Ending Chronic Homelessness State by State: Strategies for Medicaid to Make a Difference

written by Lisa Stand

May 14, 2012

“States vary” –  a top research finding in virtually every field studied inside the Beltway. When it comes to understanding how Medicaid is relevant to ending chronic homelessness, we would like to be more helpful. True, Medicaid’s relevance to ending chronic homelessness in your community depends greatly on the profile of your state. Still, success in another state is worth looking at, along with assessing what can be borrowed effectively. A pre-conference session for early arrivals at the Alliance’s summer conference will offer an opportunity to do just that.  The half-day mini-conference is co-sponsored by the U.S. Interagency Council on Homelessness. We will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless.

• Homeless Advocates at the Table. One facet is effective engagement at the right time in state health policymaking. How do homeless advocates get the ear of state health care officials before they make decisions that have implications for addressing chronic homelessness in a person-centered way? New York has an inspiring story of supportive housing stakeholders at the table of statewide Medicaid reform -- with results that bolster community-based strategies to end homelessness. In Louisiana, supportive housing is now viewed as a core element in Medicaid’s plans for managing care of behavioral health enrollees. In short, policy gaps have been successfully bridged with stakeholder input at high levels.

• Benefits and Payment Policy. Another facet is how a state defines Medicaid benefits and payment policies. Do these policies promote housing solutions in a plan of care for homeless people with significant behavioral and other health needs? As federal authorities roll out approved benefits and demonstrations, we are seeing how states embrace new community-based services allowed by the Affordable Care Act (ACA). States like Oregon and New York are doing this with a clear view of supportive housing in the domain of health care, at least for those as vulnerable as chronically homeless people. It may be too soon to know how these approaches succeed, but the state policy pieces are evident and intentional.

• Federal Policy Implementation. A third facet is coordination at the federal level, such as initiatives led by the Department of Housing and Urban Development (HUD) and various subdivisions of the Department of Health and Human Services (HHS). Which new federal policies and regulatory decisions will have the most impact on ending chronic homelessness by 2015, as the federal strategic plan envisions? Federal Medicaid rules are more favorable to the concept of permanent supportive housing, and HUD is looking for ways to promote access to Medicaid in housing for people with disabilities. Federal policy will continue to drive state and local responses.

These topics will be covered by knowledgeable speakers convening for “Opening Medicaid Doors: State Strategies to Support Homeless Assistance,” on Monday, July 16, in Washington, DC. The half-day session immediately precedes the opening of the National Conference on Ending Homelessness, which takes places July 16-18. Both events are at the Renaissance Washington Hotel. For more information about Opening Medicaid Doors, contact healthcare@naeh.org. Space limited and pre-registration is highly recommended.