The Biden administration’s actions could pave the way for Medicaid’s involvement in housing, as health plans might facilitate housing support integration. While challenges remain due to differing regulations between the health and housing sectors, data sharing is essential. This integration’s feasibility is acknowledged, but its realization seems distant. Collaborations between Medicaid plans and housing agencies could yield benefits. Experimentation, evaluations, and innovative approaches will be crucial for blending Medicaid and housing effectively.
The Biden Administration’s initiatives could set the stage for Medicaid to play a significant role in the housing sector, potentially enabled by certain policy changes. A Health Affairs article suggests that health plans might facilitate the extension of Medicaid benefits to encompass housing support, benefiting from actions taken by the administration.
Dori Glanz Reyneri, a director at consulting firm Manatt Health and the author of the article, highlights the administration’s openness to approve pilot programs under Section 1115 of the Social Security Act. These programs would empower Medicaid to allocate funds for housing development. Additionally, the administration has established guidelines that allow states and health plans to offer temporary housing support as part of their services. Currently, approximately 72% of enrollees obtain coverage through health insurers, with a small group of companies dominating a significant portion of the market.
However, Reyneri notes that despite these positive steps, the integration of Medicaid and housing remains largely theoretical. Various components that are necessary for this integration may not be aligned yet. Long-term housing initiatives are governed by the Department of Housing and Urban Development (HUD), and HUD regulations often disqualify many Medicaid recipients. For instance, individuals with substance use disorders or recent release from incarceration might not meet HUD housing criteria. Moreover, federal housing programs target specific populations, such as veterans, foster children, and domestic violence survivors.
Reyneri acknowledges that merging the realms of health and housing is a gradual and ongoing process. States that are beginning to explore such integration are in the early stages of assembling the necessary pieces. Medicaid’s efforts and housing agencies’ initiatives are gradually converging, albeit in incremental steps.
The success of this endeavor will heavily depend on the approaches adopted by individual states. Transforming Medicaid into a key housing player will necessitate robust data sharing between the healthcare and housing sectors. The Centers for Medicare & Medicaid Services (CMS) will need to expand their data auditing efforts to encompass not only Medicaid outcomes and costs but also the availability of suitable short- and long-term housing options. Some states have already initiated experiments in this direction.
Reyneri cites California as an example, describing its efforts to share data across housing support providers, managed care plans, and Continuum of Care organizations. These initiatives involve Medicaid funds, capacity-building, and performance-incentive funds, along with state-level legislation establishing a health and human services data exchange framework.
Reyneri introduces the term “braiding,” which refers to the process of combining various funding sources to support public housing efforts. To establish Medicaid as a significant player in housing, this concept of braiding funds and resources will be crucial. Providers seeking Medicaid funding might need to engage with multiple managed care plans, assess enrollee eligibility, provide service authorization data, manage referrals, and handle billing. Different programs and funding sources each come with their eligibility, referral, authorization, and payment procedures.
Richard Stefanacci, from the Jefferson College of Population Health, acknowledges that while the new CMS guidelines enhance the feasibility of Medicaid’s involvement in housing, the concept is likely to remain mostly theoretical for the foreseeable future. He suggests that the chances of this becoming a reality are modest at best.
Currently, Medicaid’s role in housing is minimal, mostly focusing on home modifications and tenancy support for seniors and the disabled. Stefanacci echoes Reyneri’s sentiment that Section 1115 necessitates partnerships and addressing housing challenges, notably the limited availability of housing.
To participate in this effort, managed Medicaid plans should establish collaborations with housing agencies, coordinate referrals and data sharing, and connect members with community resources.
Stefanacci cites a successful example involving NewCourtland, a Philadelphia company, and the state PACE program. This partnership created affordable housing for the elderly in an economically disadvantaged area.
Paul B. Ginsburg, a professor at the University of Southern California, emphasizes that experimenting and evaluating different approaches will be crucial to effectively merge housing and Medicaid. He notes that federal housing program priorities often diverge from those that could benefit Medicaid beneficiaries the most.
Reyneri suggests that managed Medicaid housing could be a profitable niche for health plans. The payment structure would depend on state authority, but plans generally receive compensation for delivering services. This parallels other healthcare services they offer.
Stefanacci proposes that short-term housing assistance for high-risk members could generate savings for Medicaid-managed care plans, potentially outweighing initial costs. Even a small reduction in hospitalizations through stabilized housing could yield significant savings and improved outcomes.
Reyneri concludes by noting that while some level of housing support has always existed, the significant shift here is Medicaid’s potential to cover housing costs directly, marking a new avenue for the program.
