The connection between housing and health outcomes has only become more prevalent in recent years. Now, the Medicaid and homelessness systems are coming together more prominently with the common goal of improving health outcomes through stable housing.
Many of the care costs for unhoused individuals are directly related to high utilization, with many individuals frequently using and returning to inpatient settings. This care access approach can often be tied back an individual's lack of stable housing. As a result, tenancy support services are considered medically-necessary for many of these individuals, who are often disabled and at-risk for or currently experiencing chronic homelessness. By using Medicaid funds for tenancy support services, more individuals can secure and remain in stable housing, which directly improves their health outcomes and reduces their care costs.
Medicaid funds tenancy support services
Traditionally, communities have used local tax dollars and homelessness program dollars to fund housing services. This has led to an under-funded, unsustainable model that leaves many unhoused individuals without sufficient support to obtain and maintain safe and affordable housing. Now, many states are partnering with Medicaid to pay for tenancy support services. These services not only help individuals find housing, but also free up tax dollars to meet other needs of the unhoused population.
While Medicaid does not pay for room and board, it does cover services that help individuals transition to and successfully maintain housing. Tenancy support services eligible for funding include housing search and application assistance, and eviction prevention to help address issues before they become a crises. And finding the right combination of organizations who offer these services is critical to creating lasting, sustainable change.
Pursuing state-wide tenancy support benefits
Helping individuals obtain and maintain housing reduces emergency care visits and costs. To make the case for funding these benefits, states first need demonstration of the potential cost savings. This includes presenting current cost data for unhoused individuals, the potential cost reductions that could be possible with supportive housing and overall health care cost savings. In Washington State, the UnitedHealthcare Community & State team is at the forefront of utilizing tenancy support services and is in its fourth year of demonstrating cost savings in pursuit of full, state-wide benefits. Other states that have similar demonstrations underway include Rhode Island, Minnesota and North Carolina.
States that do not currently have demonstrations must first get an approved waiver from the Centers for Medicare and Medicaid Services (CMS) to establish their pilot programs. Those already engaged in a pilot program can continue to pursue full state-wide benefits, in part by working with community-based organizations.
As states begin to realize the opportunity to receive Medicaid funding to help their unhoused populations, the biggest hurdle is often forming new partnerships with organizations who can provide tenancy support services. For many states, this could mean partnering with non-traditional medical partners in the housing space — and for those provider partners may explore contracting with Medicaid for the first time.
Building up community-based organizations to provide tenancy services
Capacity and capability restrictions are common barriers for many community-based organizations that can provide these Medicaid-funded tenancy support services. This includes not having the licensing or credentialing and contracting capabilities that are required to partner with Medicaid. States that pursue Medicaid tenancy support funding must work to build capacity for these community-based organizations and provider partners to ensure they meet the requirements to provide Medicaid benefits.
Coordinating these medical and nonmedical services will be critical to lowering care costs and improving health outcomes for today’s unhoused populations. As UnitedHealthcare Community & State continues to pursue efforts to make tenancy support services more accessible, we will also continue to help position community-based organizations and provider partners to offer these services through Medicaid funding.