Whose job is it anyway?

I've been participating in a conversation at SSIR that begs the question -- who's responsibility is it to pay for social services? I've been dancing around this question for the last few years from my professional life to online conversations.

Last week I met with a leader in the homeless community -- who is dealing with the issue of homeless in Maine through the housing first model. This model was introduced to pop culture by Malcolm Gladwell, in his New Yorker article Million Dollar Murray. Interestingly enough the vast majority of people at a homeless shelter on a given night will only spend that one night at a shelter -- despite the fact that there are so many of them, they are not a costly group to serve. The major costs of homelessness are borne by 10% of the homeless population that are 'chronically homeless' -- they suffer from mental diseases, substance abuse, and a host of other health issues. They are expensive to treat because once a month they will end up in emergency care for hypothermia, cirrhosis, broken bones, etc. Emergency care is a very expensive way to care for these folks. Malcolm's Million Dollar Murray is one man who cost the city of Las Vegas over $1 million because of this care.

The Homeless first model prescribes dealing with these people on the front end to reduce the high end cost of dealing with them on the back end. A model has been established in Portland and seems to be working fairly well (an economic analysis is underway to determine if any efficiencies were really gained). A new model home is being developed to support the chronically female homeless who in addition to all the other problems are more vulnerable to violence and sexual assault.

Once this home is set up, it will take a $1 million/year to service the home. This is an economic burden for a nonprofit. Should the government pay the cost because the government would have paid the more expensive costs on the back end?