Supportive Housing and Medicaid HCBS: An Offer You Can’t Refuse

In a growing number of communities, healthcare, housing, and housing assistance providers are working together to coordinate care for individuals experiencing chronic homelessness. Many of these individuals are Medicaid beneficiaries. A disproportionate share of all Medicaid spending, however, is used to provide care for a relatively small group of patients called “super-­utilizers.” Most of these super-­utilizers have multiple chronic health conditions, often including mental health and/or substance abuse disorders. This is costly for all. Though statutory provisions prohibit Medicaid from paying for housing itself, it can finance many of the health and behavioral health supportive services that enable vulnerable populations to obtain and remain in housing.

Permanent Supportive Housing, for example, combines affordable housing with the community supports needed to help homelessness individuals obtain and maintain housing. Frequently, leaders in state Medicaid agencies are not familiar with the local homeless assistance and housing systems and miss out on key opportunities to coordinate supportive housing for Medicaid beneficiaries. This is unfortunate as Permanent Supportive Housing has been shown to improve outcomes and reduce hospital admissions and emergency room visits according to the U.S. Department of Health and Human Services Office of Disability, Aging, and Long­-Term Care Policy.

Paper cutout family with house under a Medicaid umbrella

Medicaid Home and Community­-based Waivers (HCBS) can now be used to cover services which provide ongoing support for housing stability and community integration needed by those with disabilities and/or substance abuse disorders. Some of these Medicaid-­funded support services include:

  • Case management/care coordination
  • Home health aide
  • Personal care
  • Health-­related services, including skilled and unskilled nursing services to address chronic conditions
  • Habilitation
  • Psychosocial rehabilitation services
  • Social supports to participate in community activities
  • Family and caregiver supports, including training and respite care
  • Adaptive services for accessibility, including home modifications such as wheelchair ramps
  • Other services, including housing locator services

States that establish Medicaid health home programs which link these services to housing opportunities may be able to achieve significant reductions in avoidable hospital re-admissions by those experiencing chronic homelessness.

Case Study: United Healthcare Medicaid Plan Pilot

In Texas, the United Healthcare Medicaid pilot program contracts with local homeless coalitions to find and engage high­-risk members, help them develop a housing plan, and connect with their primary care providers and the health plan’s care managers. The goal of linking homeless individuals to housing assistance is to help remove housing barriers, and ensure members receive care in appropriate settings in accordance to state Medicaid quality performance standards.

Eccovia Solutions has years of experience providing case management solutions for housing assistance organizations, community supports, and state Medicaid agencies. With the convergence of health and human services, we are uniquely positioned to help organizations collaborate to improve care for vulnerable individuals experiencing chronic homelessness.

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