February 13, 2017
The Kaiser Family Foundation
Julia Paradise, Kaiser Family Foundation
Donna Cohen Ross, Health Management Associates
Research suggests that a broad range of social factors affect individual and population health. Indeed, acknowledging the role of social factors in determining health, the U.S. Department of Health and Human Services’ Healthy People 2020 report included as one its four overarching goals for the 2010-2020 decade: “Create social and physical environments that promote good health for all.”1 Housing has been identified as one such social determinant of health, as individuals experiencing homelessness or unstable housing situations face significant challenges in obtaining care and managing chronic conditions, and lack of housing and poor housing conditions can themselves adversely affect health. There is growing evidence that supportive housing can contribute to improved health outcomes for individuals experiencing homelessness or at risk of homelessness.2 Supportive housing can also promote the goal of community integration of individuals with disabilities and elders who need long-term services and supports (LTSS).
Low income, poor health, and unstable housing are often intertwined. For that reason, opportunities to deploy supportive housing resources and Medicaid strategically to improve outcomes for individuals receiving services in both sectors are of policy interest. Federal law prohibits federal matching of state Medicaid spending for room and board (except for nursing facility services, which are a covered Medicaid benefit). However, Medicaid can cover and finance a wide range of housing-related services and activities for individuals enrolled in Medicaid. The Affordable Care Act (ACA)’s expansion of Medicaid to millions of uninsured adults with income up to 138 percent of the federal poverty level (FPL), including many with supportive housing needs, increased the potential impact of Medicaid-housing collaborations.
This issue brief outlines ways in which Medicaid can support integrated strategies and, based on telephone interviews with key informants, profiles three current initiatives that illustrate distinctly different approaches to linking Medicaid and supportive housing. The three initiatives include one launched by a city (Philadelphia), one by a state (Louisiana), and one by a Medicaid MCO (Mercy Maricopa Integrated Care in Phoenix, Arizona). They target special populations including homeless individuals, people with a wide range of disabilities, and adults with mental health and/or substance use problems