Supportive Housing and Medicaid – Moving the Agenda in States

written by Lisa Stand
June 11, 2012

Leaders and innovators in supportive housing convened in Chicago last week for a multi-faceted look at integrating housing and health care. The Leadership Forum, sponsored by the Corporation for Supportive Housing, was also the occasion for the release of a “business case” for states to tap Medicaid to pay for key services in permanent supportive housing. The presenters at the day-long conference and the paper on the business case speak to recent innovations with health care and supportive housing — demonstrating what’s possible under the Affordable Care Act, and what’s actually happening in communities where state government and homeless providers are proactive.

Two stand-out ACA provisions enable homeless advocates to persuade state policymakers that supportive housing is a worthwhile Medicaid investment.

  •     First, the “health home” benefit can be a good vehicle for funding care management and service coordination, services that make supportive housing viable as a strategy to end chronic homelessness. As the Forum audience heard, a Medicaid health home is a unique concept that has to be understood in a health policy context. But once that context is understood, it is easier to bring relevant data and analysis to Medicaid decision-makers. The business case illustrates that if Medicaid pays appropriately for care management via this new benefit, states can expand their service capacity in supportive housing. That’s because Medicaid allows the state to access federal funding to pay a portion of what the state would otherwise have to pay all by itself for a given number of supportive housing units.
  •     Second, when Medicaid expands in 2014, states will have new responsibilities to care for very vulnerable people who currently lack coverage and tend to incur very high public costs, especially in hospital emergency rooms. They tend to have severe behavioral and physical health conditions, often co-occurring. And they tend to have unstable housing histories. This is not news to homeless advocates. However, the expanded Medicaid role creates an opportunity to talk to state decision-makers about the value of Housing First for clinical outcomes and managing health care costs.

This is all promising for systems of care addressing chronic homelessness. Safety net systems may always be somewhat fragmented financially, but in any case they need to be integrated and high-performing for the vulnerable people who rely on them. Of course, more needs to be done to finish the job of ending chronic homelessness, and Medicaid in supportive housing is not the answer by itself. As the business case also points out, new strategies should also consider “new processes and/or technologies to identify high-cost, chronically ill clients who could most benefit from supportive housing.” Those who are now experiencing chronic homelessness should be a priority.

The Medicaid proposition for ending chronic homelessness requires advocates to be active in statewide arenas – with Medicaid administrators, of course; but also with their partners – such as mental health directors, hospital systems, and even managed care organizations that deliver on Medicaid contracts. Advocating statewide is the theme of an Alliance pre-conference session on July 16, immediately preceding the start of the National Conference on Ending Homelessness. “Opening Medicaid Doors: State Strategies to Support Homeless Assistance for Vulnerable Populations” is co-sponsored by the U.S. Interagency Council on Homelessness. The half-day program 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. Space is limited and pre-registration is highly recommended. RSVP at healthcare@naeh.org.

Image courtesy of donbuciak.