II 

118TH CONGRESS 

1ST SESSION S. 3165 

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

Services 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 SENATE OF THE UNITED STATES 

OCTOBER 30, 2023 

Mr. PADILLA (for himself and Mr. MARKEY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

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

substance use disorder, by authorizing a grant program 

within the Department of Health and Human Services 

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 disorder, can ex17 acerbate 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 disorder frequently 


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1 makes it more difficult for people experiencing 

2 homelessness 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 disorder, often 

12 requires supportive services and close coordination 

13 between housing and social service providers, in ad14 dition to low-barrier, affordable housing. Subsidized 

15 housing is critical, but not enough—access to addi16 tional voluntary person-centered supportive services 

17 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 2 sets of services to 

18 allow for smoother pathways and simpler navigation. 

19 (10) Black, Hispanic, and Indigenous people 

20 are disproportionately underserved by person-cen21 tered supportive services. In order to address critical 

22 services deficits and affirmatively serve protected 

23 classes of people with significant behavioral health 

24 conditions, including substance use disorder, who are 

25 experiencing homelessness, the grant program estabVerDate Sep 11 2014 02:58 Nov 02, 2023 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3165.IS S3165

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1 lished under this Act can be used to build the capac2 ities of providers of homelessness services that have 

3 demonstrated cultural competencies in service provi4 sion and a record of serving Black, Hispanic, and 

5 Indigenous people and other underserved populations 

6 experiencing homelessness that also suffer from sub7 stance use disorder. 

8 SEC. 3. DEFINITIONS. 

9 In this Act: 

10 (1) BEHAVIORAL HEALTH.—The term ‘‘behav11 ioral health’’ includes mental health and substance 

12 use. 

13 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means an entity described in section 3(c)(4) that 

15 is eligible for a competitive grant under section 4. 

16 (3) INDIAN TRIBE.—The term ‘‘Indian Tribe’’ 

17 has the meaning given the term in section 4 of the 

18 Indian Self-Determination and Education Assistance 

19 Act (25 U.S.C. 5304). 

20 (4) PERSON EXPERIENCING HOMELESSNESS.— 

21 The term ‘‘person experiencing homelessness’’ has 

22 the same meaning as the terms ‘‘homeless’’, ‘‘home23 less individual’’, and ‘‘homeless person’’, as defined 

24 in section 103 of the McKinney-Vento Homeless As25 sistance Act (42 U.S.C. 11302). 


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1 (5) PUBLIC HOUSING AGENCY.—The term 

2 ‘‘public housing agency’’ has the meaning given the 

3 term in section 3(b)(6) of the United States Hous4 ing Act of 1937 (42 U.S.C. 1437a(b)(6)). 

5 (6) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Health and Human Services. 

7 (7) SUBSTANCE USE DISORDER.—The term 

8 ‘‘substance use disorder’’ means the disorder that 

9 occurs when the recurrent use of alcohol or drugs, 

10 or both, causes clinically significant impairment, in11 cluding health problems, disability, and failure to 

12 meet major responsibilities at work, school, or home. 

13 (8) TRIBAL ORGANIZATION.—The term ‘‘Tribal 

14 organization’’— 

15 (A) has the meaning given the term in sec16 tion 4 of the Indian Self-Determination and 

17 Education Assistance Act (25 U.S.C. 3504); 

18 and 

19 (B) includes entities that serve Native Ha20 waiians, as defined in section 338K(c) of the 

21 Public Health Service Act (42 U.S.C. 254s(c)). 

22 (9) TRIBALLY DESIGNATED HOUSING ENTI23 TY.—The term ‘‘tribally designated housing entity’’ 

24 has the meaning given the term in section 4 of the 


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1 Native American Housing Assistance and Self-De2 termination Act of 1996 (25 U.S.C. 4103). 

3 SEC. 4. ESTABLISHMENT OF GRANT PROGRAM. 

4 (a) IN GENERAL.—The Secretary, in consultation 

5 with the working group established under subsection (b), 

6 shall establish a grant program to award competitive 

7 grants to eligible entities in direct coordination with a con8 tinuum of care to build or increase capacity to coordinate 

9 the delivery of health care and homelessness services with10 in the continuum of care. 

11 (b) WORKING GROUP.— 

12 (1) ESTABLISHMENT.—The Secretary shall es13 tablish an interagency working group to provide ad14 vice and coordinate along relevant existing working 

15 groups to the Secretary in carrying out the program 

16 established under subsection (a). 

17 (2) COMPOSITION.—The working group estab18 lished under paragraph (1) shall include representa19 tives from the Department of Health and Human 

20 Services, the Department of Housing and Urban De21 velopment, the United States Interagency Council on 

22 Homelessness, the Department of Agriculture, and 

23 the Bureau of Indian Affairs, to be appointed by the 

24 heads of such agencies. 


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1 (3) DEVELOPMENT OF ASSISTANCE TOOLS.— 

2 Not later than 1 year after the date of enactment 

3 of this Act, the working group established under 

4 paragraph (1) shall— 

5 (A) develop training, tools, and other tech6 nical assistance materials that simplify home7 lessness services for providers of health care 

8 and simplify health care services for providers 

9 of homelessness services by identifying the basic 

10 elements the health and homelessness sectors 

11 need to understand about the other; and 

12 (B) circulate the materials described in 

13 subparagraph (A) to interested entities, particu14 larly eligible entities that apply for grants 

15 awarded pursuant to this Act. 

16 (c) CAPACITY-BUILDING GRANTS.— 

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

18 5-year grants to eligible entities, which shall be used 

19 only to build or increase capacities to coordinate 

20 health care and homelessness services. 

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

22 the grants awarded pursuant to this Act may be 

23 used to pay for— 

24 (A) health care, with the exception of ef25 forts to increase the availability of Naloxone 


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1 and provide training for the administration of 

2 Naloxone; or 

3 (B) rent. 

4 (3) AMOUNT.—The amount awarded to an eligi5 ble entity under a grant under this subsection shall 

6 not exceed $500,000. 

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

8 grant under this subsection, an entity shall— 

9 (A) be designated by a continuum of care 

10 to ensure coordination across the continuum of 

11 care geographic regions, and which may be— 

12 (i) a governmental entity at the coun13 ty, city, regional, or locality level; 

14 (ii) an Indian Tribe, a tribally des15 ignated housing entity, a Tribal organiza16 tion, or an urban Indian organization; 

17 (iii) a public housing agency admin18 istering housing choice vouchers; or 

19 (iv) a nonprofit organization; 

20 (B) be responsible for homelessness serv21 ices; 

22 (C) provide such assurances as the Sec23 retary shall require that, in carrying out activi24 ties with amounts from the grant, the entity 

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1 petent, meet the needs of the people being 

2 served, and follow trauma-informed best prac3 tices to address those needs using a harm re4 duction approach; and 

5 (D) demonstrate how the capacity of the 

6 entity to coordinate health care and homeless7 ness services to better serve people experiencing 

8 homelessness and significant behavioral health 

9 issues, including substance use disorder, can be 

10 increased through— 

11 (i) the designation of a governmental 

12 official as a coordinator for making con13 nections between health and homelessness 

14 services and developing a strategy for 

15 using those services in a holistic way to 

16 help people experiencing homelessness and 

17 behavioral health conditions such as sub18 stance use disorder, including those with 

19 co-occurring conditions; 

20 (ii) improvements in infrastructure at 

21 the systems level; 

22 (iii) improvements in technology for 

23 voluntary remote monitoring capabilities, 

24 including internet and video, which can 

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1 based behavioral health care services and 

2 ensure such improvements maintain effec3 tive communication requirements for per4 sons with disabilities and program access 

5 for persons with limited English pro6 ficiency; 

7 (iv) improvements in connections to 

8 health care services delivered by providers 

9 experienced in behavioral health care and 

10 people experiencing homelessness; 

11 (v) efforts to increase the availability, 

12 and training for the administration, of 

13 opioid antagonists indicated for emergency 

14 treatment of opioid overdose; and 

15 (vi) any additional activities identified 

16 by the Secretary that will advance the co17 ordination of homelessness assistance, 

18 housing, and behavioral health care serv19 ices and other health care services. 

20 (5) ELIGIBLE ACTIVITIES.—An eligible entity 

21 receiving a grant under this subsection may use the 

22 grant to cover costs related to— 

23 (A) hiring system coordinators; and 


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1 (B) administrative costs, including staffing 

2 costs, technology costs, and other such costs 

3 identified by the Secretary. 

4 (6) DISTRIBUTION OF FUNDS.—An eligible enti5 ty receiving a grant under this subsection may dis6 tribute all or a portion of the grant amounts to pri7 vate nonprofit organizations, other government enti8 ties, State, local, or Tribal public health depart9 ments, community health centers or organizations, 

10 public housing agencies, tribally designated housing 

11 entities, or other entities as determined by the Sec12 retary to carry out programs and activities in ac13 cordance with this section. 

14 (7) OVERSIGHT REQUIREMENTS.— 

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

16 years after the date on which grant amounts 

17 are first received by an eligible entity, the eligi18 ble entity shall submit to the Secretary a report 

19 on the activities carried out under the grant, 

20 which shall include, with respect to activities 

21 carried out with grant amounts in the commu22 nity served— 

23 (i) measures of outcomes relating to 

24 whether people experiencing homelessness 

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1 cluding substance use disorder, who sought 

2 help from an entity that received a grant— 

3 (I) were housed and did not ex4 perience intermittent periods of home5 lessness; 

6 (II) were voluntarily enrolled in 

7 treatment and recovery programs; 

8 (III) experienced improvements 

9 in their health; 

10 (IV) obtained access to specific 

11 primary care providers; and 

12 (V) have health care plans that 

13 meet their individual needs, including 

14 access to mental health and substance 

15 use disorder treatment and recovery 

16 services; 

17 (ii) how grant funds were used; and 

18 (iii) any other matters determined ap19 propriate by the Secretary. 

20 (B) RULE OF CONSTRUCTION.—Nothing in 

21 this subsection may be construed to condition 

22 the receipt of future housing and other services 

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1 comes detailed in the reports submitted under 

2 this subsection. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $20,000,000 for each of fiscal years 2023 through 2028, 

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

7 awarded to Indian Tribes, tribally designated housing en8 tities, and Tribal organizations. 

Æ 


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