I 

118TH CONGRESS 

1ST SESSION H. R. 773 

To help persons in the United States experiencing homelessness and significant behavioral health issues, including substance use disorders, by authorizing a grant program within the Department of Housing and Urban 

Development to assist State and local governments, Continuums of Care, 

community-based organizations that administer both health and homelessness services, and providers of services to people experiencing homelessness, better coordinate health care and homelessness services, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 2, 2023 

Ms. DEAN of Pennsylvania (for herself and Ms. GARCIA of Texas) introduced 

the following bill; which was referred to the Committee on Financial Services 

A BILL 

To help persons in the United States experiencing homelessness and significant behavioral health issues, including 

substance use disorders, by authorizing a grant program 

within the Department of Housing and Urban Development to assist State and local governments, Continuums 

of Care, community-based organizations that administer 

both health and homelessness services, and providers of 

services to people experiencing homelessness, better coordinate health care and homelessness services, and for 

other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Homelessness and Be5 havioral Health Care Coordination Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) The United States has a homelessness cri9 sis, with more than 582,000 people experiencing 

10 homelessness on a single night according to the De11 partment of Housing and Urban Development’s 

12 2022 Annual Homeless Assessment Report to Con13 gress. 

14 (2) While the lack of affordable housing is the 

15 primary driver of homelessness, behavioral health 

16 conditions, including substance use disorders, can 

17 exacerbate homelessness and can also be a con18 sequence of homelessness. 

19 (3) Research shows that people experiencing 

20 homelessness have higher rates of substance use dis21 order than people with housing stability. Some peo22 ple who experience homelessness use substances to 

23 cope with the trauma and deprivations of their cir24 cumstances, but substance use disorders frequently 


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1 make it more difficult for people experiencing home2 lessness to secure permanent housing. 

3 (4) Many individuals with substance use dis4 order who experience homelessness have co-occurring 

5 illnesses. The combined effect of physical illness, 

6 mental illness, and lack of housing results in higher 

7 mortality rates for individuals experiencing home8 lessness. 

9 (5) Safely and securely housing individuals who 

10 are experiencing both homelessness and behavioral 

11 health issues, including substance use disorders, 

12 often requires supportive services and close coordina13 tion between housing and social service providers, in 

14 addition to low-barrier, affordable housing. Sub15 sidized housing is critical, but not enough—access to 

16 additional voluntary person-centered supportive serv17 ices is needed. 

18 (6) It is imperative that when people experi19 encing homelessness choose to seek help that hous20 ing as well as health care and person-centered sup21 portive services be coordinated, particularly given 

22 their acute needs and the significant costs incurred 

23 by communities for law enforcement, correctional, 

24 and emergency department care for failing to do so. 


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1 (7) While participation in health care and per2 son-centered supportive services should not be a re3 quirement for people experiencing homelessness to 

4 receive housing, access to such services can be bene5 ficial in securing and successfully maintaining stable 

6 housing. 

7 (8) Integration of health and homelessness serv8 ices to achieve optimal outcomes for people experi9 encing homelessness, significant behavioral health 

10 conditions such as substance use disorder, and other 

11 health conditions can be challenging for State and 

12 local governments, continuums of care, and commu13 nity-based organizations that administer both health 

14 and homelessness services and providers of homeless15 ness services. 

16 (9) Capacity building is needed to create sys17 tems-level linkages between the two sets of services 

18 to allow for smoother pathways and simpler naviga19 tion. 

20 (10) Black, Hispanic, and Indigenous people 

21 are disproportionately underserved by person-cen22 tered supportive services. In order to address critical 

23 services deficits and affirmatively serve protected 

24 classes of people with significant behavioral health 

25 conditions, including substance use disorders, who 


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1 are experiencing homelessness, the grant program 

2 established under this Act can be used to build the 

3 capacities of homelessness services providers that 

4 have demonstrated cultural competencies in service 

5 provision and a record of serving Black, Hispanic, 

6 and Indigenous people and other underserved popu7 lations experiencing homelessness that also suffer 

8 from substance use disorders. 

9 SEC. 3. ESTABLISHMENT OF GRANT PROGRAM. 

10 (a) IN GENERAL.—The Secretary of Housing and 

11 Urban Development (in this Act referred to as the ‘‘Sec12 retary’’), in consultation with the working group estab13 lished pursuant to subsection (b), shall establish a grant 

14 program to award competitive grants to eligible entities 

15 to build or increase their capacities for the better coordi16 nation of health care and homelessness services for people 

17 who are experiencing homelessness and significant behav18 ioral health issues, including substance use disorders, and 

19 are voluntarily seeking assistance. 

20 (b) WORKING GROUP.— 

21 (1) ESTABLISHMENT.—The Secretary shall es22 tablish an interagency working group to provide ad23 vice to the Secretary in carrying out the program 

24 under subsection (a). The working group shall in25 clude representatives from the Department of HousVerDate Sep 11 2014 03:43 Mar 01, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H773.IH H773

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1 ing and Urban Development, the United States 

2 Interagency Council on Homelessness, Department 

3 of Health and Human Services, Department of Agri4 culture, and Bureau of Indian Affairs, to be ap5 pointed by the heads of such agencies. 

6 (2) DEVELOPMENT OF ASSISTANCE TOOLS.— 

7 The working group shall, not later than 12 months 

8 after the date of the enactment of this Act, develop 

9 training, tools, and other technical assistance mate10 rials that simplify homelessness services for pro11 viders of health care and simplify health care serv12 ices for providers of homelessness services by identi13 fying the basic elements the health and homelessness 

14 sectors need to understand about the other, and 

15 shall circulate such materials to interested entities, 

16 particularly those who apply for grants awarded pur17 suant to this Act. 

18 (c) CAPACITY-BUILDING GRANTS.— 

19 (1) IN GENERAL.—The Secretary shall award 

20 5-year grants to eligible entities, which shall be used 

21 only to build or increase their capacities to coordi22 nate health care and homelessness services. 

23 (2) PROHIBITION.—None of the proceeds from 

24 the grants awarded pursuant to this Act may be 

25 used to pay for health care, with the exception of efVerDate Sep 11 2014 03:43 Mar 01, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H773.IH H773

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1 forts to increase the availability of Naloxone and 

2 provide training for its administration, or rent. 

3 (3) AMOUNT.—The amount awarded to an enti4 ty under a grant under this subsection shall not ex5 ceed $500,000. 

6 (4) ELIGIBILITY.—To be eligible to receive a 

7 grant under this subsection an entity shall— 

8 (A) be— 

9 (i) a governmental entity (at the coun10 ty, city, regional, or locality level); 

11 (ii) an Indian tribe, a Tribally des12 ignated housing entity, a Tribal organiza13 tion, or an urban Indian organization; 

14 (iii) a public housing agency admin15 istering housing choice vouchers; or 

16 (iv) a continuum of care or nonprofit 

17 organization designated by the continuum 

18 of care; 

19 (B) be responsible for homelessness serv20 ices; 

21 (C) provide such assurances as the Sec22 retary shall require that, in carrying out activi23 ties with amounts from the grant, the entity 

24 will ensure that services are culturally com25 petent, meet the needs of the people being 


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1 served, and follow trauma-informed best prac2 tices to address those needs using a harm re3 duction approach; and 

4 (D) demonstrate how its capacity to co5 ordinate health care and homelessness services 

6 to better serve people experiencing homelessness 

7 and significant behavioral health issues, includ8 ing substance use disorders, can be increased 

9 through— 

10 (i) the designation of a governmental 

11 official as a coordinator for making con12 nections between health and homelessness 

13 services and developing a strategy for 

14 using those services in a holistic way to 

15 help people experiencing homelessness and 

16 behavioral health conditions such as sub17 stance use disorders, including those with 

18 co-occurring conditions; 

19 (ii) improvements in infrastructure at 

20 the systems level; 

21 (iii) improvements in technology for 

22 voluntary remote monitoring capabilities, 

23 including internet and video, which can 

24 allow for more home- and community25 based behavioral health care services and 


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1 ensure such improvements maintain effec2 tive communication requirements for per3 sons with disabilities and program access 

4 for persons with limited English pro5 ficiency; 

6 (iv) improvements in connections to 

7 health care services delivered by providers 

8 experienced in behavioral health care and 

9 people experiencing homelessness; 

10 (v) efforts to increase the availability 

11 of Naloxone and provide training for its 

12 administration; and 

13 (vi) any additional activities identified 

14 by the Secretary that will advance the co15 ordination of homelessness assistance, 

16 housing, and behavioral health care serv17 ices and other health care services. 

18 (5) ELIGIBLE ACTIVITIES.—An eligible grantee 

19 receiving a grant under this subsection may use the 

20 grant to cover costs related to— 

21 (A) hiring system coordinators; and 

22 (B) administrative costs, including staffing 

23 costs, technology costs, and other such costs 

24 identified by the Secretary. 


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1 (6) DISTRIBUTION OF FUNDS.—An eligible 

2 grantee receiving a grant under this subsection may 

3 distribute all or a portion of the grant amounts to 

4 private nonprofit organizations, other government 

5 entities, public housing agencies, tribally designated 

6 housing entities, or other entities as determined by 

7 the Secretary to carry out programs and activities in 

8 accordance with this section. 

9 (7) OVERSIGHT REQUIREMENTS.— 

10 (A) ANNUAL REPORTS.—Not later than 6 

11 years after the date on which grant amounts 

12 are first received by an eligible entity, such en13 tity shall submit to the Secretary a report on 

14 the activities carried out under the grant. Such 

15 report shall include, with respect to activities 

16 carried out with grant amounts in the commu17 nity served— 

18 (i) measures of outcomes relating to 

19 whether people experiencing homelessness 

20 and significant behavioral health issues, in21 cluding substance use disorders, who 

22 sought help from an entity that received a 

23 grant— 


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1 (I) were housed and did not ex2 perience intermittent periods of home3 lessness; 

4 (II) were voluntarily enrolled in 

5 treatment and recovery programs; 

6 (III) experienced improvements 

7 in their health; 

8 (IV) obtained access to specific 

9 primary care providers; and 

10 (V) have health care plans that 

11 meet their individual needs, including 

12 access to mental health and substance 

13 use disorder treatment and recovery 

14 services; 

15 (ii) how grant funds were used; and 

16 (iii) any other matters determined ap17 propriate by the Secretary. 

18 (B) RULE OF CONSTRUCTION.—Nothing in 

19 this subsection may be construed to condition 

20 the receipt of future housing and other services 

21 by individuals assisted with activities and serv22 ices provided with grant amounts on the out23 comes detailed in the reports submitted under 

24 this subsection. 

25 (8) DEFINITIONS.—In this section: 


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1 (A) BEHAVIORAL HEALTH.—The term 

2 ‘‘behavioral health’’ includes mental health and 

3 substance use. 

4 (B) INDIAN TRIBE; TRIBAL ORGANIZA5 TION.—The terms ‘‘Indian Tribe’’ and ‘‘Tribal 

6 organization’’ have the meanings given such 

7 terms in section 4 of the Indian Self-Deter8 mination and Education Assistance Act (25 

9 U.S.C. 5304) and shall include tribally des10 ignated housing entities (as such term is de11 fined in section 4 of the Native American Hous12 ing Assistance and Self-Determination Act of 

13 1996 (25 U.S.C. 4103)) and entities that serve 

14 Native Hawaiians (as such term is defined in 

15 section 338K(c) of the Public Health Service 

16 Act (42 U.S.C. 254s(c))). 

17 (C) PERSON EXPERIENCING HOMELESS18 NESS.—The term ‘‘person experiencing home19 lessness’’ has the same meaning as the terms 

20 ‘‘homeless’’, ‘‘homeless individual’’, and ‘‘home21 less person’’ as those terms are defined in the 

22 McKinney-Vento Act (42 U.S.C. 11302). 

23 (D) SUBSTANCE USE DISORDER.—The 

24 term ‘‘substance use disorder’’ means the dis25 order that occurs when the recurrent use of alVerDate Sep 11 2014 03:43 Mar 01, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H773.IH H773

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1 cohol or drugs, or both, causes clinically signifi2 cant impairment, including health problems, 

3 disability, and failure to meet major responsibil4 ities at work, school, or home. 

5 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated to carry out this section, 

7 $20,000,000 for each of fiscal years 2023 through 2028, 

8 of which not less than 5 percent of such funds shall be 

9 awarded to Indian tribes and tribal organizations. 

Æ 


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