This was not the home Aminata pictured for her family of 10. Cramped into a relative’s dark, leaking basement, surrounded by rats, roaches, bed bugs and mountains of wet, moldering laundry. Although Aminata paid $450 a month in rent, handed over her FoodShare benefits to stock the kitchen and cleaned the house, her relative often locked the door to the basement, denying the family access to food and the bathroom for long stretches.
A dispute with other relatives two months earlier had left Aminata’s family homeless and desperate. She frantically searched for a new home, but she couldn’t find a shelter or landlord willing to accommodate all nine of the children living with her.
“My babies kept getting sick, I kept getting sick all the time because there was always water coming down from the ceiling and it was so wet in there,” she said. “But we had no choice — we couldn’t stay outside on the streets. We didn’t have anywhere to go.”
The situation seemed so bleak that Aminata battled depression and suicidal thoughts. But a sliver of hope, like a light shining from under the crack of the basement door, emerged when Children’s Community Health Plan (CCHP) learned of the family’s abysmal living conditions. CCHP, a nonprofit health insurance organization owned by Children’s Wisconsin that serves more than 140,000 people in the state, created a housing navigator program in 2019 to help members with this sort of situation.
CCHP quickly mobilized to find the family a temporary place to stay, and then Carly Mikkila, a community intervention specialist, began her nearly year-long odyssey to find the family a more permanent home they could finally call their own.
So why would a health insurance organization help a family find housing? A person’s environment is one of the factors known as the social determinants of health, which are key factors that influence health and quality of life. Social determinants — things such as education, physical environment, employment and income — have been shown to account for as much as 90 percent of a person’s overall health and well-being.
Research shows that substandard living conditions are associated with worse health outcomes. Preventative care can fall by the wayside as families focus on their basic shelter needs instead of scheduling a checkup or filling a prescription. Poor housing conditions — such as mold, pests and asbestos — can exacerbate conditions such as asthma. And the struggle to find safe, stable housing can significantly affect a family’s mental health as well as physical health.
“When you look at Maslow’s Hierarchy of Needs, shelter is part of the base of the pyramid. It’s a basic human need,” said Carly. “When people have a stable place to sleep at night, somewhere that is warm and properly cared for, it allows them to have a little more head space freed up to focus on what’s important to them. The ripple effect is really great. You might be helping one member, but then everyone in the family is helped.”
And that’s especially important for children. “For kids, when that basic need of shelter isn’t met, it’s tremendously stressful and traumatizing,” said Carly. “Those kinds of adverse childhood experiences affect mental health and anxiety, school work and health long term.”
CCHP has two community health navigators on staff who connect members to various resources, including food, transportation, housing and other household needs. The staff navigators handle any basic housing needs, but more complex cases are turned over to Carly. Although Carly works for Milwaukee County Housing Division, her position is funded by CCHP. CCHP also provides some money to help members with security deposits, rent and furniture, when needed.
And the need continues to grow. Homelessness has surged in the wake of COVID-19-related job losses, and some families have opted to live outside because of fears of catching COVID-19 at a shelter.
Sometimes a family isn’t homeless but needs help advocating for better housing conditions. “Quite a few of the houses I see are in disrepair, infested with rodents, and just in really bad shape, and people are afraid to talk to their landlord for fear of retaliation,” said Carly. She helps families connect with resources or navigate eviction court.
CCHP has made more than 200 referrals for housing navigation services since it began its partnership with Milwaukee County Housing Division in January 2019. More than 700 people have been served by the program so far, about 60 percent of them children.
The impact on a member’s health can be dramatic. Carly recalls one CCHP member who had 44 ER visits and 11 hospitalizations over a seven-month period because of various medical concerns that weren’t addressed while he was homeless. After she helped him find housing, he had five ER visits and no hospitalizations over the next seven months, reducing his health care costs from an average of $11,000 per month before housing to an average of $400 per month after housing.
Some health insurance organizations focus on addressing the housing needs of “high utilizers” — members with the highest medical bills — but CCHP takes a more holistic view, especially when children are involved. Aminata’s family members weren’t considered high utilizers of their health plan, but when CCHP staff heard about the family’s situation, they knew they had to get involved.
“They know that not everything is going to yield a high return on investment, but it was the right thing to do,” said Carly. “It was absolutely wonderful that CCHP is on board with helping families like this one.”
Aminata’s situation was Carly’s most challenging case yet. “The shelters don’t have capacity to accommodate a family that large,” she said. “You don’t want to break families up, and you can’t split shelter placement when there’s one adult in the family.”
Fortunately, CCHP had access to a three-bedroom house. Still small for a family that size, but much better than the basement they’d been living in.
“That made a big difference,” said Aminata. The family moved in just before Christmas 2019, and the kids talked about how excited they were to set up a Christmas tree. Mikkila brought them a donated tree from her office, and CCHP staff contributed ornaments. “They were just so happy to have a place where they could put up a Christmas tree and celebrate together,” she said.
The unexpected gift brought tears to Aminata’s eyes. “The other thing that made us cry was that we were finally in our own home. That was the big part,” she said.
Next, Carly worked on a permanent housing plan, which included applying for a Section 8 voucher through the Housing Authority of the City of Milwaukee. COVID-19 delayed the process, but the voucher was finally issued in late July 2020. The voucher brought the cost of the rental down to 30 percent of Aminata’s income, making it possible for her to afford a house large enough for her family.
“Finding a five-bedroom voucher for this family was nothing short of a miracle — these are really hard to come by,” said Jamie Heberer, director of case management and health promotion for CCHP. “Having our housing navigator involved was critical in this case.”
Then the clock started ticking.
“When a voucher is issued, they have 90 days to find a place, which sounds like a long time, but it goes fast. It was very tough,” said Carly.
But with Carly’s help, Aminata and her kids finally found a five-bedroom home and moved in September 2020.
While Carly usually works with families over a few months’ time, she worked with Aminata for nearly a year.
“It was a really long road, and we were so happy when they were permanently housed,” Carly said. CCHP provided the funds to outfit the home with four sets of bunk beds, two other beds, couches and a table.
“Carly was a godsend,” said Aminata. “She was really good. She helped us a lot. She kept a lot of the stress off of us.”
Aminata is relieved to finally have her family settled. She and the kids recently gathered around their dining room table to enjoy Thanksgiving dinner, complete with Aminata’s home-cooked ham, baked macaroni and cheese, and green bean casserole with potatoes and bacon. And the best ingredient of all: A home and healthy family to celebrate with.