When William finally unlocked the door to his own apartment in Lake Worth Beach, it marked a turning point after years of housing instability.

For much of his adult life, the 30-year-old moved between family members’ homes across Florida and Georgia. Even while working — most recently for the school district — permanent housing remained out of reach.

“I was a little depressed,” William said. 

That began to change when William enrolled in Palm Beach County’s H2O program, a pilot initiative designed to stabilize housing while addressing healthcare and long-term economic opportunity for people. The 12-month program helped him secure an apartment and covered his rent, utilities, moving costs, and more while he worked toward financial stability and stayed connected to healthcare.

OutSFL is using William’s first name only to protect his privacy, given the sensitive health context of the program.

“They were able to make sure that I stayed on top of my health,” he said. 

Beyond covering basic costs, William said the program focused on helping him build the skills needed to stay housed long term — especially budgeting and financial planning.

“They showed me the difference between what I want, and what I need,” he said. 

Today, William says the stability has improved not only his finances, but his mental health as well.

“I feel way better,” he said. “I feel great about myself.”

Where Health and Housing Intersect

William’s experience reflects a broader experiment underway in Palm Beach County — one that challenges traditional approaches to poverty by treating housing and healthcare as inseparable.

The H2O program, short for Healthcare and Housing Opportunities, launched in 2023 through the county’s Community Services Department. It is funded by a federal grant from the Health Resources and Services Administration and currently serves people living with HIV.

The program emerged in response to a post-pandemic reality: COVID-era rental assistance programs expired, housing costs never returned to pre-pandemic levels, and wages failed to keep pace. According to Casey Messer, who helped design the program for the county, some households across South Florida now spend more than half their income just to remain housed.

“We wanted to try something new and try something different,” he said. “We wanted to try to address some of the root causes of housing instability and lack of access to affordable housing. And so we created this healthcare and housing opportunities program to try to do that.”

According to Messer the average cost is $12,474 per client. 

“Even if program costs were triple this amount there would still be a net positive return on investment from a client increasing their earnings and reducing reliance on social support services for the rest of their lives,” Messer said. “It’s better to invest upfront to help someone become self-sufficient than to subsidize housing and healthcare for years or the rest of someone’s life as costs keep rising.”

That instability is often driven by costs and systems that compound each other. People living with HIV face lifelong medical expenses, including daily antiretroviral medications that can cost thousands of dollars a month without insurance or assistance. Missed medication, untreated health issues, or time off for medical appointments can directly affect job performance and income, pushing already fragile household budgets closer to collapse.

That pressure hits LGBTQ communities especially hard. Nationally, LGBTQ people account for a disproportionate share of new HIV diagnoses — particularly gay and bisexual men and transgender women. In South Florida, those disparities collide with soaring housing costs and persistent employment discrimination.

At Compass Community Center, where many participants are referred, staff see those challenges daily.

“If you don’t have employment, you don’t have health insurance,” said Raymond Cortes, Compass’s health services director. “If you have no insurance, you have no linkage to care. It all goes hand in hand.”

Cortes oversees Ryan White Part A services, which provide case management for people living with HIV. 

Without stability especially in terms of housing and employment income, everything else unravels.

A Different Kind of Support Model

Traditional housing assistance programs often focus on short-term relief. H2O was designed differently.

“There are really two variables that determine whether housing is affordable,” Messer said. “How much housing costs and how much income a person has.”

Local governments have little control over market rents. What they can influence, Messer said, is access to education, training, and opportunities that allow people to earn more.

The H2O program enrolls participants for up to 12 months, providing rental and utility assistance while simultaneously investing in upward economic mobility. Participants can use program funds for GED and ESOL courses, vocational training, licensing fees, business training, childcare, food assistance, transportation, and healthcare costs such as insurance premiums, co-pays, and deductibles.

“The intent of this program is really to try to assist individuals from reliance on long-term financial assistance to be able to be stably housed and to be self-sufficient,” Messer said.

Unlike traditional safety-net systems — where services are spread across multiple agencies — H2O combines housing, healthcare, and workforce support into one coordinated model.

“You can’t piece together five different programs on your own when you’re just trying to survive,” Messer said.

Cortes concurs. 

“That’s where we lose the clients,” he said, describing fragmented systems that send people to different locations for care. “When we have everything centralized, that’s when we’re successful.”

He described one client he worked with for nearly nine years who struggled to stay engaged in care. After moving closer to Compass and receiving coordinated mental health and medical support, the client was able to get their HIV under control for the first time.

“She has a stable home right now. She is employed,” Cortes said. “She is undetectable.”

In HIV care, “undetectable” means the virus is suppressed to levels so low it no longer harms the patient’s health and cannot be transmitted to others.

Maintaining that level of health and stability often depends on removing everyday barriers beyond medical care.

Messer said transportation quickly emerged as one of the biggest barriers. While many participants could manage daily life using buses or Tri-Rail, vocational training sites were often located across the county — sometimes requiring one- to two-hour commutes each way, particularly for residents in western communities.

To address that, the county adjusted the program.

“We will provide ride-share funding for individuals to get door-to-door services from Uber or Lyft,” Messer said.

The program is flexible enough to serve people who are employed, unemployed, underemployed, stably housed, unstably housed, or even experiencing homelessness. In some cases, participants are placed in short-term housing, including hotels, so they can stabilize and attend training.

Early Results

According to Messer, 67% of participants became self-sufficient within 12 months, meaning they no longer required financial assistance to afford housing, healthcare, food, or transportation.

“We really didn’t know what to expect,” Messer said. “Any percentage of self-sufficiency was going to be an improvement.”

An additional 17% exited the program early because they reached stability before the 12-month mark — bringing the effective success rate to 84%.

Of the remaining participants, 8% transitioned to permanent supportive housing programs such as housing choice vouchers, reflecting longer-term needs. Another 8% died during participation, underscoring the serious health challenges many participants face.

What’s Next 

Although H2O currently serves only people living with HIV, Messer emphasized that the model itself is not diagnosis-specific.

“This works for anyone dealing with chronic instability,” he said. “People with HIV face housing and employment barriers, but so do people with behavioral health needs, substance use disorders, or other chronic illnesses. The same structure applies.”

The county developed the program internally over six to eight months, drawing on best-practice components from cities and states including New York, Dallas, and Utah, then adapting them to local needs. The design intentionally allows for flexibility as new barriers emerge.

Palm Beach County is now exploring how the framework could be adapted for behavioral health and substance use populations, potentially using long-term opioid settlement funds. Other counties, including Broward, have already requested program materials to explore replication.

A Bridge Forward

For William, the difference was having space to focus on progress rather than survival.

“They helped me get on the right track. I’ve come a long way,” he said. “They helped me out very tremendously throughout this journey that I've been going through.”

For Cortes, outcomes like these reinforce a core belief of his.

“You cannot give up on clients,” he said. “You got to meet them where they’re at.”

As housing costs rise and safety-net programs face uncertainty, Palm Beach County’s experiment offers a new approach.