Can Medicaid Support Public Housing and Homeless Systems?- Come to Portland NAHRO to Find Out

Public Housing Authorities and the Medicaid system need to work together.  We are going to attempt to create a better common understanding in Portland on April 29th and April 30th.   The PNRC NAHRO conference will bring together Medicaid directors from 3 states.  Oregon, Washington and Arizona will send their directors to discuss affordable housing.  

Lets get back to the point.  If you read a CSH article, blog or research report and you will see that Medicaid is a major strategy within the homeless service delivery system.  It makes sense that Medicaid and the homeless systems align and work together as they serve so many of the same individuals.  In Medicaid expansion states, it is likely that 90%-95% of homeless individuals qualify for Medicaid.  A large part of these individuals especially the chronically homeless population suffer from an assortment of physical, mental and substance use issues that require clinical intervention.

Medicaid Understands Importance of Housing

On the Medicaid side, they are in a spot where they need to keep costs down.  It has now been proven that only 20% of a person’s overall health is tied to their clinical experiences like going to the doctor, hospital or a mental health professional.   The other 80% of a person’s health is tied to environmental factors like where they live, their careers, where they are born.  That makes housing a very important resource for individuals that are homeless.  The Medicaid system and their affiliated health plans are putting a large emphasis and in some cases investment into affordable housing.  Homeless individuals that are also Medicaid members can often be high cost and high needs.  That means that these individuals are higher cost to the Medicaid system and their health plans.  Homelessness drives many individuals to ignore their health issues and leads to escalation.  It is hard to take your medication that must be refrigerated when you are on the street.  It is hard to take medications for your behavioral health issues when you are sleeping on the street.

Medicaid and Public Housing Need Each Other

I do not think anyone will pretend that the Medicaid/Homeless service sector has figured it all out.  However; I think it is safe to say that the partnership has come a lot further than the Medicaid/Public Housing partnership.  Getting homeless individuals off the street is high priority but the question must now be asked, how about those who are currently housed?  Public housing and section 8 vouchers are often the housing of last resort.  When tenants of these housing programs get evicted or terminated, the street is often where many ends up.  If these terminations and evictions are based on untreated behavioral health issues, it is incumbent for the Medicaid and Public Housing industries to come together and figure this out.


Coming fresh out of the Medicaid system I can tell you very easily what the major challenges are.

  1. Privacy Issues- Sharing information is tough. There are many HIPPA rules which will make it tough for public housing authorities and Medicaid related agencies to share info.
  2. Funding- Yes Medicaid has billions of dollars. No, it is not an unlimited pool of money setup to run services just for your housing authority.  I will not pretend to understand the complexities, but each state Medicaid agency gives a certain amount of money to each health plan, CCO, MCO or whatever name is being used in your community.  Setting up a new partnership to provide services to your PHA will cost money.
  3. Staffing and Network Capacity- It is interesting to watch a healthcare system build up and provide a network of doctors, mental health professionals, para-professionals and nurses for their members. Scaling up and finding the right staff with the right skill sets to help people find and stay in housing is a network capacity issue.  This is somewhat new to the healthcare industry.


I do think that these challenges can be overcome.  However; the housing authority field will need to organize and learn how to talk to the Medicaid system.  Remember this is a two-way street.  What can you offer back?  Healthcare makes affordable housing look like basic math.  The complexity of that industry especially behavioral health is something to behold.   The quickest way to screw it up is for 13 public housing authorities in a state to start showing up at the doorsteps of health plans, behavioral health clinics and Medicaid systems separately.  The public housing industry is going to need to figure out a national and state-wide strategy in working with Medicaid.



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