The Intersection of Health and Housing: CMS’s Potential Medicaid Investments

Publication Year: 2018
Patient Need Addressed: Chronic Conditions, Homelessness/housing
Population Focus: Medicaid beneficiaries
Type of Literature: Grey

Emerging evidence indicates that affordable, safe, and stable housing directly impacts an individual’s health and well-being, including the ability to manage chronic diseases and mental conditions, maintain personal hygiene, access education and employment, and build healthy relationships. Individuals experiencing homelessness face illness at three to six times the rate of housed individuals and are three to four times more likely to prematurely die than the general population. Furthermore, conditions like asthma can be exacerbated by poorly maintained housing conditions, and neighborhood conditions can inhibit an individual’s ability to support a healthy lifestyle.

Insights Results

Overview of article

  • Ensuring that patients have stable housing can also reduce healthcare costs. For example, an analysis of Oregon Medicaid claims data found individuals who were placed in stable and affordable housing reduced their Medicaid expenditures by 12%. Housing placement also correlated with a 20% increase in primary care visits and an 18% decrease in emergency department visitations among Oregon Medicaid beneficiaries. Hospitals and health systems are increasingly interested in supporting access to stable and quality housing as a method of reducing downstream healthcare spending
  • While direct spending on room and board is not permitted under the Medicaid statute, several state Medicaid programs are already pursuing demonstrations that allow for innovations or flexibilities in Medicaid-managed care programs that address beneficiaries’ housing needs or other social determinants of health. North Carolina, for example, recently received approval of its amended Section 1115 waiver, which transitions the state’s Medicaid program to managed care (e.g., North Carolina piloting the Healthy Opportunities program, which allows Medicaid managed care to cover evidence-based, non-medical interventions that have a direct impact on enrollees’ health outcomes and costs)
  • In addition, The Center for Medicare and Medicaid Innovation (CMMI) is currently exploring the impact of health systems screening and referrals for health-related social needs (including housing and beyond) of Medicaid and Medicare dual beneficiaries. The Accountable Health Communities model will test whether screenings and referrals to community-based organizations and social services can generate improvements to health outcomes and reduce healthcare spending. The model is being piloted through 31 organizations in 23 states (AZ, CO, CT, GA, IL, IN, KY, MD, MI, MN, MS, NJ, NM, NY, OH, OK, OR, PA, RI, TN, TX, VA, and WV)
  • Moving forward, state and public health agencies will be well-positioned to invest in housing needs and resources by convening various stakeholders and utilizing public health data