Nowhere is the struggled more real than here in California 
as those experiencing homelessness tonight are more likely to be 
unsheltered than sheltered or housed. We must acknowledge there are 
continuing and growing serious issues and major challenges in this work 
and it will take our best efforts, collectively and individually to dig 
deeper, to stretch our understanding, and test our assumptions, and be 
bold in our determination and decisions. We must not be afraid to act, 
to learn, analysis and coordinate at the system level not only as 
individual programs or funding sources but as leaders too. We need to 
be nimble and act with urgency to address local homeless issues and 
scale up proven practices that the data shows are effective. We must 
fully utilize all of the resources we have as efficiently and as 
collaboratively as possible. We ask this committee to continue to work 
to increase access to these dedicated resources to serve veterans so 
their homelessness may be rare, brief and nonrecurring. We need to 
return dignity to our citizens and communities, and remove the 
demoralizing effects homelessness has on communities that struggle to 
meet the needs of its most vulnerable citizens and veterans.
                                 ______
                                 

                   Prepared Statement of Gary Cooper

    Good Afternoon. My name is Gary Cooper, and I am the Chairman of 
the Board of Directors of the National American Indian Housing Council. 
I am a citizen of the Cherokee Nation, and I currently serve as the 
Executive Director of the Housing Authority of the Cherokee Nation. I 
would like to thank Chairman Levin, Ranking Member Bilirakis and all 
committee members for having this hearing today and for including 
tribes in this discussion regarding the HUD-Veteran Affairs Supportive 
Housing (HUD-VASH) program.
    The NAIHC is comprised of 289 voting members that represent 496 
tribes and tribally designated housing entities across the United 
States. The NAIHC was established in 1974 to advocate on behalf of 
tribal housing programs and now NAIHC also provides vital training and 
technical assistance to increase the managerial and administrative 
capacity of tribal housing programs.

       Background on the National American Indian Housing Council

    The NAIHC was founded in 1974 and for over four decades has 
provided invaluable Training and Technical Assistance (T&TA) to all 
tribes and tribal housing entities; provided information to Congress 
regarding the issues and challenges that tribes face in their housing, 
infrastructure, and community development efforts; and worked with key 
Federal agencies to ensure their programs' effectiveness in native 
communities. Overall, NAIHC's primary mission is to promote and support 
American Indians, Alaska Natives and Native Hawaiians in their self-
determined goal to provide culturally relevant and quality affordable 
housing for Native people.
    The membership of NAIHC is comprised of 289 members representing 
496 \1\ tribes and tribal housing organizations. NAIHC's membership 
includes tribes and tribally designated housing entities throughout the 
United States, including Alaska and Hawaii. Every member of this 
Committee serves constituents that are members of NAIHC, either 
directly through tribes located in your Districts, or generally through 
the United States government-to-government relationship with all tribes 
within the United States. NAIHC's members are deeply appreciative of 
your work to improve the lives of veterans throughout the Country. As 
many of you know, Native Americans have historically served in the 
United States Armed Forces at the highest rate of any other 
demographic.
---------------------------------------------------------------------------
    \1\ There are 573 federally recognized Indian tribes and Alaska 
Native villages in the United States, all of which are eligible for 
membership in NAIHC. Other NAIHC members include state-recognized 
tribes eligible for housing assistance under the 1937 Housing Act and 
that were subsequently grandfathered in under the Native American 
Housing Assistance and Self-Determination Act of 1996, and the 
Department of Hawaiian Home Lands, the State agency that administers 
the Native Hawaiian Housing Block Grant program.
---------------------------------------------------------------------------

                       Profile of Indian Country

    There are 573 federally recognized Indian tribes in the United 
States. Despite progress over the last few decades, many tribal 
communities continue to suffer from some of the highest unemployment 
and poverty rates in the United States. Historically, Native Americans 
in the United States have also experienced higher rates of substandard 
housing and overcrowded homes than other demographics.
    The U.S. Census Bureau reported in the 2017 American Community 
Survey that American Indians and Alaska Natives were almost twice as 
likely to live in poverty as the rest of the population--25.4 percent 
compared with 13.4 percent. The median income for an American Indian 
Alaska Native household is 30 percent less than the national average 
($40,315 versus $57,652).
    In addition, overcrowding, substandard housing, and homelessness 
are far more common in Native American communities. In January 2017, 
the Department of Housing and Urban Development (HUD) published an 
updated housing needs assessment for tribal communities. According to 
the assessment, 5.6 percent of homes on Native American lands lacked 
complete plumbing and 6.6 percent lacked complete kitchens. These are 
nearly four times than the national average, which saw rates of 1.3 
percent and 1.7 percent, respectively. The assessment found that 12 
percent of tribal homes lacked sufficient heating.
    The assessment also highlighted the issue of overcrowded homes in 
Indian Country, finding that 15.9 percent of tribal homes were 
overcrowded, compared to only 2.2 percent of homes nationally. The 
assessment concluded that to alleviate the substandard and overcrowded 
homes in Indian Country, 68,000 new units need to be built.
    Since the Native American Housing Assistance and Self-Determination 
Act (NAHASDA) was enacted in 1996, tribes have built over 37,000 new 
units according to HUD. However, as the IHBG appropriations have 
remained level for a number of years, inflation has diminished the 
purchasing power of those dollars, and new unit construction has 
diminished as tribes focus their efforts on unit rehabilitation. While 
averaging over 2,400 new unit construction between Fiscal Year 202007 
and 2010, new unit construction has dropped in recent years with only 
2,000 new units between 2011 and 2014, and HUD estimating less than 
1,000 new units in future years as tribes maintain existing housing 
stock.

                            Tribal HUD-VASH

    HUD-VASH was first established in 2008 to better help homeless 
veterans by combining HUD rental assistance to homeless veterans with 
case management and supportive clinical services provided through the 
VA. While Native American veterans were generally eligible for the HUD-
VASH program, they could only receive HUD-VASH assistance through 
public housing agencies (PHA), as tribes and tribally designated 
housing entities (TDHE) were not eligible to receive HUD-VASH funding 
or vouchers directly. This left a gap in service to many Native 
American veterans, as many Native Americans often look first to their 
tribe for needed services and would not necessarily be aware to, or may 
be reluctant to, request services from PHAs. An additional gap existed 
as many PHAs do not necessarily serve individuals living within a 
tribe's reservation or service area, as those individuals would 
primarily be served by the tribe or its tribally designated housing 
entity (TDHE).
    To address this gap, tribal leaders and tribal housing 
professionals advocated for an expansion of the HUD-VASH program to 
include funding to tribes. Congress eventually responded by creating a 
demonstration Tribal HUD-VASH program with a $4 million set aside from 
Fiscal Year 202015 appropriations. HUD and the VA announced the 
establishment of the demonstration program in January 2015. After some 
consultation with tribes, HUD invited 30 tribes to participate in the 
demonstration program, and in March 2016, 26 tribes were awarded 
initial tribal HUD-VASH grants.
    The participating tribes have had varying levels of success with 
their implementation of the HUD-VASH program. End of Fiscal Year 
reports from 2018 and 2019 show that the 26 tribes in the demonstration 
have held steady at serving approximately 350 veterans each year. 
Measuring success has often included looking at the percentage of 
housed veterans against the total level of funding appropriated. When 
the total number of veterans expected to be served is shown as 500, 
that level of success seems low at 69 percent. However, in 2018, HUD 
and the VA were measuring the number of housed veterans against the 
lower number of ``active allocations'' based on the decreased 
appropriation for that year, and the percentage shows a better success 
rate of 92 percent.
    Further, any attempt to reduce funding to Tribal HUD-VASH or deem 
the program unsuccessful based on these year end numbers overlooks two 
important facts. First, there are over 550 other federally and state-
recognized tribes that could serve veterans in their communities if 
given access to the program. Second, many, if not all, of the 350 
veterans served annually by the participating tribes would not have 
received these services if not for the Tribal HUD-VASH program.
    Success can also be seen in the number of veterans housed upon exit 
from the program. While data seems to be differ, one report provided by 
the VA at the February 2019 NAIHC Legislative Conference showed that 45 
of 56 veterans (80 percent) who exited the program prior to 2/11/2019 
were housed on exit, either with permanent, temporary, or in a 
treatment setting. Finally, while the year-end reports show tribes 
holding steady with the total number of veterans housed through the 
Program, it does not necessarily capture the full total number of 
veterans that program has served over time. For instance, the Cherokee 
Nation has served over 40 veterans in total since the demonstration 
program began, while the year-end reports only ever show the number of 
veterans actively being served at the time of the report.
    One of the initial barriers was the lack of case managers from the 
VA that were able to serve individuals in tribal communities. Many of 
the tribal communities participating in the demonstration program are 
rural and do not have nearby access to VA hospitals or clinics. This 
has improved, through a combination of relaxing the qualifications 
required to be a case manager within the tribal HUD-VASH program and 
including tribes in the process to identify and hire qualified case 
managers.
    A second common obstacle is the severe shortage of housing options 
available within the tribal communities. This issue is not specific to 
HUD-VASH housing needs, as a 2017 HUD report found that tribal 
communities together require 68,000 new units to replace substandard 
and/or overcrowded homes. Tribes that have been the most successful in 
utilizing the HUD-VASH funding have found housing options outside the 
reservation or away from tribal communities. Nearly all tribes own and 
manage their own housing stock, but often these are fully utilized 
through a tribe's regular low-income rental assistance program with 
many having extensive wait-lists.
    Additionally, many tribally owned housing units that could be used 
for HUD-VASH recipients also contribute to the formula that determines 
the tribe's level of assistance through the Indian Housing Block Grant. 
HUD has made the determination that a tribe must remove the unit from 
its formula count if it applies the HUD-VASH subsidy to that unit. This 
creates a disincentive to the Tribe on both an administrative and 
funding level. While HUD has maintained that a tribe could place the 
unit back into its formula count once the HUD-VASH subsidy is removed 
from the unit, many tribes are reluctant to go through the 
administrative steps to do so. HUD-VASH funding was also seen as a 
mechanism to provide additional resources to tribes to specifically 
help a subset of their members but doing so using existing tribally 
owned units essentially negates the HUD-VASH funding as a net positive 
resource.
    Other barriers reported by tribes include finding eligible veterans 
(particularly those able to travel distances needed for case 
management), changes in TDHE staff and expertise, lack of privately 
owned rental stock available to tribal veterans, and a lack of 
resources for ancillary housing needs, such as transportation, 
furniture, supplies etc.
    One key difference that may need to be addressed moving forward is 
how funding for veterans in the program is treated year to year. In the 
larger HUD-VASH program, veterans added to the program each year are 
often re-characterized or added in the next year to a PHA's allocation 
of funding for normal tenant-based vouchers. In essence, each Fiscal 
Year Congress is adding appropriations for new HUD-VASH vouchers that 
can serve newly identified veterans in need. In the tribal context, 
annual appropriations for tribal HUD-VASH must continue to serve the 
same veterans in the program each year, as new funds are not added to a 
tribe or TDHE's overall funding level similar to a PHAs increased 
voucher funding.

          S. 257 & H.R. 2999 , the Tribal HUD-VASH Act of 2019

    NAIHC supports the bills that have been introduced this Congress to 
improve and expand the Tribal HUD-VASH program. S. 257 has already 
passed the Senate this Congress, and we urge all members of the House 
to support and pass the bill so it can be enacted. H.R. 2999 is a 
bipartisan companion bill, and currently both are pending with the 
House Financial Services Committee.
    The bill would codify and make permanent the Tribal HUD-VASH 
program within the larger HUD-VASH program and ensure funding for the 
program. The bill would make all tribes and their tribal housing 
programs eligible for the HUD-VASH program, which to date has remained 
limited to the original 26 recipients. The bill would also call on the 
Indian Health Service to assist the program as requested by the HUD or 
VA. Primarily, the bill is intended to give the Secretaries of HUD and 
the VA the flexibility to make further improvements to the program to 
overcome the obstacles the tribes and agencies have identified.
    The flexibility provided to the agencies by the bill would allow 
the VA and HUD to address the two primary concerns that NAIHC has heard 
regarding HUD-VASH implementation: the lack of case managers the VA can 
identify willing or able to work in tribal areas, and the restrictions 
placed on certain tribal housing units by HUD that make them ineligible 
for VASH vouchers. Many communities have housing shortages and limiting 
the housing stock that can be used in the tribal HUD-VASH program 
forces some of the participating tribes to house their tribal veterans 
in nearby urban areas, rather than the tribal community as intended by 
the program.
    NAIHC wants to thank the Members of Congress who have introduced, 
sponsored and supported the HUD-VASH program and legislation. After 
passing the Senate in the 115th Congress, the Tribal HUD-VASH Act was 
nearly passed by the House but was pulled from the suspension calendar 
just prior to the end of the year. Being passed by the Senate and 
initially placed on the suspension calendar shows the level of 
bipartisan support the Tribal HUD-VASH program and bill enjoy. NAIHC is 
hopeful that the bill, having been passed by the Senate again, can 
finally be passed by the full House this Congress and enacted into law.

                                 [all]