The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 1442
INTRODUCER: Senator Grall
SUBJECT: Pregnancy Support Services
DATE: February 5, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Morgan Brown HP Favorable
2. AHS
3. FP
I. Summary:
SB 1442 creates s. 381.97, F.S., to establish a Florida State Maternity Housing Grant Program
(program) within the Department of Health (DOH) to provide approved living arrangements and
resources to Florida’s women and families experiencing homelessness during the prenatal period.
The program is designed to assist approved persons in achieving residency via an alternative
living arrangement for a period not to exceed eight months, and includes a maximum of six
weeks of postpartum care.
The bill requires the DOH to use grant funds specifically appropriated for the program in order to
cover expenses identified in the bill and provides that the total amount of grants awarded may
not exceed the funding appropriated for the grant program.
The bill authorizes the DOH to adopt rules necessary to administer the program.
The bill provides an effective date of July 1, 2024.
II. Present Situation:
Homelessness in the United States
Homeless persons are defined as those who lack a fixed, regular, and adequate nighttime
residence, or those living in shelters and temporary housing, or public and private places not
designed for sleeping accommodations. While many homeless individuals are alone, others are
couples, families with children, or unaccompanied youth.
1
1
Florida Department of Children and Families, Homelessness Frequently Asked Questions, available at
https://www.myflfamilies.com/services/public-assistance/homelessness/homelessness-frequently-asked-questions (last visited
Feb. 1, 2024).
REVISED: BILL: SB 1442 Page 2
There are two types of homelessness: “sheltered” and “unsheltered.” Unsheltered homeless
persons live on the streets or live in tents, cars, or abandoned buildings. Sheltered homeless
persons stay in emergency or transitional
housing temporarily. Sheltered homeless
persons are still considered homeless due
to a lack of stable permanent housing.
2
On a single night in 2023, roughly
653,100 people, about 20 of every
10,000 people in the U.S., were
experiencing homelessness. This is the
highest number reported since the
inception of point-in-time count
reporting in 2007. The data indicated that
six in ten people were experiencing
sheltered homelessness, while the
remaining four in ten were experiencing
unsheltered homelessness in places not
meant for human habitation.
3
Reporting has also shown experiences of homelessness increased nationwide across all
household types. Between 2022 and 2023, the number of people experiencing homelessness
increased by 12 percent, roughly 70,650 more people. Nearly three of every ten people
experiencing homelessness (28 percent or approximately 186,100 people) did so as part of a
family with children. Between 2022 and 2023, the number of people in families with children
who were experiencing homelessness increased by more than 25,000 people (or 16 percent),
ending a downward trend in families experiencing homelessness that began in 2012.
4
The following exhibits demonstrate the approximate U.S. homeless population by state, as well
as the people in families with children experiencing homelessness by sheltered status from 2007
to 2023.
5
2
Id.
3
U.S. Department of Housing and Urban Development’s Office of Community Planning and Development, The 2023 Annual
Homelessness Assessment Report (AHAR) to Congress – Part 1: Point-in-Time Estimates of Homelessness (December 2023),
available at https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf (last visited Feb. 1, 2024).
4
Id.
5
Id. BILL: SB 1442 Page 3
BILL: SB 1442 Page 4
Homelessness in Florida
On a given night in January 2023, more than half of all people experiencing homelessness in the
U.S. were in four states:
6
California (28 percent of all people experiencing homelessness in the U.S., or 181,399
people);
New York (16 percent or 103,200 people);
Florida (5 percent or 30,756 people); and
Washington (4 percent or 28,036 people).
Between 2022 and 2023, the states with the largest absolute increases in homelessness were:
7
New York (29,022 more people);
California (9,878);
Florida (4,797);
Colorado (4,042); and
Massachusetts (3,634).
Over a longer period, from 2007 to 2023, the number of people experiencing homelessness
declined in 25 states and the District of Columbia. The largest absolute decreases were in Florida
(17,313 fewer people) and Texas (12,411 fewer people).
8
Between 2022 and 2023, the number of people in families with children experiencing
homelessness increased in 34 states and the District of Columbia. The largest increases were in:
9
New York (18,890 more people, a 54 percent increase);
Massachusetts (2,906 more people or 29 percent);
Colorado (1,490 more people or 69 percent);
Florida (1,391 more people or 22 percent); and
Illinois (1,077 more people or 36 percent).
Pregnant Women Experiencing Homelessness
Due to the very transient nature of homelessness, the exact number of pregnant homeless women
is difficult to determine. This represents a significant gap in knowledge that could be used to
inform social and health policy, as well as service delivery, thus researchers have continued in
their attempts to identify the extent of pregnancy among the homeless population.
10
In the U.S., one study estimated that one in five homeless women are pregnant at any given time,
almost twice the rate of the general population. Other research uncovered even higher rates of
6
Id.
7
Id.
8
Id.
9
Id.
10
Council to Homeless Persons, The Extent, Nature and Impact of Homelessness on Pregnant Women and Their Babies,
available at https://chp.org.au/parity/the-extent-nature-and-impact-of-homelessness-on-pregnant-women-and-their-babies/
(last visited Feb. 1, 2024). BILL: SB 1442 Page 5
pregnancy among homeless women, finding that while ten percent of women in the U.S. were
pregnant in 2009, 50 to 60 percent of homeless women were pregnant.
11
Another study conducted in Florida determined about 183 pregnant homeless women live in
Northeast Florida in any given month.
12
The Impact of Homelessness on Maternal and Infant Health
Stable housing has been identified as one of the most important predictors of health as housing
instability or homelessness lessens access to health care. This is more pressing during pregnancy,
a time when access to affordable, high-quality health care is crucial. Although prenatal care is
available, pregnant mothers and parents experiencing homelessness face barriers (e.g., lack of
transportation, site-related factors, provider-client relationship, inconvenience, fear, cost, etc.).
13
For some, these obstacles bar them from accessing care altogether. Additionally, people
experiencing housing instability or homelessness are more likely to live in conditions that are
hazardous to their health.
14
A number of studies have shown that homelessness has a negative impact on the health of
pregnant mothers and infants:
15
Pregnant mothers experiencing homelessness are significantly less likely to have a prenatal
visit during the first trimester, breastfeed, and have a well-baby checkup than their housed
counterparts.
In comparison with a housing-secure group with similar characteristics, pregnant mothers
experiencing homelessness are significantly more likely to have various pregnancy-related
conditions and complications, including high blood pressure, iron deficiency and other
anemia, nausea and vomiting, hemorrhage, placental problems, and abdominal pain.
One in five mothers who experienced homelessness in the year prior to giving birth had an
infant with a low birthweight, a nearly 50 percent increase in risk compared to consistently
housed people with otherwise similar characteristics.
Newborn infants of people experiencing homelessness have longer stays in the hospital and
are more likely to require intensive care than infants of consistently housed people.
People who were homeless as infants are more likely to have upper respiratory infection,
other respiratory disease, fever, allergy, injuries, developmental disorders, and asthma,
compared to people who were stably housed during infancy. These individuals also show a
propensity for increased emergency department visits, hospitalizations, and health care costs.
11
Id.
12
Journal of Obstetric, Gynecologic, and Neonatal Nursing, Bloom, K. C., Bednarzyk, M. S., Devitt, D. L., Renault, R. A.,
Teaman, V., & Van Loock, D. M., Barriers to prenatal care for homeless pregnant women (2004), available at
https://www.jognn.org/article/S0884-2175(15)34192-7/fulltext (last visited Feb. 1, 2024).
13
Id.
14
National Partnership for Women & Families, Homelessness Hurts Moms and Babies, available at
https://nationalpartnership.org/report/homelessness-hurts-moms-and-babies/ (last visited Feb. 1, 2024).
15
Id. BILL: SB 1442 Page 6
The Department of Children and Families (DCF)
Office on Homelessness
The Office on Homelessness (office), through the DCF, oversees policy and funding toward
ending and serving persons experiencing homelessness. The office recognizes and designates
local Continuum of Care (CoC) entities to serve as lead agencies for the homeless assistance
system throughout the state of Florida.
16
CoCs are organizations composed of representatives of nonprofit homeless providers, victim
service providers, faith-based organizations, governments, businesses, advocates, public housing
agencies, school districts, social service providers, mental health agencies, among other
stakeholders.
17
Services offered through CoCs and their providers include operation and maintenance of
emergency shelters, outreach to individuals who are homeless, rental assistance to prevent
individuals from becoming homeless, and rapid rehousing of individuals from shelters or
homelessness.
18
The CoC model creates a framework for a comprehensive array of emergency, transitional, and
permanent housing, and supportive services to address the varying needs of the persons who are
homeless or at-risk of becoming homeless. The purpose of the CoC is to help communities
envision, plan, and implement coordinated, long-term solutions to address homelessness.
19
Currently, Florida has 28 CoCs.
20
Council on Homelessness
The Council on Homelessness (council) was created in 2001 to develop and coordinate policy to
reduce the prevalence and duration of homelessness, and work toward ending homelessness in
Florida.
21
With this goal in mind, the council annually produces a report documenting its
findings and recommendations, which offers insight on homelessness among special populations
not captured by the federal point-in-time count, such as parenting youth.
22
Parenting youth are a percentage of youth who experience homelessness and are pregnant or
parenting. While lack of permanent housing can be traumatic in itself, these youth are also
16
Florida Department of Children and Families, Homelessness, available at https://www.myflfamilies.com/services/public-
assistance/homelessness (last visited Feb. 1, 2024).
17
Id.
18
Id.
19
Id.
20
Id.
21
Florida Department of Children and Families, Council on Homelessness, available at
https://www.myflfamilies.com/services/public-assistance/homelessness/council-homelessness (last visited Feb. 1, 2024).
22
Florida Department of Children and Families, Florida’s Council on Homelessness, Annual Report (June 2023), available at
https://www.myflfamilies.com/sites/default/files/2023-
07/Florida%27s%20Council%20On%20Homelessness%20Annual%20Report%202023.pdf#:~:text=The%20number%20of%
20people%20experiencing%20unsheltered%20homelessness%20in%20Florida%20increased,the%20number%20of%20unsh
eltered%20homeless. (last visited Feb. 1, 2024). BILL: SB 1442 Page 7
burdened with concerns of trying to provide stable and safe housing for their children. One
hundred and ninety-four parenting youth were accounted for in the council’s 2023 report. Data
from 2018 also indicated that about 1.1 million children had a young parent who experienced
homelessness during the past year. The challenges faced by this segment of the homeless youth
population requires systems of care to support developmentally appropriate services that address
the unique needs of young homeless parents.
23
Affordable Housing
Affordable housing is defined in terms of household income. Housing is considered affordable
when it costs less than 30 percent of a family’s gross income.
24
A family paying more than 30
percent of its income for housing is considered “cost burdened,” while those paying more than
50 percent are considered “extremely cost burdened.”
25
Severely cost burdened households are
more likely to sacrifice other necessities such as healthy food and healthcare to pay for housing,
and to experience unstable housing situations such as eviction.
26
Resident eligibility for Florida’s state and federally funded housing programs is typically
governed by area median income (AMI) levels. These levels are published annually by the
federal Department of Housing and Urban Development (HUD) for every county and
metropolitan area. The following are standard household income level definitions and their
relationship to the 2023 Florida state AMI of $85,500
27
for a family of four (as family size
increases or decreases, the income range also increases or decreases):
28
Extremely low income – earning up to 30 percent AMI (at or below $25,650);
29
Very low income – earning from 30.01 to 50 percent AMI ($25,651 to $42,750);
30
Low income – earning from 50.01 to 80 percent AMI ($42,751 to $68,400);
31
and
Moderate income – earning from 80.01 to 120 percent of AMI ($68,401 to $102,600).
32
Housing costs reflect what people are willing to pay to live in an area, which may make it
difficult for growing families to find affordable homes and apartments. The government helps
make housing affordable through decreased monthly rent or mortgage payments so that income
eligible families are able to pay less for housing than it would otherwise cost at “market rate.”
23
Id.
24
Florida Housing Coalition, Affordable Housing in Florida, available at https://www.flhousing.org/wp-
content/uploads/2019/03/Affordable-Housing-in-Florida-Book-WEB.pdf (last visited Feb. 2, 2024).
25
Id.
26
The Florida Senate Staff Analysis of SB 102, February 24, 2023, available at
https://www.flsenate.gov/Session/Bill/2023/102/Analyses/2023s00102.ap.PDF (last visited Feb. 2, 2024).
27
U.S. Department of Housing and Urban Development’s Office of Policy Development and Research, FY 2023 Median
Family Income for States, Metropolitan and Nonmetropolitan Portions of States Attachment, available at
https://www.huduser.gov/portal/datasets/il/il23/FY23-Median-Attachment-State-Medians.pdf (last visited Feb. 1, 2024).
28
U.S. Department of Housing and Urban Development’s Office of Policy Development and Research, Income Limits,
Access Individual Income Limits Areas – Click Here for FY 2023 IL Documentation, available at
https://www.huduser.gov/portal/datasets/il.html#query_2023 (last visited Feb. 1, 2024).
29
Section 420.0004(9), F.S.
30
Section 420.0004(17), F.S.
31
Section 420.0004(11), F.S.
32
Section 420.0004(12), F.S. BILL: SB 1442 Page 8
Lower monthly payments or down payment assistance is a result of affordable housing
financing.
33
Impact on Homelessness
Over the last 30 years, lack of affordable rental housing for low-income households has fostered
homelessness in the U.S. In 1970, there were 6.5 million low-cost rental units in the U.S. and 6.2
million low-income renter households with 300,000 available units. By 1985, the number of low-
cost units fell to 5.6 million and the number of low-income renter households grew to 8.9
million, a disparity of 3.3 million units. In 2019, the National Low Income Housing Coalition
reported that the State of Florida had a shortage of 428,622 affordable rental units.
34
In 2017, the median rent, including utilities, for an apartment in Florida was $1,130 per month, a
16 percent increase since 2001, while income only increased by a disproportionate one percent
35
.
As a result, 1,666,000 people in 769,400 low-income Florida households paid more than half
their income in rent. Often low-income individuals and families forego necessities, like food or
medicine, to keep a roof over their heads.
36
According to the Center on Budget and Policy Priorities, 50 percent of low-income people in
Florida are homeless or pay over half their income in rent. Currently, most do not receive federal
rental assistance due to limited funding, but research has shown that rental assistance has helped
286,700 people in families with children in Florida avoid homelessness.
37
Florida Housing Finance Corporation
The 1997 Legislature created the Florida Housing Finance Corporation (FHFC) as a public-
private entity to assist in providing a range of affordable housing opportunities for Floridians.
38
The FHFC is a corporation held by the state and housed within the Department of Commerce.
The FHFC is a separate budget entity, and its operations, including those relating to personnel,
purchasing, transactions involving real or personal property, and budgetary matters, are not
subject to control, supervision, or direction by the Department of Commerce.
39
The goal of the FHFC is to increase the supply of safe, affordable housing for individuals and
families with very low to moderate incomes by stimulating investment of private capital and
encouraging public and private sector housing partnerships. As a financial institution, the FHFC
administers federal and state resources to finance the development and preservation of affordable
rental housing and assist homebuyers with financing and down payment assistance.
40
33
Supra note 26.
34
Florida Coalition to End Homelessness, The Issue – The Fight to End Homelessness: Past, Present, and Future, available
at https://fchonline.org/the-issue/ (last visited Feb. 1, 2024).
35
Id.
36
Center on Budget and Policy Priorities, Florida Federal Rental Assistance Fact Sheet, available at https://apps.cbpp.org/4-
3-19hous/PDF/4-3-19hous-factsheet-fl.pdf (last visited Feb. 1, 2024).
37
Id.
38
Chapter 97-167, Laws of Fla. From 1980 through 1997, the former Florida Housing Finance Agency, placed within the
former Department of Community Affairs, performed similar duties.
39
Section 420.504(1), F.S.
40
Supra note 26. BILL: SB 1442 Page 9
State Apartment Incentive Loan Program
The State Apartment Incentive Loan (SAIL) Program is administered by the FHFC and provides
low-interest loans on a competitive basis to multifamily affordable housing developers.
41
These
funds often serve to bridge the gap between the developments’ primary financing and the total
cost of the development. SAIL dollars are available for developers proposing to construct or
substantially rehabilitate multifamily rental housing.
42
At a minimum, developments financed by SAIL must set aside 20 percent of units for
households at or below 50 percent of AMI, or if the development also receives Low Income
Housing Tax Credits
43
(LIHTC), 40 percent of units for households up to 60 percent of AMI.
44
Loan interest rates are set at zero percent for those developments that maintain 80 percent of
their occupancy for farmworkers, commercial fishing workers or homeless people. The interest
rates are set at one percent for all other developments. Generally, loans are issued for 15 years
and cover approximately 25 to 35 percent of the total development cost.
45
State Housing Initiatives Partnership Program
The State Housing Initiatives Partnership (SHIP) Program was created in 1992
46
to provide funds
to local governments as an incentive to create partnerships that produce and preserve affordable
homeownership and multifamily housing. The SHIP program provides funds to all 67 counties
and 52 Community Development Block Grant
47
entitlement cities on a population-based formula
to finance and preserve affordable housing based on locally adopted housing plans.
48
The
program was designed to serve very-low, low-, and moderate-income families and is
administered by the FHFC. SHIP funds may be used to pay for emergency repairs, rehabilitation,
down payment and closing cost assistance, impact fees, construction and gap financing,
mortgage buy-downs, acquisition of property for affordable housing, matching dollars for federal
housing grants and programs, and homeownership counseling.
49
Funds are expended per each local government’s adopted Local Housing Assistance Plan
(LHAP), which details the housing strategies that will be utilized, such as helping those affected
by mobile home park closures, encouraging innovative housing design to reduce long-term
housing costs, preserving assisted housing, and reducing homelessness.
50
Local governments
41
Section 420.5087, F.S.
42
Florida Housing Finance Corporation, State Apartment Incentive Loan, available at
https://floridahousing.org/programs/developers-multifamily-programs/state-apartment-incentive-loan (last visited Feb. 1,
2024).
43
Low Income Housing Tax Credits are a financial instrument administered by the Department of Housing and Urban
Development that provide financing for low income housing developments. Credits are allocated to states on a per capita
basis and state-level administration is performed by FHFC. Eligible developments are income-limited similarly to SAIL
requirements.
44
Section 420.5087(2), F.S.
45
Supra note 26.
46
Chapter 92-317, Laws of Fla.
47
The Community Development Block Grant program is a federal program created in 1974 that provides funding for housing
and community development activities.
48
See ss. 420.907-420.9089, F.S.
49
Section 420.9072(7), F.S.
50
Section 420.9075(3), F.S. BILL: SB 1442 Page 10
submit their LHAPs to the FHFC for review to ensure that they meet the broad statutory
guidelines and the requirements of the program rules. The FHFC must approve an LHAP before
a local government may receive the SHIP funding.
51
Certain statutory requirements restrict a local government’s use of funds made available under
the SHIP program (excluding amounts set aside for administrative costs):
52
At least 75 percent of SHIP funds must be reserved for construction, rehabilitation, or
emergency repair of affordable, eligible housing; and
Up to 25 percent of SHIP funds may be reserved for allowed rental services.
53
III. Effect of Proposed Changes:
Section 1 creates s. 381.97, F.S., to establish the Florida State Maternity Housing Grant Program
(program) within the DOH, to provide approved living arrangements and resources to Florida’s
women and families experiencing homelessness during the prenatal period. The bill provides
Legislative intent that the provisions of this bill assist those whose financial resources have been
determined inadequate to meet residential costs, regardless of age or marital status.
The bill designs the program to support approved persons in achieving residency via an
alternative living arrangement for a period not to exceed eight months, and includes a maximum
of six weeks of postpartum care.
The bill identifies the types of expenses program funds can be utilized towards:
Housing in an authorized living arrangement for a period of time determined by the mother’s
estimated delivery date.
Services recommended by the DOH for women and families approved for the program to
encourage economic independence and positive health outcomes for participants.
Staffing and reimbursements for providers of authorized living arrangements.
All other related costs for the administration of the program, not to exceed five percent of the
total grant funds.
The bill specifies that the total amount of grants awarded cannot exceed the state allocation, as
its provisions are subject to appropriated funds.
The bill authorizes the DOH to adopt rules necessary to administer the program, which may
include:
A framework for the payment or reimbursement of funds to the mother for authorized living
arrangements.
Eligibility criteria for pregnant mothers and expecting families seeking maternity housing
services, including a sliding fee scale for participants.
Requirements for program applications.
51
Supra note 26.
52
Section 420.9075(5), F.S.
53
Section 420.9075(5)(b), F.S. However, a local government may not expend money distributed to it to provide ongoing rent
subsidies, except for: security and utility deposit assistance; eviction prevention not to exceed six months’ rent; or a rent
subsidy program for very-low-income households with at least one adult who is a person with special needs or is homeless,
not to exceed 12 months’ rental assistance. BILL: SB 1442 Page 11
Guidelines for assessing the appropriateness of authorized living arrangements and for a
determination of approval for authorized living arrangements.
Section 2 provides an effective date of July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
Since funding has not been appropriated under this bill, no fiscal impact exists at this
time. However, should the Legislature appropriate funding for the program, the
program’s implementation may have an impact to community partners and Florida
residents that receive grant funds.
Additionally, health care providers that treat the homeless women and families identified
in the bill may also be positively impacted. Through the provision of stable housing,
illnesses and injuries can be better prevented, and conditions can be improved or better
maintained. This could result in a decrease in potentially preventable emergency
department visits, reducing costs and allowing facilities such as hospitals to utilize
limited funds on others in need. BILL: SB 1442 Page 12
C. Government Sector Impact:
As funding has not been appropriated under this bill, no fiscal impact exists at this time.
However, similar to private entities, should the Legislature appropriate funds, the
government sector may also experience the same positive fiscal impact as a result of this
bill. Potentially, state expenditures could decrease in relation to government funded
health care previously spent on ailments worsened as a result of homelessness.
The DOH indicates that SB 1442 will have a significant fiscal impact on the department,
with an estimated cost of approximately $5,969,693 total:
54
Expense: $70,846 recurring and $26,636 non-recurring;
Salary and Benefits: $396,772 recurring;
Contracted Services: $5,474,000 recurring;
Human Resources: $1,439 recurring.
The additional costs for authorized living arrangements are indeterminate, but the DOH
anticipates they will be significant.
55
VI. Technical Deficiencies:
None.
VII. Related Issues:
The DOH staff analysis indicates that the department does not have programs or an established
infrastructure to address homelessness in Florida. At a minimum, the DOH will require one year
to establish the framework for the program, as the department will need to procure staff for
authorized living arrangements and develop rules, an administrative system, the application
process, and the payment methodology for eligible pregnant women and families.
56
SB 1442 does not define “postpartum care,” leaving its meaning unclear as used in the bill. For
better understanding as to the intent, it is recommended that an amendment be filed to provide
further clarity.
The bill may duplicate services currently provided by the DCF and the FHFC.
57
The bill may
also duplicate pregnancy support and wellness services provided by the DOH under s. 381.96,
F.S.
58
While the bill does not directly impact Medicaid, postpartum care as used in ch. 409, F.S., is a
service provided to eligible low-income mothers via Medicaid, potentially suggesting there could
be a duplication of services already reimbursed by the Agency for Health Care Administration
and the federal government.
54
DOH Staff Analysis of SB 1442, January 12, 2024. On file with Senate Health Policy Committee staff.
55
Id.
56
Id.
57
Id.
58
Id. BILL: SB 1442 Page 13
VIII. Statutes Affected:
This bill creates section 381.97 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.