Housing is the Best Health Care
August 05, 2016
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.
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.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,  while increasing the potential funding for effective programs and supportive services through waivers and amendments to a state’s Medicaid State Plan.  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.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 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
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.  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. 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.”  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
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.
 State Payment and Financing Models to Promote Health and Social Service Integration, CHCS, Inc., 2015
 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
 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
 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.
 CMCS Informational Bulletin, 2015
 A Quick Guide to Improving Medicaid Coverage for Supportive Housing Services, CSH and USICH, 2015
 Housing is the Best Medicine, CSH, 2014
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