Bill Summary – FastDemocracy

The Florida Senate
                    BILL ANALYSIS AND FISCAL IMPACT STATEMENT
                (This document is based on the provisions contained in the legislation as of the latest date listed below.)
          Prepared By: The Professional Staff of the Appropriations Committee on Health and Human Services
BILL:             CS/SB 1442
INTRODUCER:       Appropriations Committee on Health and Human Services and Senator Grall
SUBJECT:          Pregnancy Support Services
DATE:             February 15, 2024               REVISED:
           ANALYST                      STAFF DIRECTOR                 REFERENCE                                 ACTION
1. Morgan                             Brown                                 HP              Favorable
2. Gerbrandt                          McKnight                             AHS              Fav/CS
3.                                                                          FP
    I.    Summary:
          CS/SB 1442 creates s. 414.1611, F.S., to establish the Florida State Maternity Housing Grant
          Program within the Department of Children and Families (DCF) to provide annual housing
          grants to local homelessness continuums of care lead agencies. Grant funds must be used for
          specified purposes to assist Florida’s women and families experiencing homelessness during the
          prenatal period.
          The bill authorizes the DCF to adopt rules to administer the program.
          The bill has a significant, negative fiscal impact on state expenditures. See Section V., Fiscal
          Impact Statement.
          The bill takes effect July 1, 2024.
    II.   Present Situation:
          Homelessness in the United States
          Homeless persons are defined as those who lack a fixed, regular, and adequate nighttime
          residence, or those living in shelters and temporary housing, or public and private places not
          designed for sleeping accommodations. While many homeless individuals are alone, others are
          couples, families with children, or unaccompanied youth.1
1
 Florida Department of Children and Families, Homelessness Frequently Asked Questions, available at
https://www.myflfamilies.com/services/public-assistance/homelessness/homelessness-frequently-asked-questions (last visited
Feb. 1, 2024).
BILL:   CS/SB 1442                                                                                                Page 2
         There are two types of homelessness: “sheltered” and “unsheltered.” Unsheltered homeless
         persons live on the streets or live in tents, cars, or abandoned buildings. Sheltered homeless
         persons stay in emergency or transitional housing temporarily. Sheltered homeless persons are
         still considered homeless due to a lack of
         stable permanent housing.2
         On a single night in 2023, roughly
         653,100 people, about 20 of every
         10,000 people in the U.S., were
         experiencing homelessness. This is the
         highest number reported since the
         inception of point-in-time count
         reporting in 2007. The data indicated that
         six in ten people were experiencing
         sheltered homelessness, while the
         remaining four in ten were experiencing
         unsheltered homelessness in places not
         meant for human habitation.3
         Reporting has also shown experiences of
         homelessness increased nationwide across all household types. Between 2022 and 2023, the
         number of people experiencing homelessness increased by 12 percent, roughly 70,650 more
         people. Nearly three of every ten people experiencing homelessness (28 percent or
         approximately 186,100 people) did so as part of a family with children. Between 2022 and 2023,
         the number of people in families with children who were experiencing homelessness increased
         by more than 25,000 people (or 16 percent), ending a downward trend in families experiencing
         homelessness that began in 2012.4
         The following exhibits demonstrate the approximate U.S. homeless population by state, as well
         as the people in families with children experiencing homelessness by sheltered status from 2007
         to 2023.5
2
  Florida Department of Children and Families, Homelessness Frequently Asked Questions, available at
https://www.myflfamilies.com/services/public-assistance/homelessness/homelessness-frequently-asked-questions (last visited
Feb. 1, 2024).
3
  U.S. Department of Housing and Urban Development’s Office of Community Planning and Development, The 2023 Annual
Homelessness Assessment Report (AHAR) to Congress – Part 1: Point-in-Time Estimates of Homelessness (December 2023),
available at https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf (last visited Feb. 1, 2024).
4
  Id.
5
  Id.
BILL:   CS/SB 1442   Page 3
BILL:   CS/SB 1442                                                                                                  Page 4
         Homelessness in Florida
         On a given night in January 2023, more than half of all people experiencing homelessness in the
         U.S. were in four states:6
          California (28 percent of all people experiencing homelessness in the U.S., or 181,399
            people);
          New York (16 percent or 103,200 people);
          Florida (5 percent or 30,756 people); and
          Washington (4 percent or 28,036 people).
         Between 2022 and 2023, the states with the largest absolute increases in homelessness were:7
          New York (29,022 more people);
          California (9,878);
          Florida (4,797);
          Colorado (4,042); and
          Massachusetts (3,634).
         Over a longer period, from 2007 to 2023, the number of people experiencing homelessness
         declined in 25 states and the District of Columbia. The largest absolute decreases were in Florida
         (17,313 fewer people) and Texas (12,411 fewer people).8
         Between 2022 and 2023, the number of people in families with children experiencing
         homelessness increased in 34 states and the District of Columbia. The largest increases were in:9
          New York (18,890 more people, a 54 percent increase);
          Massachusetts (2,906 more people or 29 percent);
          Colorado (1,490 more people or 69 percent);
          Florida (1,391 more people or 22 percent); and
          Illinois (1,077 more people or 36 percent).
         Pregnant Women Experiencing Homelessness
         Due to the very transient nature of homelessness, the exact number of pregnant homeless women
         is difficult to determine. This represents a significant knowledge gap that could be used to inform
         social and health policy, as well as service delivery, thus researchers have continued in their
         attempts to identify the extent of pregnancy among the homeless population.10
         In the U.S., one study estimated that one in five homeless women are pregnant at any given time,
         almost twice the rate of the general population. Other research uncovered even higher rates of
6
  U.S. Department of Housing and Urban Development’s Office of Community Planning and Development, The 2023 Annual
Homelessness Assessment Report (AHAR) to Congress – Part 1: Point-in-Time Estimates of Homelessness (December
2023), available at https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf (last visited Feb. 1, 2024).
7
  Id.
8
  Id.
9
  Id.
10
   Council to Homeless Persons, The Extent, Nature and Impact of Homelessness on Pregnant Women and Their Babies,
available at https://chp.org.au/parity/the-extent-nature-and-impact-of-homelessness-on-pregnant-women-and-their-babies/
(last visited Feb. 1, 2024).
BILL:   CS/SB 1442                                                                                                   Page 5
         pregnancy among homeless women, finding that while ten percent of women in the U.S. were
         pregnant in 2009, 50 to 60 percent of homeless women were pregnant.11
         Another study conducted in Florida determined about 183 pregnant homeless women live in
         Northeast Florida in any given month.12
         The Impact of Homelessness on Maternal and Infant Health
         Stable housing has been identified as one of the most important predictors of health as housing
         instability or homelessness lessens access to health care. This is more pressing during pregnancy,
         a time when access to affordable, high-quality health care is crucial. Although prenatal care is
         available, pregnant mothers and parents experiencing homelessness face barriers (e.g., lack of
         transportation, site-related factors, provider-client relationship, inconvenience, fear, cost, etc.).13
         For some, these obstacles bar them from accessing care altogether. Additionally, people
         experiencing housing instability or homelessness are more likely to live in conditions that are
         hazardous to their health.14
         Several studies have shown that homelessness has a negative impact on the health of pregnant
         mothers and infants:15
          Pregnant mothers experiencing homelessness are significantly less likely to have a prenatal
            visit during the first trimester, breastfeed, and have a well-baby checkup than their housed
            counterparts.
          In comparison with a housing-secure group with similar characteristics, pregnant mothers
            experiencing homelessness are significantly more likely to have various pregnancy-related
            conditions and complications, including high blood pressure, iron deficiency and other
            anemia, nausea and vomiting, hemorrhage, placental problems, and abdominal pain.
          One in five mothers who experienced homelessness in the year before giving birth had an
            infant with low birth weight, a nearly 50 percent increase in risk compared to consistently
            housed people with otherwise similar characteristics.
          Newborn infants of people experiencing homelessness have longer stays in the hospital and
            are more likely to require intensive care than infants of consistently housed people.
          People who were homeless as infants are more likely to have upper respiratory infections,
            other respiratory diseases, fever, allergies, injuries, developmental disorders, and asthma,
            compared to people who were stably housed during infancy. These individuals also show a
            propensity for increased emergency department visits, hospitalizations, and health care costs.
11
   Council to Homeless Persons, The Extent, Nature and Impact of Homelessness on Pregnant Women and Their Babies,
available at https://chp.org.au/parity/the-extent-nature-and-impact-of-homelessness-on-pregnant-women-and-their-babies/
(last visited Feb. 1, 2024).
12
   Journal of Obstetric, Gynecologic, and Neonatal Nursing, Bloom, K. C., Bednarzyk, M. S., Devitt, D. L., Renault, R. A.,
Teaman, V., & Van Loock, D. M., Barriers to prenatal care for homeless pregnant women (2004), available at
https://www.jognn.org/article/S0884-2175(15)34192-7/fulltext (last visited Feb. 1, 2024).
13
   Id.
14
   National Partnership for Women & Families, Homelessness Hurts Moms and Babies, available at
https://nationalpartnership.org/report/homelessness-hurts-moms-and-babies/ (last visited Feb. 1, 2024).
15
   Id.
BILL:   Continuums of Care
                                                                                                                       Page 6
         The Department of Children and Families (DCF)
         State Office on Homelessness
         The State Office on Homelessness (State Office) within the Department of Children and Families
         (DCF) was created in 2001 as a central point of contact within state government on
         homelessness.16 Section 420.622, F.S., requires the State Office to coordinate resources and
         programs across all levels of government and with private providers that serve the homeless
         pursuant to policies set by the Council on Homelessness and available funding.17
         The inter-agency Council on Homelessness (Council) is a 19-member council18 required to
         develop policy and advise the State Office on how to reduce homelessness statewide. The
         Council is statutorily required to submit an annual report to the Governor, Legislature, and the
         DCF’s Secretary that summarizes the extent of homelessness in Florida and recommendations
         for ending homelessness. 19
         Continuums of Care
         Continuums of Care (CoC) groups organize to coordinate, plan, and pursue ending homelessness
         in designated areas throughout Florida.20 Section 420.621(1), F.S., requires CoCs to be
         composed of representatives from certain organizations, including, but not limited to:
          Nonprofit homeless providers,
          Victim services providers,
          Faith-based organizations,
          Governments,
          Businesses,
          Advocates,
          Public housing agencies,
16
   Ch. 2001-98, Laws of Fla.
17
   Section 420.622(3), F.S.
18
   The individuals and agencies included in the Council of Homelessness are: the Secretary of Children and Families, or his
or her designee; the Secretary of Economic Opportunity, or his or her designee, who shall advise the council on issues related
to rural development; the State Surgeon General, or his or her designee; the Executive Director of Veterans’ Affairs, or his or
her designee; the Secretary of Corrections, or his or her designee; the Secretary of Health Care Administration, or his or her
designee; the Commissioner of Education, or his or her designee; the Executive Director of CareerSource Florida, Inc., or his
or her designee; one representative of the Florida Association of Counties; one representative of the Florida League of Cities;
one representative of the Florida Supportive Housing Coalition; one representative of the Florida Housing Coalition; the
Executive Director of the Florida Housing Finance Corporation, or his or her designee; one representative of the Florida
Coalition for the Homeless; the secretary of the Department of Elder Affairs, or his or her designee; and four members
appointed by the Governor.
19
   Section 420.622, F.S.
20
   Section 420.621, F.S. The Office of Economic Self-Sufficiency (Office) within the Department of Children and Families
employs a Continuum of Care (CoC) model to provide services for individuals experiencing homelessness. Local CoCs are
organizations composed of representatives of nonprofit homeless providers, victim service providers, faith-based
organizations, governments, businesses, advocates, public housing agencies, school districts, social service providers, mental
health agencies, etc. The Office designates local CoC entities to serve as lead agencies for homeless services throughout
Florida. The DCF, Homelessness, available at: https://www.myflfamilies.com/services/public-assistance/homelessness (last
visited Dec. 28, 2023).
BILL:   Continuums of Care
                                                                                                                   Page 7
            School districts,
            Social service providers,
            Mental health agencies,
            Hospitals,
            Universities,
            Affordable housing developers,
            Law enforcement, and
            Organizations that serve homeless and formerly homeless persons.21
         The purpose of a CoC is to coordinate community efforts to prevent and end homelessness in a
         catchment area designated by the State Office. Florida’s designated catchment areas must be
         consistent with the CoC catchment areas recognized by HUD for the purpose of awarding federal
         homeless assistance grant funding.22 The State Office recognizes one CoC lead agency for each
         designated catchment area.23
         The following table lists Florida's CoC lead agencies and the counties served by each.24
                          CoC Lead Agency                                   Counties Served
          Opening Doors of NWFL                                Escambia and Santa Rosa
          Homelessness & Housing Alliance                      Okaloosa and Walton
                                                               Bay, Calhoun, Gulf, Holmes, Jackson, and
          Doorways of Northwest Florida
                                                               Washington
                                                               Franklin, Gadsden, Jefferson, Leon,
          Big Bend Continuum of Care
                                                               Liberty, Madison, Taylor, and Wakulla
                                                               Columbia, Hamilton, Lafayette, and
          United Way of Suwannee Valley
                                                               Suwannee
                                                               Alachua, Bradford, Gilchrist, Levy, and
          United Way of North Central Florida
                                                               Putnam
          Changing Homelessness                                Clay, Duval, and Nassau
          Volusia/Flagler Coalition for the Homeless           Flagler and Volusia
          Flagler Hospital – St. Augustine                     St. Johns
          Ocala/Marion Joint Office on Homelessness            Marion
          Mid Florida Homeless Coalition                       Citrus, Hernando, Lake, and Sumter
          Coalition for the Homeless of Pasco County           Pasco
          Homeless Services Network of Central Florida         Orange, Osceola, and Seminole
          Tampa Hillsborough Homeless Initiative               Hillsborough
          Homeless Coalition of Polk County                    Polk
          Brevard Homeless Coalition                           Brevard
          Treasure Coast Homeless Services Council             Indian River, Martin, and St Lucie
21
   Section 420.621(1), F.S.
22