• <div class="header-image" style="background-image: url(/live/image/gid/4/2635_V6N3_Header.rev.1522162449.jpg);">​</div><div class="header-background-color"/>

Housing is the Best Health Care

August 05, 2016
Emerging research continues to link poor housing quality and stability to poor health outcomes, high healthcare costs and higher utilization of expensive public services. Conversely, the presence and availability of safe and affordable homes show a marked reduction in these high costs and chronic diseases, leading to healthier families and communities.[1]

By Vanessa Kopp, MA’16

This connection between health and housing has worked its way into landmark legislation such as the Affordable Care Act (ACA). With the ACA and optional Medicaid expansion entering the full breadth of implementation, states are beginning to facilitate partnerships among healthcare and housing providers. Healthcare and housing have traditionally operated in a siloed capacity, yet their patients and clients are often the same. Ultimately, the fields of housing and healthcare need each other to provide quality care and stability for the most vulnerable in our society.

Supportive housing is the emerging housing model to meet this need and merge these fields through affordable or subsidized housing and intensive support services; however, communities and states are finding it difficult to bring supportive housing to scale. The ACA and Medicaid answer this concern through renewed funding streams and an expanded definition of possible services available for Medicaid reimbursement.

Medicaid

Under the Affordable Care Act, the Center for Medicaid and Medicare Services (CMS) incentivizes states to apply for research and demonstration waiver to test and evaluate new Medicaid programs or delivery systems in their states under the condition of cost neutrality. The ACA also offers states the option to expand Medicaid to include single adults with incomes below 138% of the federal poverty level.[2]In return, the federal government will cover a percentage of funds spent on Medicaid beneficiaries through the Federal Medical Assistance Percentage (FMAP). This offers states the ability to insure individuals who were previously ineligible for Medicaid coverage, [3][4] while increasing the potential funding for effective programs and supportive services through waivers and amendments to a state’s Medicaid State Plan. [5] It is through demonstration waivers that the affordable housing and homeless provider network can increase the available supportive services for individuals and families. The Center for Medicaid and Medicare Services released an Informational Bulletin clarifying the types of services reimbursable by Medicaid. The bulletin is explicit: Federal Medicaid dollars can’t cover rent or building costs but can potentially be reinvested into other state funding sources to cover these costs. Federal Medicaid will also cover services deemed medically necessary including tenancy support services, long-term supportive services (LTSS), home and community-based services, targeted case management and more.[6]Many of these services are the stabilizing agents for individuals who could not access or maintain housing without them. Through a State Plan Amendment (SPA) or waiver, states can expand services to reach target populations or enhance the structural components of their Medicaid plans. Also, states that choose not to expand Medicaid can still access funding for services through state plan amendments and waivers.

Supportive Housing

Supportive housing is a combination of rental subsidies and supportive services designed to meet the complex barriers preventing individuals and families from accessing and maintaining housing. These include pre-tenancy and tenancy-sustaining services, case management, treatment for s

Affordable Housing ubstance abuse disorders and/or mental illnesses, medication management, assessments, referrals, job skills training, academic support and more. tudies show that individuals who are experiencing chronic homelessness and housing instability, or those moving in and out of an institutional setting such as prison or mental health hospitals, demonstrate a higher likelihoods of developing chronic physical and behavioral health conditions. This includes HIV/AIDS, hypertension, diabetes, and substance abuse disorders. The fluidity of an individual’s housing circumstances can lead these highly vulnerable people to face complications and interruptions in treatment, becoming the highest utilizers of emergency medical care. [8]  Study after study continues to demonstrate the inextricable link between a lack of housing and a high utilization of health care services. Statewide analyses show a marked decrease in emergency health care and Medicaid costs when housing, in tandem with supportive services, is accessible and widely available.[9]  The ACA responds that it is “designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living.” [10]  Ultimately, the ACA, Medicaid, and supportive housing are moving integrated care to the forefront of ending chronic homelessness and developing healthier communities.

CSH-The Source for Housing Solutions

CSH- The Source for Housing Solutions 

At CSH we work across four primary business lines: training and education, lending, consulting and assistance, and policy reform with the goal of using housing as a platform for services that improve the lives of the most vulnerable, maximize public resources and build healthy communities. My role at CSH is to help providers and consumers across multiple sectors easily understand the complexities of the healthcare and housing fields and to provide tools for advocacy at all levels. As an intern for the National Consulting Services team at CSH, I am privileged to observe the inner workings of an organization dedicated to partnering with legislators, state administrative officials and supportive housing providers and advocates as well as communities as we communities to build a stronger, healthier, more sustainable future for those who need it most.  

 

  [1] State Payment and Financing Models to Promote Health and Social Service Integration, CHCS, Inc., 2015

 

  [2] Medicaid Expansion and What It Means For You

 

  [3] Medicaid and the Children’s Health Insurance Program (CHIP) currently insure an estimated 31 million children including half of all low-income children, 11 million non-disabled adults including pregnant women and low-income            parents, more than 8.8 million non-elderly individuals with disabilities, and over 4.6 million low-income seniors.https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html

  [4] Medicaid Expansion, coverage extends to all households with an annual income of 138% below the poverty line regardless of the other factors traditionally used to determine eligibility. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/eligibility.html

  [5] Medicaid State Plan is a contract between the federal and state government that outlines who is eligible for Medicaid, covered medical and health-related services, payment methods, and prover requirements. 

  [6] CMCS Informational Bulletin, 2015

  [7] A Quick Guide to Improving Medicaid Coverage for Supportive Housing Services, CSH and USICH, 2015

  [8] Medicaid-Financed Services in Supportive Housing for High Need Homeless Beneficiaries: The Business Case, CHCS, 2012

  [9] Housing is the Best Medicine, CSH, 2014

  [10] HHS.gov- Building Healthier Communities by Investing in Prevention

Student Blog Disclaimer
  • The views expressed on the Student Blog are the author’s opinions and don’t necessarily represent the Penn Wharton Public Policy Initiative’s strategies, recommendations, or opinions.

PENN WHARTON PPI
RESOURCE SPOTLIGHT:

  • <h3>National Bureau of Economic Research (Public Use Data Archive)</h3><p><img width="180" height="43" alt="" src="/live/image/gid/4/width/180/height/43/478_nber.rev.1407530465.jpg" class="lw_image lw_image478 lw_align_right" data-max-w="329" data-max-h="79"/>Founded in 1920, the <strong>National Bureau of Economic Research</strong> is a private, nonprofit, nonpartisan research organization dedicated to promoting a greater understanding of how the economy works. The NBER is committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community.</p><p> Quick Link to <strong>Public Use Data Archive</strong>: <a href="http://www.nber.org/data/" target="_blank">http://www.nber.org/data/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The World Bank Data (U.S.)</h3><p><img width="130" height="118" alt="" src="/live/image/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg" class="lw_image lw_image484 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 2x, /live/image/scale/3x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 3x" data-max-w="1406" data-max-h="1275"/>The <strong>World Bank</strong> provides World Development Indicators, Surveys, and data on Finances and Climate Change.</p><p> Quick link: <a href="http://data.worldbank.org/country/united-states" target="_blank">http://data.worldbank.org/country/united-states</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Congressional Budget Office</h3><p><img width="180" height="180" alt="" src="/live/image/gid/4/width/180/height/180/380_cbo-logo.rev.1406822035.jpg" class="lw_image lw_image380 lw_align_right" data-max-w="180" data-max-h="180"/>Since its founding in 1974, the Congressional Budget Office (CBO) has produced independent analyses of budgetary and economic issues to support the Congressional budget process.</p><p> The agency is strictly nonpartisan and conducts objective, impartial analysis, which is evident in each of the dozens of reports and hundreds of cost estimates that its economists and policy analysts produce each year. CBO does not make policy recommendations, and each report and cost estimate discloses the agency’s assumptions and methodologies. <strong>CBO provides budgetary and economic information in a variety of ways and at various points in the legislative process.</strong> Products include baseline budget projections and economic forecasts, analysis of the President’s budget, cost estimates, analysis of federal mandates, working papers, and more.</p><p> Quick link to Products page: <a href="http://www.cbo.gov/about/our-products" target="_blank">http://www.cbo.gov/about/our-products</a></p><p> Quick link to Topics: <a href="http://www.cbo.gov/topics" target="_blank">http://www.cbo.gov/topics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>NOAA National Climatic Data Center</h3><p><img width="200" height="198" alt="" src="/live/image/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg" class="lw_image lw_image483 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 3x" data-max-w="954" data-max-h="945"/>NOAA’s National Climatic Data Center (NCDC) is responsible for preserving, monitoring, assessing, and providing public access to the Nation’s treasure of <strong>climate and historical weather data and information</strong>.</p><p> Quick link to home page: <a href="http://www.ncdc.noaa.gov/" target="_blank">http://www.ncdc.noaa.gov/</a></p><p> Quick link to NCDC’s climate and weather datasets, products, and various web pages and resources: <a href="http://www.ncdc.noaa.gov/data-access/quick-links" target="_blank">http://www.ncdc.noaa.gov/data-access/quick-links</a></p><p> Quick link to Text & Map Search: <a href="http://www.ncdc.noaa.gov/cdo-web/" target="_blank">http://www.ncdc.noaa.gov/cdo-web/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The Penn World Table</h3><p> The Penn World Table provides purchasing power parity and national income accounts converted to international prices for 189 countries/territories for some or all of the years 1950-2010.</p><p><a href="https://pwt.sas.upenn.edu/php_site/pwt71/pwt71_form.php" target="_blank">Quick link.</a> </p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>MapStats</h3><p> A feature of FedStats, MapStats allows users to search for <strong>state, county, city, congressional district, or Federal judicial district data</strong> (demographic, economic, and geographic).</p><p> Quick link: <a href="http://www.fedstats.gov/mapstats/" target="_blank">http://www.fedstats.gov/mapstats/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>USDA Nutrition Assistance Data</h3><p><img width="180" height="124" alt="" src="/live/image/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg" class="lw_image lw_image485 lw_align_right" srcset="/live/image/scale/2x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 2x, /live/image/scale/3x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 3x" data-max-w="1233" data-max-h="850"/>Data and research regarding the following <strong>USDA Nutrition Assistance</strong> programs are available through this site:</p><ul><li>Supplemental Nutrition Assistance Program (SNAP) </li><li>Food Distribution Programs </li><li>School Meals </li><li>Women, Infants and Children </li></ul><p> Quick link: <a href="http://www.fns.usda.gov/data-and-statistics" target="_blank">http://www.fns.usda.gov/data-and-statistics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Center for Education Statistics</h3><p><strong><img width="400" height="80" alt="" src="/live/image/gid/4/width/400/height/80/479_nces.rev.1407787656.jpg" class="lw_image lw_image479 lw_align_right" data-max-w="400" data-max-h="80"/>The National Center for Education Statistics (NCES) is the primary federal entity for collecting and analyzing data related to education in the U.S. and other nations.</strong> NCES is located within the U.S. Department of Education and the Institute of Education Sciences. NCES has an extensive Statistical Standards Program that consults and advises on methodological and statistical aspects involved in the design, collection, and analysis of data collections in the Center. To learn more about the NCES, <a href="http://nces.ed.gov/about/" target="_blank">click here</a>.</p><p> Quick link to NCES Data Tools: <a href="http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4" target="_blank">http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4</a></p><p> Quick link to Quick Tables and Figures: <a href="http://nces.ed.gov/quicktables/" target="_blank">http://nces.ed.gov/quicktables/</a></p><p> Quick link to NCES Fast Facts (Note: The primary purpose of the Fast Facts website is to provide users with concise information on a range of educational issues, from early childhood to adult learning.): <a href="http://nces.ed.gov/fastfacts/" target="_blank">http://nces.ed.gov/fastfacts/#</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Reserve Economic Data (FRED®)</h3><p><strong><img width="180" height="79" alt="" src="/live/image/gid/4/width/180/height/79/481_fred-logo.rev.1407788243.jpg" class="lw_image lw_image481 lw_align_right" data-max-w="222" data-max-h="97"/>An online database consisting of more than 72,000 economic data time series from 54 national, international, public, and private sources.</strong> FRED®, created and maintained by Research Department at the Federal Reserve Bank of St. Louis, goes far beyond simply providing data: It combines data with a powerful mix of tools that help the user understand, interact with, display, and disseminate the data.</p><p> Quick link to data page: <a href="http://research.stlouisfed.org/fred2/tags/series" target="_blank">http://research.stlouisfed.org/fred2/tags/series</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Aviation Administration: Accident & Incident Data</h3><p><img width="100" height="100" alt="" src="/live/image/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg" class="lw_image lw_image80 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 2x, /live/image/scale/3x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 3x" data-max-w="550" data-max-h="550"/>The NTSB issues an accident report following each investigation. These reports are available online for reports issued since 1996, with older reports coming online soon. The reports listing is sortable by the event date, report date, city, and state.</p><p> Quick link: <a href="http://www.faa.gov/data_research/accident_incident/" target="_blank">http://www.faa.gov/data_research/accident_incident/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Internal Revenue Service: Tax Statistics</h3><p><img width="155" height="200" alt="" src="/live/image/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg" class="lw_image lw_image486 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg 2x" data-max-w="463" data-max-h="596"/>Find statistics on business tax, individual tax, charitable and exempt organizations, IRS operations and budget, and income (SOI), as well as statistics by form, products, publications, papers, and other IRS data.</p><p> Quick link to <strong>Tax Statistics, where you will find a wide range of tables, articles, and data</strong> that describe and measure elements of the U.S. tax system: <a href="http://www.irs.gov/uac/Tax-Stats-2" target="_blank">http://www.irs.gov/uac/Tax-Stats-2</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>HUD State of the Cities Data Systems</h3><p><strong><img width="200" height="200" alt="" src="/live/image/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg" class="lw_image lw_image482 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 3x" data-max-w="612" data-max-h="613"/>The SOCDS provides data for individual Metropolitan Areas, Central Cities, and Suburbs.</strong> It is a portal for non-national data made available through a number of outside institutions (e.g. Census, BLS, FBI and others).</p><p> Quick link: <a href="http://www.huduser.org/portal/datasets/socds.html" target="_blank">http://www.huduser.org/portal/datasets/socds.html</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>