Recently, the Department of Health and Human Services (DHHS) approved a plan to expand health-related social needs (HRSN) covered by Medicaid to include housing. The reason is that lack of housing “can create physical, social, or emotional conditions that are counterproductive to the otherwise positive effects of the health services an individual receives, including through Medicaid.” I have argued that people struggling with a range of health issues, especially mental health and addictions, housing can be part of health and lasting recovery. Does it make sense to add the complexities of Medicaid to a housing assistance solution? It could. It is worth looking at the demonstration project approved in Massachusetts and Oregon.
As with most things done by government, expanding HRSN coverage is extremely complicated and a challenge to understand. Time magazine billed the approval as the first time Medicaid would be used to cover the impacts of climate change, as it would allow payment for things like air conditioning. Ok, that’s certainly one way to look at the extensive set of documents accompanying the announcement for the two affected states, Massachusetts and Oregon.
But without getting bogged down in the details, what about the idea? First, it’s important to outline how Medicaid works. The program is governed by federal mandates, but is implemented at the state level and generally operates on a reimbursement model. States receive funding, and then schedules are developed for which types of things are “covered” by the program, like any other health insurance program. There are things like capitation, “a contracted rate based on the total number of eligible people in a service area. Funding is provided in advance, creating a pool of funds from which to provide services. You can learn more about Medicaid funding at the Centers for Medicare and Medicaid Services (CMS).
Based on my own experience in Washington State working at a Federal Qualified Health Center (FQHC), many states have created rules that support a community clinic model of Medicaid service delivery. Clinics enroll their eligible clients based on income and other factors, then manage their care at the capitation rate; the less health problems there are, the less use there is, and therefore some value recovered from the prepaid tariff. It’s a model that has inspired nonprofit clinics to become entrepreneurial in keeping their clients healthy through prevention and cost savings. The success of the system depends on the level of reimbursement and the efficiency of management.
The new rules would essentially add housing costs to eligible customers as one of the “covered” items, such as an annual checkup or treatment for high blood pressure. The new directive would include “transitional housing supports for people in clinical need or transitioning out of institutional care, congregate settings, homelessness or homeless shelter, or the welfare system. ‘childhood. They also include case management, outreach and education, and infrastructure investments, to support these services.
Specifically, enclosure element coverage includes,
1. Rental or temporary accommodation for up to 6 months,
3. Pre-tenancy and tenancy maintenance services, including tenant rights education and eviction prevention;
4. Housing Transition Navigation Services;
5. One-time transition and relocation costs;
6. Accommodation deposit, administration and inspection fees;
7. Medically necessary air conditioners, heaters, humidifiers, air filtration devices, generators and refrigeration units; and
8. Medically necessary repairs and upgrades to the ventilation system, and removal of mold and pests
I am completely opposed to item number 3 because it only adds to the foment of a really rare thing, expulsion. In fact, if HHS wanted to deal with deportation, it would rewrite the rules to allow reimbursement to prevent deportation by paying the amount in dispute. It wouldn’t cost that much since there are few evictions as a percentage of rental units.
Generally, though, I think all of these things make sense. Yes, that’s more money pumped into an already inflationary economy. But that’s better than billions to buy land, build, and then manage housing forever. In addition, temporary housing is intended for,
“Individuals leaving residential care or congregate settings such as nursing homes, large group homes, congregate residential facilities, mental health facilities (IMD), correctional facilities and acute care hospitals ; people who are homeless, at risk of homelessness or coming out of an emergency shelter.
Today, elected officials are being pressured into passing wasteful, wasteful legislation to do things like ban credit checks, criminal background checks, and seal evictions. It doesn’t help pay the rent. This use of Medicaid would help pay rent as part of broader treatment, aiding recovery and shoulder health rather than mistakenly assuming that struggling people are one apartment key away. to be completely healthy and sustainable.
In Ohio, discussions are already underway about how to link housing to health. But the wise thing to do is not to demand that housing providers become healthcare providers with more requirements and limits on housing operations, but to support general health and well-being. people eligible for Medicaid.
It makes sense that someone coming out of treatment for, say, drug addiction would be enrolled in a Medicaid program anyway. It would be an added value if, at the end of the treatment, the person could also access help to find accommodation; and that help wouldn’t be a brochure and a waiting list application, but actual funds to pay a deposit, application fees and the first six months’ rent. It’s a sustainable way to solve housing problems for people with health issues, not mandates to ban credit checks or other mandates. Finally, mold can be a serious and costly problem. States like Ohio are starting to demolish homes with mold issues. It doesn’t make sense if there is a way to repair these houses for use. These funds could help.
Ultimately I’m skeptical but hopefully maybe in Oregon and Massachusetts some smart people will find a way to use this demonstration project to promote creativity and innovation, funneling the funds in a way that shows how more direct subsidies rather than housing construction can really address serious housing challenges compassionately and effectively. There’s a big evaluation element written into the new rules, so hopefully we’ll see a lot of data soon.
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