In southeast Kansas, housing is treated as health care, and people are getting off the streets

PITTSBURG — Stevie and Brandon Perez could not stay awake any longer. They found two chairs in Mercy Hospital’s intensive care unit waiting room, a place they knew would be open, and they drifted off.
Around 1 a.m., a hospital staff member shook them awake: “You guys gotta go.”
It was time to move again, but this time would be the last.
They were serious.
Stevie and Brandon mostly walked around at night. They would stay with friends, sleep in people’s yards or camp in public places, sometimes in the shelter of playground equipment.
“It was,” Stevie said, then paused. “It was. It was very degrading.”
They were sick and tired of living on the streets. Cold winters. Glares and murmurs from other residents of Pittsburg. Drug addiction. It had become unbearable. It had become life-threatening.
In southeast Kansas, which is home to the highest poverty rates in the state, collaborative solutions tailored to the needs of the community have proven successful in addressing homelessness and in shrinking uninsured rates for people like Stevie and Brandon. These programs act as safety nets for people whom traditional systems leave behind. The Community Health Center of Southeast Kansas is one of those safety nets, expanding the definition of health care to consider every aspect of a person’s life, including housing.
Stevie and Brandon, at the time they were homeless, fell into what health care advocates call the coverage gap, which includes the more than 240,000 Kansans who are uninsured because of unaffordable health insurance. The gap is especially prominent in the 10 states, including Kansas, that haven’t expanded Medicaid to include low-income adults without children or disabilities.
A parent or caretaker living in a two-person household and making more than $8,100 a year is ineligible for Medicaid in Kansas. The state spends about $10,000 on each of its roughly 427,000 Medicaid patients each year, but as congressional Republican leaders look to cut federal funding for the program, its future here is uncertain, and advocates fear more people could lose coverage.
About one-third of people in the U.S. who have experienced a bout of homelessness in their lifetime relied on Medicaid, according to a survey from research and news organization KFF.
In Kansas, relying on Medicaid is nearly impossible.
People who experience homelessness, particularly those who don’t stay in a shelter like Stevie and Brandon, often have unmet health needs and are more likely to have chronic diseases, serious mental health challenges or substance use disorders. Without housing or income, health care is often out of reach. That’s especially true when health care for those with housing and income can be unaffordable and inaccessible.
“The stability of the place came first,” Stevie said. “Then we got better physically and mentally.”
Recovering from drug addiction and a persistent pain in her side, which she suspects is from the years of drug use and living outside, only could be addressed once she had a stable place to sleep.
Then came the job, “and then it was like, sky’s the limit,” she said.
Housing as health care
Stevie, 43, was born and raised in Pittsburg, a daughter to a well-off family who took a wrong turn, as she describes it. She is a former pageant kid, which remains evident in her bouncy personality and constant smile. Optimism and gratitude are part of almost every breath, even as she confronts the side effects of homelessness, including rebuilding relationships with her three children.
The first time Becky Gray, the executive director of Building Health Inc. in Pittsburg, met Stevie was at a temporary overnight shelter.
“I was walking in and she held the door open for me,” Gray said. “I said, ‘How are you doing?’ ”
“I’m three days sober,” Stevie told her.
“And she hasn’t come back,” Gray said.
Building Health, a subsidiary of the Community Health Center of Southeast Kansas, was designed specifically with the relationship between housing and health in mind.
“Housing is health care,” Gray said, “and oftentimes homelessness is preceded by poor health.”
Sometimes it causes it.
People experiencing homelessness — particularly those living in cars, encampments or makeshift shelters — are at a higher risk of contracting infectious and noninfectious diseases, including HIV, tuberculosis and hepatitis C, according to the Centers for Disease Control and Prevention. They also often face mental illness, alcohol and substance use disorder, diabetes, and heart and lung disease. Homelessness and its side effects shorten a person’s life expectancy by more than 17 years.
Since the 2010 Affordable Care Act authorized Medicaid expansion for low-income adults, experts identified unhoused populations as a group that could benefit from expanded coverage and, in turn, improve public health outcomes. In recent years, the federal government, for the first time, allowed states to use up to 3% of their Medicaid budgets toward specific housing-related services, cementing the link between housing and health. But states have to opt to do so.
Homelessness in Kansas reached its highest number in a decade in 2024, with more than 2,500 people experiencing homelessness on any given night, according to data from the U.S. Department of Housing and Urban Development. Stagnant wages and increasing housing costs have catapulted homelessness numbers in the U.S. since the COVID-19 pandemic.

Building Health was formed in 2020 and is just beginning to get off the ground. Gray has a 15-year plan full of meaningful solutions that enable the community to track new housing units and effects on health outcomes in certain areas. With funding from the federal government and a local philanthropic foundation, the project, dubbed “The Station,” will include 10 rental units for people exiting homelessness with supportive services and an adult education center.
“Our homeless program managers are currently designing courses so that when people who are homeless come into our program, we can, in addition to their housing goals, adjust some of their education and employment goals as well,” Gray said.
That includes a model kitchen to prepare people for hospitality jobs and basic courses on how to set up an email account and create a digital calendar. The $4 million project also plans to fund street outreach and access to showers, lockers, laundry machines, telehealth visits and mental health care.
Kansas is at a point, in Gray’s mind, where large-scale change is possible. That’s because statewide organizations have shifted from competition to collaboration, Gray said. Pittsburg is operating as a pilot program, meaning its approach to addressing homelessness is set to be replicated across the state.
Everyone matters
Of the more than 443,000 Kansans on Medicaid, 32% of children and 11% of adults live in rural communities, according to the American Hospital Association. Rural areas contain about a third of the state’s population.
Uninsured rates across the state vary, with higher percentages in rural and impoverished areas. The portion of the state’s population without health insurance plateaued at around 8.5%, beginning in 2022.
Crawford County, where Pittsburg is the largest city with around 20,000 people, has been able to reverse its uninsured rate, despite having one of the highest poverty rates in the state. In 2010, nearly 22% of residents were uninsured. That number shrank to roughly 16% in 2020 and is now around 12%.
The Community Health Center of Southeast Kansas offers care to the region regardless of a patient’s ability to pay. The center is one example among several rural solutions across the state, filling in the coverage gap and turning the tide of generational poverty by fostering healthier communities.
Stevie, a patient at the center, calls it a one-stop shop.
“They’ll go out of their way to make sure you get what you need done,” she said. “They also facilitate everything out there.”
That includes housing help, clothing, transportation, legal assistance and education.
The health center’s headquarters in Pittsburg sit on the grounds of a former hospital run by the Sisters of St. Joseph, who cared for the town’s miners at little to no cost beginning in 1903.
The health center has grown since then into a multimillion-dollar nonprofit receiving grants from the federal government. Its 1,000 employees serve 85,000 patients a year across almost 20 locations in 10 counties in southeast Kansas and northeast Oklahoma. With one foot in the city’s history and another in its future, the health center’s leaders have grappled with how to confront disproportionate levels of poverty and poor health outcomes.
The center’s board of directors realized that only about 30% of a person’s health is affected by what happens in an exam room, said Jason Wesco, president of the health center. Health care providers can’t solve a lifetime of problems in one visit, or even a series of visits, he said.
“I want our providers to feel like they matter and they’re making progress, and often they don’t, because the problems we’re trying to solve have taken 150 years to happen,” he said.

So he began asking questions about how to house people, create infrastructure for transportation and provide food — the other 70% of a patient’s health.
“At the core of all that is a belief that all this matters,” Wesco said, “that there aren’t throwaway communities, and there aren’t throwaway people.”
At the same time, Wesco tries to cut through the politics of the decidedly political issues of homelessness and affordable, accessible health care.
“I think we waste an awful lot of time blaming, and I think that gets left behind,” Wesco said. “And I think rural communities have this really unique opportunity to solve problems quickly.”
Kansas Gov. Laura Kelly, a Democrat, has proposed Medicaid expansion each of her seven years in office. The Republican-led Legislature has blocked the proposal every year.
Despite the unpopularity of potential federal Medicaid cuts and the popularity of Medicaid expansion among Kansas residents, Republican leaders continue to demonize the program. House Speaker Dan Hawkins, a Wichita Republican, applauded the prospect of massive federal cuts.
“For years, we have said that expanding Medicaid beyond those who truly need it will jeopardize the program, and now here we are,” Hawkins said in a May 5 press release. “Our country cannot continue spending money like drunken sailors.”
If Kansas lawmakers were to adopt Medicaid expansion, nearly 150,000 adults and children would gain coverage, and the state would have access to an additional $650 million in federal funding each year, according to a 2023 estimate.
Watching her blossom
Since December 2023, Stevie and Brandon have been drug-free and off the streets. They married in March 2024, then moved into an apartment two months later with rental help from a charitable organization as they built up their income from working at a local fried chicken restaurant.
Stevie obtained health insurance from the private marketplace with an affordable plan that is tailored to lower-income earners who can’t qualify for Medicaid. After five years of waiting for public housing assistance, Stevie and Brandon now have subsidized rent, which means they can build up their credit, keep their bills paid and look toward the future.
For Stevie, that could mean owning a home or a career change that puts her college degrees to use, she said. In her free time, she volunteers at a local food bank called Wesley House, which once functioned as a homeless shelter where Stevie spent the night.
“The thing is that they’ve all seen me at my lowest,” she said, “and now they’re all seeing me, like, blossoming.”
This story is part of “Uninsured in America,” a collaborative project led by Public Health Watch that focuses on life in America’s health-coverage gap and states that haven’t expanded Medicaid under the Affordable Care Act.
