CW: Homelessness
States are investing billions of dollars in a risky health care experiment that is taking off across the country: using scarce public health insurance funds to provide housing for the poorest and sickest Americans.
According to the Centers for Medicare & Medicaid Services, at least 19 states are directing funds from Medicaid, the state-federal health insurance program for low-income people, toward housing assistance and addressing the nation’s rising homelessness epidemic.
Even though there is little consensus on whether this would provide a long-term solution for vulnerable patients’ health or housing, the Biden administration is encouraging additional states to participate.
Several are in the works, including Tennessee, West Virginia, and Montana, while New York received approval from the federal government in January.
California is allocating $12 billion to a program designed to help homeless people find housing, pay for it, and hopefully avoid eviction. Oregon is spending $1 billion on emergency rental assistance for the homeless, and even Arkansas will use $100 million in state Medicaid funds to assist people in finding housing.
Last year, homelessness in the United States climbed by 12% to an estimated 653,104 Americans, the highest figure on record, despite a significant increase in the country’s inventory of permanent housing and temporary shelter beds.
As people linger on the streets, frequently struggling from addiction, severe mental illness, and untreated chronic ailments, health care providers and political leaders are turning to health insurance funds for assistance. They contend that providing housing assistance will improve health and save public money by keeping individuals out of institutions like nursing homes, hospitals, and jails.
However, evidence shows mixed results. in a study conducted by researchers at the University of California-San Francisco, homeless people in Santa Clara County, California, who were randomly assigned to receive long-term housing and services used the psychiatric emergency department 38% less than a control group over four years while increasing their use of routine mental health care. However, participants remained hospitalized at a high rate and continued to rely on the emergency room for routine medical care and rest.
Across the country, state Medicaid programs are broadening the definition of health care and expanding into social services, providing a variety of benefits such as healthy home-delivered meals for diabetics and air filters for asthma patients. While the federal government previously prohibited the use of Medicaid funds for direct rent payments, this has changed.
Arizona obtained federal permission in 2022 for an effort known as “H2O,” which will prioritize homeless people and those at risk of losing their homes who either have a mental health problem or chronic illness. When it opens in October, it will focus on two services: rent payments for up to six months and transitional housing, which may include shelters with intensive assistance.
According to state data, the program reduced ER visits by 45% and hospital inpatient admissions by 53% six months after patients began receiving treatments, while boosting less costly preventative care by 56% and saving $4,300 per member each month.
These programs seem promising. However, more must be done to homeless Americans. More housing and shorter waitlists, job training, and other services are needed as well.
Sources:
Hart, Angela. “Is Housing Health Care? State Medicaid Programs Increasingly Say ‘Yes.’” California Healthline, KFF Health News, 5 Feb. 2024, californiahealthline.org/news/article/housing-homeless-medicaid-supports-waivers-health-insurance/amp/.
Raven, Maria C., et al. ‘A Randomized Trial of Permanent Supportive Housing for Chronically Homeless Persons with High Use of Publicly Funded Services’. Health Services Research, vol. 55, no. S2, John Wiley & Sons, Ltd, Oct. 2020, pp. 797–806, https://doi.org10.1111/1475-6773.13553.