Medicaid & Housing: Establishing Contexts for Successful Care Access

At the 2022 Fall Conference, the System Linkages track focused on the partnerships between Medicaid and other programs that can deliver improved outcomes for Medicaid members. One of these partnerships is with housing, as seen in the Advancing Health through Housing panel moderated by Shannon McMahon, MPA, Executive Director, Medicaid Policy, Kaiser Permanente and former Medicaid Director, Maryland.

The panel featured Elizabeth Adkins, Deputy Assistant Secretary, Louisiana Department of Health, Judith Cash, Director, State Demonstrations Group, CMCS, Christy Respress, MSW, Executive Director, Pathways to Housing DC. The panel highlighted that while Medicaid is not a housing program, housing has a deep and direct impact on health outcomes. Partnerships between housing programs and state Medicaid agencies can help Medicaid programs deliver improved outcomes for members.

The conversation identified the current climate for housing support work, and how Medicaid can help close gaps in access to housing for certain individuals experiencing homelessness. Four takeaways from this conversation included:

• Some states have begun to leverage Medicaid 1115 waivers to pay for housing on a targeted and time-limited basis. These housing payments are in addition to case management and services. The goal of these waivers is to create solid ground for clients to stand on to begin to seek and receive clinical care, which will ultimately improve outcomes and prevent unnecessary hospitalizations.
• Increased coverage for case management offers more access to knowledge about different resources that are available. This a “bridge” between people in need of housing (and housing supports) and landlords or other providers. States, like Louisiana, have seen a major impact from supporting these connections and linking members to other available resources.
• Data matters. Robust data and data sharing also allows for evidence-based decision making and tracking program growth. This includes recuperative and short-term care needs and allows for tracking populations who frequently use Emergency Rooms when seeking health care. While Medicaid programs encourage this work by gathering and sharing certain data from members, the ability to centralize and provide a “source of truth” must be expanded and deepened.
• Operationalizing this work is not without its challenges. For example, complex billing systems can make it difficult for housing partners to engage with Medicaid. Similarly, it is difficult for Medicaid and its housing partners to respond to rapid changes in cost of living, which may create gaps in services and support.

Medicaid partnerships with housing can open doors to improve outcomes. These partnerships between Medicaid and housing are complex and take time and intention to build. Many early signs point to it being well worth the effort.