Contributors: Emily Kane and Kevin Leacock
Housing insecurity is one of many impacts of COVID-19, and one of the many aspects our nation must tackle during this crisis. It's essential to understand public housing infrastructure to build on it and improve this system for the millions of people who rely on local and federal government assistance for stable housing. Health centers serve over 28 million patients across the country from a variety of historically under-resourced populations, including those living in public housing. For healthcare practitioners, understanding the nuances of the housing programs patients and clients utilize can paint a picture of the lived experienced of the communities they serve.
U.S. Department of Housing and Urban Development (HUD) Programs/Services:
The Housing Choice Vouchers (HCV) program (commonly known as the tenant-based arm of the Section 8 program) is designed to provide residents of public housing with increased mobility and choice by enabling them to select housing options from the private market. The HCV program has grown exponentially since its inception in 1974; to date, over 21% of all renters receiving federal assistance are supported through HCVs, making it the largest single program under the public housing umbrella. Individuals apply for HCVs through their local public housing authority (PHA) by meeting eligibility requirements set by the PHA (though generally, individuals are eligible if their income is at or below 50% of the area’s median income). PHAs then determine both the suitability of the resident’s housing selection and their required rent payment. Individuals using HCVs pay 30% of its monthly adjusted gross income for rent and utilities, and if the unit rent is greater than the payment standard the family is required to pay the difference. Due to the volume of applicants for vouchers across the country, many cities have years-long waiting list or have closed their voucher application process indefinitely.
Like the HCV program, project-based vouchers (PBVs) subsidize rent for individuals and families who qualify for housing based on their income. One key difference between the HCV and PBV programs is the relationship between local housing authorities and private landlords. Under the PBV program, PHAs contract with landlords to designate one or more units for subsidized housing. Landlords then accept PBVs from families deemed eligible by the PHA. The typical criteria for resident eligible is similar to the qualifications needed to obtain HCVs: the majority of PBV recipients have “incomes not exceeding 30 percent of the local median or the poverty line, whichever is higher.” Families usually contribute 30 percent of their income to rent/utilities while HUD (through PHAs) provides the remaining funds for the unit. To increase flexibility within the voucher program, HUD allows PHAs to convert up to 20% of their HCVs to PBVs if necessary, and enables them to combine waiting lists for both voucher programs to streamline assistance.
The Project Based Rental Assistance (PBRA) program operates through HUD’s Office of Multifamily Housing Program, where HUD directly engages in a Housing Assistance Payment (HAP) contract with private owners to provide subsidized units for low-income tenants. This project-based rental assistance is attached to specific units in a housing development/property. Ninety-six percent of residents in this program have incomes that are less than 50% of the area’s median income. In 1983, in an act that still stands today, Congress disallowed the construction of new units built in connection to the PBRA program. However, funding remains available today for landlords to renew existing HAP contracts as they continue to provide rental units to individuals in need. Recent examples illustrate this fact, as $800 million of CARES Act supplemental appropriations went to roughly 16,500 properties with established PBRA contracts to help “maintain normal operations” during the COVID-19 pandemic.
HUD distributes federal funds to approximately 3,300 housing agencies throughout the country to ensure eligible, low-income renters can live in affordable housing. Currently, approximately 1.2 million households utilize HUD’s Public Housing Program, which encompasses tradition, PHA-run units. Though income limits may vary based on location, these limits set by HUD for the Public Housing program mirror those of other public housing programs (the lower income limit is set at 80% of the area’s median income, with very low-income limits set at 50% of the area’s median income). Once eligible, residents will either be put on a waiting list or offered a lease for a public housing unit. Typically, gross family income determines the amount of rent, or Total Tenant Payment (TTP), to be paid each month. In other cases, housing agencies use a specific formula that assesses additional financial variables to determine the TTP for each family. Public housing through this program should remain available to residents if they adhere to program rules and regulations.
According to HUD and the Office of Policy Development and Research, the Low-Income Housing Tax Credit (LIHTC) “is the most important resource for creating affordable housing in the United States today.” The LIHTC supports the creation or rehabilitation of roughly 111,000 affordable rental units each year. This is currently the largest federally funded affordable housing creation program, costing approximately $9.5 billion per year. Born out of the Tax Reform Act of 1986, LIHTC facilitates the disbursement of federal income tax credits as an incentive to private developers so they can invest (rehabilitate, acquire, construct, etc.) in low-income rental housing units. State and local housing agencies have the authority to allocate the incentives through a competitive process that, again, focuses on the ability of the developer to create affordable housing. To qualify and receive this credit, developers must agree to a “use restriction” to ensure that the property will have appropriately priced units. Though tenants cannot technically enroll into this program, it is important to note just how integral the LIHTC program can be in housing this vulnerable population.
Healthcare providers are entrusted with the health and wellbeing of those residing in subsidized housing, whether through a voucher or traditional public housing unit. To that end, providers should be equipped to offer resources and assistance to families as they navigate this complex landscape to ensure that housing – a key social determinant of health – is incorporated into a holistic plan of care.
Emily Kane is a Senior Program Manager at the National Nurse-Led Care Consortium.
Kevin Leacock is a Public Health Project Coordinator at the National Nurse-Led Care Consortium.Read more Housing is Health