I have worked most of my career in the public housing realm.  Whether it was learning a caseload and HQS in Walla Walla, running the MTW program and writing admin/acop plans in Tacoma or implementing mobile technology at the Seattle Housing Authority, my career has been PHA heavy.  I spent a few years in the European Union doing research on social housing in Germany, England, Scotland and the Netherlands.

In January of this year, I took a job as the housing administrator for the State of Arizona’s Medicaid Department.  I did not officially leave housing but the agency I work for is focused on healthcare.  As an agency, the State of Arizona’s Medicaid Department subsidizes over 3200 members with mental illness and or substance use disorder.  Leaving an affordable housing agency for a Medicaid Department has allowed me to learn some important lessons.

1. Medicaid Agencies Needs Public Housing Authorities and Vice-Versa:  State Medicaid Plans have thousands of their members living in public housing properties or using vouchers.  Medicaid needs those members to stay housed.  Without housing, medical interventions will increase as well as costs.  Public Housing Authorities are not equipped to handle the complex mental health and physical issues that many of their tenants have.  These two systems need each other to ensure happy, healthy and housed tenants/members.
2. Public Housing Authorities Can Be Confused By Multiple Health Plans- I have heard about some very innovative programs already in place in regards to housing and healthcare.  I will say that when I hear many housing authorities talk about who they are working with, they confuse a singular health plan with the Medicaid agency.  The partnerships are amazing but working with one health plan might limit options for your PHA.  If there are multiple health plans working in your state, you might not be partnering with all of the players.
3. Every Medicaid Agency is Different in Regards to Physical Housing:  Arizona has a lot of actual housing within it’s Medicaid system.  A lot of that is historical and based in a law suit.  In some states, the Medicaid program has zero housing but health plans have housing units.  Some health plan do rental subsidies, some provide capital money.  Some states have zero dollars for physical housing period regardless of the Medicaid system and health plans.  The point is, your PHA should be looking into your Medicaid system and the affiliated health plans to see what the options are.
4. Supportive Housing Services Are Available But Vary:  Even if a Medicaid agency has zero housing, there are probably some form of services and supports available.  That does not mean there is an unending pot of money for services, but there might be some opportunities to partner.  Go back to point 1.  PHAs and Medicaid Agencies share persons.  The Center for Medicaid Management allows for states to provide permanent supportive housing supports.  If your tenants at a PHA are at risk of losing housing, there might be some really good partnerships to be worked out.  Check out and understand the Medicaid waiver in your state to see what has been agreed upon.
5. Housing is Healthcare Movement is Real But All Over the Place:   Every state is a bit different in how far along they are in tying housing into healthcare.  I spoke with several states but there is a real push to work housing into the healthcare world.  Medicaid Agencies and maybe more importantly health plans understand housing can really drive member’s health outcomes and decrease costs.  The problem I see so far is the disjointed efforts with multiple health plans in multiple states all trying to define what social determinants will be tracked and how/if housing should be implemented.  One thing I feel strongly about is that the State needs to play a role in the overall tracking of social determinants data around housing.  I also think the state should play a role facilitating the discussions on what housing interventions and what data points should be key.  From my very limited experience, it seems like the innovation needs to come from the health plans.

Conclusion:  I am still at the very early stages of working in the Medicaid system but the change has been interesting.   The people I have met within Arizona and other states Medicaid Departments are dedicated and putting housing at the top of the agenda.  The health plans are enacting these thoughts and pushing their boundaries.  What have you seen in your work? Leave a comment.