Many people are shocked to learn that Arizona’s Medicaid Department ((AHCCCS) plays such a large role in the affordable housing and homeless world.  In many ways, the role has increased in the last year and will continue to grow.  Arizona is not the only Medicaid system where housing subsidy and development are embedded.  States like New York and North Carolina are leaning on their Medicaid Departments to take a more active role in housing and homelessness.   As you learn more about the Medicaid  system, Social Determinants of Health (SDOH) and the affect of housing on health, it makes more sense to embed more housing programs directly with the health care sector.   Lets look at 5 reasons:

1. Services- Medicaid organizations can leverage their network of health plans and providers for supported housing services.  Most of these services can be billed back to Medicaid.  This is a huge benefit as housing navigation and housing stability are two of the largest factors facing those who are hard to house.   Medicaid services can include driving a homeless person around to look for apartments and helping sign a lease.  Services can range from helping a person keep their apartment clean to mitigating hoarding and other anti-social behavior.  With Medicaid expansion taking place in most states, a majority of low-income and homeless individuals qualify for Medicaid and probably supported housing services.
2. Care Coordination-  Having your housing programs located within a Medicaid system allows for coordination of care that cannot be replicated.  Many of the issues that face lower income individuals and the homeless relate to their physical and behavioral health.  A housing authority or department of housing simply cannot coordinate the services in a way that will be meaningful.  If your Medicaid Department is running point on a rental subsidy program, they can ensure that housing is not only taken care of but the mental health and acute care is in place.
3. Stability and Retention Rate- Because the services are embedded with the housing, many  housing programs with Medicaid oversight are seeing high housing retention rates.  In Maricopa County alone, the retention rates for programs serving those who are seriously mentally ill are as high as 95% .  The clinical staff that work with these individuals develop relationships that allow them to treat and stabilize individuals who might struggle in housing otherwise.   Medicaid Departments can also contract to bring in companies to monitor fidelity to important indicators of success like housing first.
4. Implementation and Innovation – A State Medicaid plan has the ability to lean on their health plans which can breed innovation.  Because of the nature of contracting and ensuring networks are sufficient, health plans do a good job of standing up programs quickly and with low costs.  Working through a health plan allows the Medicaid Department to leverage their contracting departments, legal departments and business strategy.  In Arizona, we have seen unique partnerships with housing authorities and the homeless systems come to fruition.
5. Overall State Cost Savings- Running affordable housing and homeless programs through a Medicaid Department allows the state to realize cost savings on the healthcare side.  When housing high cost/high needs individuals, it is not uncommon to see hundreds of thousands of dollars in healthcare costs reductions.  Some homeless individuals in the Phoenix metro area have utilized the emergency room as many as 300 times in one year.  It is much easier to complete research studies and understand the overall affects on cost of the housing programs are already within the Medicaid program.

What programs have you seen within housing and healthcare?  Leave a comment.