Enact a Statewide Housing First Policy

Opinion · By Dexter Dow

---

Introduction

Homelessness isn’t just a tragic headline—it’s a complex social, economic, and moral crisis. In the state of New Hampshire (“the Granite State”), the current system of responding to homelessness remains fractured: reactive, shelter-based, and too often subject to preconditions (sobriety, employment, documentation) that delay or deny housing. This article examines the case for codifying a statewide Housing First policy—making permanent, unconditional housing the first step out of homelessness—under the proposed Law 19: Enact a Statewide Housing First Policy.

We will review the problem as it exists in New Hampshire, examine the evidence base for Housing First, explore a proposed statutory framework, weigh the implications for citizens and public budgets, consider anticipated opposition (and rebuttals), and finally offer a detailed proposal for implementation and evaluation.

---

The Problem in New Hampshire

Rising homelessness and unsheltered crisis

New Hampshire is facing a worsening homelessness challenge. According to the annual report by the New Hampshire Coalition to End Homelessness (NHCEH), the state recorded a 52.1% increase in its Point-In-Time (PIT) count from 2022 to 2023, the highest percentage increase among all U.S. states. (Concord Coalition to End Homelessness)
Further, unsheltered homelessness—people sleeping outdoors, in encampments or on the streets—more than doubled between 2019 and 2022, a 125% increase, according to researchers cited by WMUR. (WMUR)
These data underscore the urgency: more people — including children and families — are without stable housing, and the existing shelter-dominant system is being overwhelmed.

Fragmented system and pre-condition barriers

The current approach in New Hampshire (and in many jurisdictions) tends to follow a “treatment first” or “housing readiness” model: individuals must demonstrate sobriety, employment, or fulfill certain documentation/training requirements before housing is provided. The problem: these preconditions erect access barriers, lengthen time homeless, and increase risk of poor outcomes (ER visits, jail, death).
In Concord, NHPR reported in December 2022 that city and state officials cleared three encampments at once, including one of about 15 people on state-owned land near Everett Arena and two on city land with about 15 to 20 people each. People monitoring the clearances told NHPR it was unclear where most residents went or whether they had new housing options. (NHPR) Clearing camps without a housing pathway is what happens when shelter or street responses dominate and stable housing is absent.

The vicious cycle and public cost

Chronically homeless individuals cycle through jails, emergency rooms (ERs), shelters and the streets—often at far greater public cost than if housing-based interventions had been provided earlier. One key premise: it’s very difficult to treat addiction, manage mental health, or secure employment when you don’t know where you’ll sleep tonight. Housing is the foundation. Without it, other interventions are much more costly and less effective.

---

The Evidence: Why Housing First Works

(Yes, data nerds: I’ve pulled the receipts.)

What is Housing First?

The “Housing First” model flips the traditional approach. Rather than requiring treatment or sobriety first, it offers immediate access to permanent housing, without preconditions, and pairs that housing with voluntary, wrap-around supportive services (mental health, substance use, employment, case-management). (United Neighborhood Centers)
The principle: stable housing + optional services = improved outcomes. The logic: remove the barrier of homelessness itself as step one.

Strong outcomes in housing stability

According to a summary published by the U.S. Department of Housing and Urban Development (HUD): compared with “treatment first” (rigid requirements, transitional housing) models, Housing First resulted in significantly better long-term housing retention and stability. HUD’s review reported that “Housing First participants experienced significantly faster decreases in homeless status and increases in stably housed status than the TAU group did,” where TAU means treatment as usual. (HUD User)
In plain language: people housed under Housing First stay housed longer, exit homelessness faster, and are less likely to cycle back into homelessness.

Cost-effectiveness and service-utilization reduction

The literature also documents savings. By keeping people housed rather than cycling through shelters, jails, hospitals and emergency services, jurisdictions save money. For example, a National Alliance to End Homelessness fact sheet states that Housing First “drives significant reductions in the use of costly crisis services and institutions.” (National Alliance to End Homelessness fact sheet)
In certain HUD-supported jurisdictions, reductions of high-cost service use (ER, hospitalization, incarceration) have been documented. While the exact savings vary by context, one key takeaway: housing first often costs less over time than continuing a shelter/ER cycle.

Supportive housing matters for “highest-need” populations

For individuals experiencing chronic homelessness with co-occurring mental health/substance use disorders, the pairing of housing plus supportive services (“permanent supportive housing,” PSH) yields better outcomes than housing alone or transitional models. For veterans, the National Low Income Housing Coalition reports that the Housing First approach “has been instrumental in reducing veteran homelessness by 11% since early 2020 and by more than 55% since 2010.” (National Low Income Housing Coalition)
The logic: offering housing alone helps, but combining it with services maximizes stability and quality of life.

Case-studies from other jurisdictions

• The “100,000 Homes Campaign” (U.S.) housed 105,580 chronically homeless people by July 2014, adopting a Housing First philosophy. (Wikipedia)
• In Utah, the “Housing First” approach (via the Utah Department of Workforce Services, etc.) reportedly reduced chronic homelessness by ~91% by focusing on rapid housing placement combined with services (though methodological caveats apply). See also summary in Wikipedia: (Wikipedia)
  These successes show that, with political will and resources, the model scales.

What the evidence does not show

Important nerd caveat: Housing First is not a magic wand. Some criticisms:

• It may require significant upfront investment (housing units, subsidies, services).
• Context matters: affordable housing supply, landlord participation, local housing markets influence outcomes.
• If supportive services are weak or optional, some households may struggle.
• The “chronic homeless only” framing limits broader application (families, youth, veterans require tailored design).
  Still: among the strongest evidence-based innovations in homelessness policy.

---

Why New Hampshire Should Adopt a Statewide Housing First Law

Putting together the problem + evidence yields a compelling argument for moving to a statutory, statewide Housing First policy. Here are key rationales:

1. Provides a clear foundational policy shift

Currently, New Hampshire’s homelessness policy is piecemeal and localised (continuum of care regions, shelters, service agencies). A statewide law enshrining Housing First shifts the paradigm: housing become the right first step, not last.
This creates policy clarity for state agencies, local governments, service providers, and funders.

2. Better outcomes and improved human dignity

By prioritizing housing first, you give people a stable base from which recovery, employment, education and health become feasible. This aligns with a human-rights approach (“no one should sleep under a bridge when housing is possible”).
Moreover, better housing stability leads to better quality of life and reduces harmful outcomes (ER stays, incarceration, despair).

3. Reduced public cost and system burden

By locking into a model that reduces crisis service usage, shelters, jails etc., the state stands to save public dollars. Those savings can be redirected into housing subsidies, service expansion, and prevention.
For example: HUD’s “Housing First Works” summary reports that Housing First “improve(s) some health outcomes and reduce(s) the use of high-cost services.” (HUD User)

4. Addresses fragmentation and builds coordination

The proposed law’s creation of a “State Office of Supportive Housing” (see draft legislation) would provide coordination across behavioral health, substance use, housing, and local units. This breaks down silos and aligns statewide goals.

5. Aligns with national best practices

Adopting Housing First aligns New Hampshire with national best practices identified by HUD, the VA, the National Alliance to End Homelessness, and others. It demonstrates commitment to evidence-based policy.

6. Responds to local urgency

Given the dramatic growth in homelessness in New Hampshire (52% increase in PIT count in 2023) and double-digit rises in unsheltered populations, the case for a transformative policy is strong. (Concord Coalition to End Homelessness)

---

Proposed Draft Legislation

New RSA Chapter [number to be assigned] (Housing First Framework for Homelessness Response)

Section 1. The State of New Hampshire adopts a Housing First framework as the foundation of its homelessness response.

Section 2. A “State Office of Supportive Housing” (SOSH) is created within the Department of Health and Human Services (DHHS) to:
(a) Oversee funding, compliance, and evaluation of Housing First-oriented programs;
(b) Award grants for the construction or adaptation of permanent supportive housing;
(c) Coordinate service delivery across behavioral health, substance use, housing, and community development agencies.

Section 3. No state-funded homelessness-response program shall deny access to permanent housing because of sobriety status, employment status, criminal history, or documentation status alone.

Section 4. Capital grant programs are established to expand permanent supportive housing supply. Annual targets: increase rental assistance and case-management slots by 50% over five years.

Section 5. Annual reporting requirements: SOSH must publish metrics on number housed, retention rates, service use, cost savings, and system outcomes.

---

Implementation: Operationalizing the Law

For the law to succeed—not just on paper—it must be supported by practical steps, data infrastructure, vendor/landlord relations, funding, coordination and accountability.

a) Funding mechanism and subsidies

• Increase rental assistance vouchers dedicated to Housing First placements.
• Expand capital grants for construction/adaptation of permanent supportive housing units.
• Secure state budget line and leverage federal funds (HUD, HUD-VASH, HOPWA, etc.).
• Consider matching incentives for municipalities.

b) Supportive services integration

• Housing must be paired with case management, mental health/substance use services, vocational support.
• Services should be voluntary—not forced—but readily available.
• SOSH should track service‐uptake and outcomes, disaggregated by demographic groups and vulnerability profiles.

c) Data, metrics and evaluation

• Establish a unified data system (linked HMIS + state behavioral health/criminal justice) to track individuals across systems.
• Key metrics: time to housing after referral; housing retention at 6/12/24 months; reduction in ER/hospital/correctional service use; cost savings per person.
• Publish an annual “State of Housing First” report to the legislature and public.

d) Supply side (housing units)

• Build or convert units for permanent supportive housing.
• Encourage scattered-site housing (integrated into community), not only congregate shelters.
• Partner with developers, affordable housing nonprofits, landlord networks. Offer incentives (tax credits, subsidy guarantees).
• Address local zoning/land use barriers (accessory dwelling units, mixed‐income developments, fast-track approval).

e) Landlord engagement and tenant supports

• Create landlord incentives (damage mitigation pools, guaranteed rent subsidy, streamlined leasing) to encourage participation.
• Onboard tenants with orientation, peer-support, neighbour relations programming.
• Ensure eviction prevention supports: mediation, rapid rehousing backstop, legal aid.

f) Local/regional infrastructure and coordination

• Local Continuums of Care (CoCs) or regional agencies should align with Housing First principles: minimize barriers to entry, prioritize highest‐need individuals, coordinate intake.
• SOSH should provide technical assistance/training in Housing First fidelity.
• Create local stakeholder tables: housing developers, social services, landlords, local governments, formerly homeless peers.

---

Expected Impacts on Citizens and Public Systems

Positive outcomes

• For individuals: stable housing provides the platform to pursue employment, education, recovery, community integration. It reduces trauma, isolation and health risks.
• For families and children: avoiding repeated shelter moves, instability, or street homelessness leads to better school attendance, psychosocial outcomes, and long-term life chances.
• For taxpayers and public systems: fewer emergency hospital stays, fewer jail/ER/shelter costs, fewer repeat episodes of homelessness. Over time, cost savings may offset or exceed initial investment.
• For communities: fewer tent encampments, improved public safety perceptions, more efficient service delivery, improved neighbourhood stability.

Potential challenges and cost considerations

• Up-front investment in housing, subsidies, services can be substantial.
• Housing market constraints (low vacancy, high rents) may limit ability to rapidly scale.
• Success depends on coordination—services that are underfunded or poorly implemented may weaken outcomes.
• Landlord resistance or zoning restrictions may slow unit creation.
• Performance measurement must be credible; without accountability, outcomes may languish.

Fiscal modelling (rough sketch)

Suppose the state invests X dollars for every person housed via Housing First. If the alternative cost (ER, jail, shelters) is Y dollars (with Y > X) then net savings = Y – X per person per year. Savings vary by program and place. A Seattle study reviewed by HUD found that a Housing First program “was associated with a relative decrease in costs after 6 months.” (HUD User) A New Hampshire estimate requires state data.

---

Anticipated Opposition & Rebuttals

Objection: “You’re giving housing to people who haven’t earned it.”

Rebuttal: Housing is not a reward but a precondition for recovery, stability, employment and dignity. Numerous studies show that requiring sobriety or employment before housing delays or denies access, which in turn increases cost and trauma. Housing First removes a major barrier.

Objection: “It encourages dependency or enables drug/alcohol use.”

Rebuttal: The model does not require sobriety as a precondition, but services are available and optional. Evidence shows that clients placed without preconditions remain housed at equal or higher rates than those in “housing readiness” programs. (HUD User)
Also, many people already using substances or facing mental health challenges are homeless; the barrier is being without housing—not the housing.

Objection: “The cost is too high for the state budget.”

Rebuttal: Up-front investment is valid, but longer-term cost savings from avoided crisis services and improved outcomes often deliver net savings. A strong fiscal argument can be made—and ultimately, the status quo (reactive, episodic services) is itself costly and unsustainable.

Objection: “It will lead to neighborhoods declining / property values falling.”

Rebuttal: Properly managed housing (scattered-site, integrated, supportive services, landlord screening) does not lead to neighborhood deterioration. In fact, housing stability contributes to community wellbeing. Outreach, training and partnership with local municipalities ensure proper management.

---

Scale & Scope: Why This Should Be Statewide

While local programs might already use Housing First elements, a statewide law ensures consistency, scale and equitable coverage across rural and urban New Hampshire. The law ensures:

• Uniform eligibility standards (no precondition barriers).
• Central oversight (SOSH) for funding, data, evaluation.
• A strategic pipeline of new housing units and rental subsidies.
• Statewide data and accountability to drive performance.
• Rural communities (which often have fewer resources) can access state support.

A statewide approach also avoids “postcode lotteries” (where some regions adopt Housing First, others stay reactive) and ensures alignment with state budget and federal funding priorities.

---

The Granite State Landscape: Specific Considerations

Housing market constraints

New Hampshire’s housing market presents both challenges and opportunities. The state has struggled with affordable housing supply, rising rents, and limited vacancies. Any Housing First rollout must account for these constraints: perhaps by incentivizing the creation of new units, using adaptive reuse, and partnering with community development authorities.

Shelter infrastructure vs. permanent housing

The current system emphasizes shelters and transitional housing. The new law aims to shift focus from what to do when someone is homeless (shelter) to how to prevent/dissolve homelessness (permanent housing). That paradigm shift must also entail stakeholder training, redirecting funds, and phasing out models that impose heavy barriers.

Rural & urban differences

New Hampshire is diverse: rural towns, small cities, and larger regions such as Manchester and Nashua. Implementation must tailor for these differences. In rural areas, landlords may be fewer, distances greater, services less accessible. The law must allow for flexibility within the Housing First framework (e.g., mobile services, remote case-management, regional hubs).

Coordination with behavioral health and substance use systems

Given many experiencing homelessness have mental health/substance use disorders, Housing First programs must coordinate closely with the state’s behavioral health system (via DHHS) and local providers. The proposed SOSH office must act as effective convener.

Workforce and service capacity

Supportive services require skilled case managers, mental health professionals, peer specialists, and maintenance of housing stock. The state should anticipate workforce development needs (training programs, certification incentives, peer-worker hiring) tied to Housing First implementation.

---

Monitoring, Evaluation & Continuous Improvement

To avoid policy drift, the law must include rigorous monitoring, transparent reporting and continuous improvement mechanisms.

Key Performance Indicators (KPIs)

• Number of individuals placed in permanent supportive housing per year.
• Average time from referral to housing placement.
• Housing retention rates at 6, 12, 24 months.
• Changes in ER/hospital/jail/shelter usage for the housed cohort.
• Cost savings per person relative to baseline crisis-service usage.
• Demographic breakdowns: veterans, families, youth, unsheltered, rural.
• Number of new units (capital grants) created per year.
• Landlord participation rates, vacancy rates of supported units, lease turnovers.

Reporting and transparency

SOSH should publish an annual “Housing First Report” to the Governor and Legislature and make it publicly accessible online. The report should include narrative analysis, data tables, funding flows, successes, challenges and next-year targets.

Fidelity to Housing First model

Ensure that funded housing retains core elements of the Housing First philosophy: low-barrier housing, voluntary services, choice of housing, separation of housing and services (i.e., tenancy is not contingent on service compliance). SOSH should develop a “Housing First fidelity checklist” and conduct periodic audits.

Feedback loops and policy adjustment

The law must allow for mid-course corrections: learning from data, adjusting eligible populations, modifying subsidy levels, adapting service models. For example: if rural retention rates lag urban ones, create specialized rural models.

---

Case Study: Concord’s Encampment Clearances – What Went Wrong, What Could Be

In December 2022, city and state officials cleared three Concord encampments. About 15 people lived on state-owned property near Everett Arena, and about 15 to 20 people each lived at two city-owned sites off Route 106 and Locke Road. The state gave notice on Dec. 5 to leave by Dec. 15, as snow fell. People monitoring the clearances told NHPR it was unclear where most people went or whether they had new housing options. (NHPR) The episode shows the gaps this law targets: no housing pathway, reliance on removal rather than placement, and weak coordination between services and housing.
Under a Housing First law, the framework would have been different:

• Referral pathway from the encampment into permanent housing (not just evacuation).
• No preconditions delaying housing.
• Wrap-around services engaged from day one.
• Data tracking and metrics to monitor outcomes (retention, service usage).
• A local bed (rental subsidy) + unit availability for rapid placement.

The Concord case shows that doing nothing new simply repeats the cycle: homelessness → shelter/encampment → clearance → homelessness again. Housing First interrupts that cycle.

---

Financial Implications & Budgetary Outlook

Let’s step into fiscal-nerd mode for a minute.

Up-front costs

• Capital grants for new permanent supportive housing units (buy/convert).
• Rental subsidies/vouchers to ensure affordability for households in need.
• Funding for supportive service workforce expansion.
• Administrative costs for SOSH and data infrastructure.

Offsetting savings

• Reduced shelter usage (fewer overnight stays, staffing costs).
• Fewer emergency room visits and hospitalizations.
• Fewer jail/incarceration episodes and lower correctional costs.
• Reduced crisis-response spending by municipalities (police, EMS).
• Potential increased tax base through stable housing → employment → consumption.

ROI and timeframe

HUD’s evidence summary reports that in Charlotte-Mecklenburg, “Housing First reduced high-cost service uses, including fewer nights spent in shelter, fewer arrests and incarceration events, and fewer health and emergency department visits,” and that in a Seattle study “more cost savings were achieved the longer individuals stayed in housing.” (HUD User)
In New Hampshire’s context, given the steep increase in homelessness, the cost of not acting is also rising (more unsheltered, more hospitalizations, more deaths). Thus, sooner deployment likely improves ROI.

Budget recommendation

• A five-year ramp-up:
  • Year 1: baseline expansion of subsidies + pilot units.
  • Years 2-3: major capital investment + service expansion + statewide rollout.
  • Years 4-5: full scale stateside, evaluation and refinement.
• State funds leveraged with federal dollars (HUD CoC, HUD-VASH, HOPWA, SAMHSA grants) and private partnerships (foundations, community development finance).
• Transparent tracking of “cost-avoidance” savings to justify continuation and expansion.

---

Political and Ethical Framing

Ethical imperative

Housing should be viewed as a human right, or at least a foundational need. As the Homeless Hub describes the model, Housing First is “a rights-based intervention rooted in the philosophy that all people deserve housing, and that adequate housing is a precondition for recovery.” (Homeless Hub)
From an ethical standpoint, offering stable housing before imposing conditionality is the humane path.

Political pragmatism

Housing First appeals across ideological lines:

• Conservatives can appreciate cost-avoidance, reduction in jail/ER costs, and fewer taxpayer-burdened cycles.
• Progressives can highlight human dignity, social justice, equity, and service access.
  Framing the policy as smart spending + human dignity helps build a broad coalition.

Local control with state coordination

While the law sets the statewide structure, the implementation allows for regional/local flexibility. This respects New Hampshire’s tradition of town/county level control while offering state coordination, funding, oversight.

Messaging and public perception

• Emphasize: “Stable housing first, services as needed later → better outcomes for everyone.”
• Counter the “unearned” stigma by showing data: Housing First improves employment, reduces crisis costs, and is supported by evidence.
• Use testimonials: former homeless persons who succeeded because they got housing first.
• Highlight savings: shelter, hospital, jail costs go down.

---

Implementation Risks & Mitigation

Risk: Insufficient housing supply

Mitigation: Include incentives for developers/nonprofits, streamline zoning, use adaptive reuse, partner with municipalities. Early years should focus capital grants aggressively.

Risk: Service capacity gap

Mitigation: Invest in workforce training (case managers, peer specialists), partner with existing service providers, leverage tele‐health in rural areas.

Risk: Lack of landlord participation

Mitigation: Create landlord guarantees (damage mitigation funds, subsidy “backstop”), landlord outreach programs, tax credit incentives for landlords.

Risk: Weak fidelity to Housing First model

Mitigation: Develop fidelity checklist, require funded programs to comply, conduct audits, tie future funding to performance.

Risk: Political or budgetary back-lash

Mitigation: Build bipartisan oversight committee, link funding to measurable savings, publish periodic successes publicly, show early wins.

---

Real‐World Impacts: What Citizens Will See

In practical terms, enacted and implemented well, here’s what citizens (especially vulnerable populations) will experience:

• A formerly homeless individual will be referred and housed quickly, not after months of treatment or “readiness” hurdles.
• Families who otherwise cycle through shelters will receive rental assistance and be placed into permanent housing with support.
• Communities will see fewer people living unsheltered in tent‐encampments or on sidewalks.
• Emergency services (ER visits, hospitalizations, jail bookings) tied to homelessness decline.
• Taxpayer money spent on shelters, crisis services, and incarceration is partially shifted to more effective upstream housing interventions.
• Service providers operate on a more predictable, coordinated state-funded program rather than ad-hoc emergency responses.

---

Timing and Opportunity

• New Hampshire’s 2023 count rose 52.1%, the largest percentage increase of any state. (Concord Coalition to End Homelessness) The 2024 count fell 8%, to 2,245 people, but unsheltered homelessness rose 71.3% and chronic homelessness rose 16.5%, according to the New Hampshire Coalition to End Homelessness 2025 report. (Union Leader)
• Federal policy turned against the model. Section 5(a) of Executive Order 14321, signed July 24, 2025, calls for “ending support for ‘housing first’ policies that deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency.” (White House) A state law would set New Hampshire’s own standard for state-funded programs. HUD’s 2023 Evidence Matters issue remains the federal research review of the model. (HUD User)
• State momentum: with public concern growing and service providers sounding alarms, a bold legislative step has political salience.
• From a cost perspective: delaying only increases expense and human suffering. Early action maximizes savings and lives saved.

---

Summary & Conclusion

Enacting a statewide Housing First policy via this law is not just morally compelling—it is grounded in strong empirical evidence, offers cost-effective solutions, and aligns with what we know works for ending homelessness. In New Hampshire, where homelessness is rising dramatically, relying on shelters, encampments, or precondition-based programs is no longer sufficient.

The proposed framework—creating a State Office of Supportive Housing, expanding permanent supportive housing, removing barriers to access (sobriety, employment, documentation), increasing rental assistance and services—is the backbone of a transformative policy shift. Success will require commitment: funding, coordination, housing supply, services, landlord partnerships, rigorous data and accountability.

For the people of New Hampshire—individuals, families, communities and taxpayers—this approach promises better outcomes: fewer lives in crisis, fewer cycles of shelter-jail-ER, more stability, more dignity. For the state, it promises smarter spending and a system built on evidence, not inertia.

The first step out of crisis is a place to live. Housing First offers that step. Let the Granite State lead.

---

References

• U.S. Department of Housing and Urban Development. Housing First: A Review of the Evidence. Spring/Summer 2023. (HUD User)
• National Alliance to End Homelessness. Housing First Fact Sheet (PDF). (National Alliance to End Homelessness)
• National Low Income Housing Coalition. The Evidence Is Clear: Housing First Works. 2022 (PDF). (National Low Income Housing Coalition)
• New Hampshire Coalition to End Homelessness. The State of Homelessness in New Hampshire Annual Report – 2024 Edition. December 16, 2024. (NH Coalition to End Homelessness)
• MyKeeneNow. “New Hampshire faces alarming surge in homelessness, report reveals.” Dec 2024. (My Keene Now)
• NHPR. “2021 annual homelessness report: N.H.’s unsheltered population has doubled since 2020.” May 2022. (New Hampshire Public Radio)

---

Related from Granite State Report: Addressing New Hampshire’s Mental Health and Homelessness Crisis · If I Were Governor of New Hampshire: Priority #1 — Fix the Housing Crisis · The 60,000-Home Question · New Hampshire’s Housing Crisis and the Political Fight at the State House in 2026

Corrections: Granite State Report corrects verified errors promptly and appends a dated note identifying what changed and when. The corrections policy and the corrections register are public, and correction notes are never removed.