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Disability-Forward Policy Recommendations To Advance Accessible and Affordable Housing for All

Washington, D.C., was sued by AARP and other advocacy groups for failing to help eligible Medicaid recipients move out of nursing homes and receive care in their homes, August 2016.

Authors’ note: The disability community is rapidly evolving to using identity-first language in place of person-first language. This is because it views disability as being a core component of identity, much like race and gender. Some members of the community, such as people with intellectual and developmental disabilities, prefer person-first language. In this column, the terms are used interchangeably.

More than a year into the COVID-19 pandemic, the U.S. housing crisis has emerged as a critical public health concern. An estimated 30 million to 40 million people have been at risk for eviction since the start of the pandemic, and more than a third of the approximately 550,000 people who have died of COVID-19 in the United States lived in long-term care facilities such as nursing homes. As the country begins to recover from the pandemic, the federal government must commit to solving the shortage of accessible, affordable, and inclusive housing for all.

The country’s resilience through and recovery from the pandemic are inextricably linked to the government’s collective responsibility to ensure that every person has a place that they can call home. Homes must be affordable, accessible, and close to community supports and services. They must also be inclusive to ensure that people can live in housing that fits their needs without being segregated or isolated from society. The federal government must take bold action to create more equitable, accessible, inclusive, and affordable housing for marginalized populations, communities that have historically been excluded from quality housing, and individuals experiencing homelessness.

The following recommendations include a range of solutions to affirm housing rights and access, increase access to home and community-based services, and improve accessibility standards across new and existing housing. Importantly, these solutions center the needs of disabled people, especially disabled people of color, as well as Black, Latinx, Indigenous, and Asian American and Pacific Islander communities in U.S. housing policy reform.

Affirm housing rights and access to housing

The federal government should take the following steps to solve the U.S. housing shortage and ensure that every person has access to an affordable home that fits their needs.

  • Increase access to current housing stock. This should include housing choice vouchers, mainstream vouchers, and public housing—all of which are needed to adequately support current housing needs. Prioritizing resources to maintain existing public housing—for example, by fixing maintenance backlogs—and their neighborhoods is necessary, as all tenants deserve safe, desirable living conditions. Overall, at least 4 million people use some form of federal rental assistance. Among this population are 2.4 million people with disabilities and 1.9 million older adults, most of whom also live with a disability. Increasing access to federal housing assistance would substantially improve disabled peoples’ ability to find safe, affordable homes.
  • Increase investment in affordable housing funding streams. These investments must include capital advances and project rental assistance through the U.S Department of Housing and Urban Development (HUD) Section 811 program; increased funding to the federal Low-Income Housing Tax Credit program in Section 202; and federal HOME funds and new housing subsidies, especially for people with disabilities who use supportive services. Increased investment must prioritize affordable housing due to the disproportionate rate of people with disabilities, particularly disabled people of color, who live on fixed incomes and experience deep poverty, defined as less than 50 percent of the federal poverty line. This funding should be flexible and quickly deployed, leveraged with local and state funding sources, and used for developments that are either shovel ready or close to shovel ready. In the longer term, HUD should evaluate programs to determine which provide the most units reserved for people with disabilities on fixed incomes and which programs have been effective at keeping people with disabilities in those reserved units; this evaluation can help determine which programs should be expanded or amended.
  • Incentivize states, regions, and municipalities through federal funding and policies that allocate funding for accessible, affordable, and integrated housing development. These sources should be coordinated with existing investment vehicles for affordable housing such as tax credits, Community Reinvestment Act investments, and the Community Development Financial Institutions Fund. Investing in metropolitan land trusts and in partnership with transit-oriented development can also ensure that housing is situated close to resources such as grocery stores, hospitals, and employment. These funds can be used to fund existing, locally run programs that target affordable housing creation and preservation.
  • Create a pilot mechanism for housing costs that can follow a person from an institutional setting into a community-based integrated setting. The 1999 Supreme Court decision Olmstead v. L.C. established disabled peoples’ protected civil right to live in the most integrated housing with their services. However, the ruling did not come with solutions to guarantee community-based, accessible, and affordable housing. As advocacy to close congregate settings and institutions continues and more people transition into community-based settings, commensurate housing investments at the local, state, and federal level in affordable, accessible, and inclusive housing are paramount. Medicaid funds support individual services—including those related to housing—but corresponding housing infrastructure is also essential in the form of HUD housing development subsidies and other federal housing incentives that support more noninstitutional, affordable, and accessible housing stock. In the long term, this federal investment would both be cost-effective and ensure that the right to community living for people with disabilities can be fully realized.
  • Advance the Obama-era Affirmatively Furthering Fair Housing (AFFH) Act and disparate impact rule. HUD established these rules in order to hold communities that receive federal funding accountable for taking steps to actively end housing Although they were suspended under the Trump administration, the Biden administration announced that it would reinstate these fair housing regulations. As of April 2021, the rules are in an internal review process with the Office of Management and Budget. In alignment with AFFH, the agency can increase funding for initiatives that explicitly prioritize the needs of the most undeserved and at-risk communities, aiming to end housing discrimination and segregation for marginalized populations. Any incentives to house people with disabilities, including people who use home and community-based services, should be prioritized alongside the needs of other marginalized and housing-insecure communities such as Black and Indigenous communities. Underserved communities should not be pitted against each other for resources but rather prioritized simultaneously.
  • Guarantee tenants’ rights to counsel. Currently, the publicly funded nonprofit Legal Services Corporation can assist renters at or below 125 percent of the poverty level with legal aid services, including counsel for tenants. However, the corporation’s breadth of responsibility, lack of funding, and eligibility requirements mean that individuals who need counsel are not always represented. Congress can begin to solve this by simply increasing funding to the Legal Services Corporation. Pilot programs, research studies, and existing policy across the country, including in Boston and New York, have found that access to legal representation decreases the rate of evictions. In one Minnesota study, 52 percent of tenants with full representation remained in their homes, while 78 percent left with a clear record. Counsel and mediation efforts can benefit individuals’ long-term housing prospects, even for those who are unable to keep their homes. Expanding the right to counsel and access to mediation in housing cases will help people stay sheltered.

Increase access to home and community-based services

The federal government should take the following steps to ensure that people with disabilities have full access to home and community-based services, which can be necessary to both live in and stay in one’s community.

  • Eliminate Medicaid’s institutional bias. Federal Medicaid law requires funding of institutional services, but funding for home and community-based services is still enshrined as optional. This federal bias toward institutions does not align with disabled peoples’ civil right to live in the most integrated setting and perpetuates the ableist notion that disabled people and older adults can only reside in segregated, congregate settings where their housing and services are controlled by the same entity. Eliminating Medicaid’s institutional bias would direct more funding toward services that support a person’s ability to live in their community of choice and age in place.
  • Complete implementation of the Home and Community-Based Services (HCBS) Settings Rule. Established in 2014 by the Centers for Medicare and Medicaid Services, this rule standardizes community-based settings and living arrangements for people receiving HCBS. It requires giving people the option to live in a nondisability-specific setting—such as integrated housing where people with and without disabilities live—and allows them to choose and control their services and providers. COVID-19 has revealed the acute dangers of congregate settings, with more than 180,000 people in long-term care facilities having died from the virus to date. It is critical that the Centers for Medicare and Medicaid Services eliminate this implementation delay and require states to move forward with their transition plan, rather than continuing to prioritize the profit of congregate settings.
  • Invest in HCBS infrastructure so that people with disabilities and older adults have the support they need. Specifically, these investments will ensure that people are able to access and remain in housing in their communities of choice and age in place without losing access to services they need. Programs in need of greater investment include Money Follows the Person and HCBS Medicaid waivers. In both programs, any funding related to an individual’s support services follows them as they transition to community-based, integrated housing.

Improve accessibility standards in existing and new housing

The federal government should take the following steps to increase new and existing accessible housing stock.

  • Increase the accessibility requirements for new housing under Section 504 regulations for required mobility units and sensory units. Section 504 of the Rehabilitation Act of 1973 prevented discrimination against people with disabilities by entities receiving federal funds. It also required that 5 percent of new federally funded housing be made accessible for people with mobility disability and 2 percent for those with sight and vision disabilities. These current thresholds are far too low for the growing demand for accessible housing, and requirements should be changed to match, at minimum, American Community Survey data on the disability needs of specific metropolitan areas.

    Additionally, the federal government should increase physical accessibility requirements by broadening the funding streams that are required to follow HUD Section 504 requirements, including the Low-Income Housing Tax Credit program and any other programs that are currently exempt. In addition, Congress can pass new legislation such as the Inclusive Home Design Act of 2019, which would require all new federally assisted single-family homes and townhouses to meet minimum standards of visitability, such as barrier-free access to the first or main floor of a home.

  • Create a national home modification program through the National Housing Trust Fund. In many cases, older housing stock can be made accessible or at least usable for people with mobility impairment through physical modifications such as widened doors, bathroom grab bars, or lowered counters. Because a disproportionate share of disabled people live in poverty, these investments and improvements are often out of reach for the people who need them most. Making funds such as microgrants or forgivable loans available to tenants and property owners to make these modifications would go a long way toward increasing the stock of accessible housing and would allow older adults to more easily age in place as they acquire new disabilities.

Conclusion

From improving housing access and protection to supporting the services that millions of Americans need to stay or become housed, these policy recommendations, though not exhaustive, are a roadmap for providing stability, health, and well-being to millions of people with disabilities, their families, and communities across the country. Systemic and cultural barriers have stood in the way of accessible, affordable, and inclusive housing for disability communities and communities of color for far too long. All housing-related policy advancements must be built on the framework of disability justice, racial justice, and intersectionality. Regardless of a person’s disability, it is difficult to acquire and keep housing. Disabled leaders—particularly disabled leaders of color—across disability type must be key decision-makers in how, where, and for whom housing gets built.

Housing should not be a privilege but rather a universal right. As the federal government crafts solutions to heal from the pandemic, it must prioritize long-term housing reforms in order to build a more equitable and just country that meets the needs of its most vulnerable communities.

Valerie Novack is a fellow with the Disability Justice Initiative at Center for American Progress. Allie Cannington is the manager of advocacy and organizing at The Kelsey. Cathleen O’Brien is a housing community development organizer at Access Living of Metropolitan Chicago. Adam Ballard was the housing and transportation policy analyst at Access Living of Metropolitan Chicago when he contributed to this piece and now works at AARP Illinois.

The authors would like to thank the following for their input: The National Alliance to End Homelessness, Consortium for Citizens with Disabilities Housing Task Force, National Council on Independent Living Housing Committee, Jennifer Molinsky, Michael Zonta, Jaboa Lake, and editors.