States See Ending Chronic Homelessness as Important to Medicaid Goals

Evidence that permanent supportive housing improves health and lowers health care costs is spreading.   Just recently, Congressman Paul Ryan’s assessment of Federal anti-poverty efforts, while critical of many Federal programs, noted that supportive housing programs “have been shown to decrease homelessness and reduce costs related to health care and institutionalization.” 

New developments now indicate that this evidence on permanent supportive housing has reached the health care sector as well.  As states and health policymakers seek ways to achieve better health outcomes while containing Medicaid costs, more and more are realizing that ending chronic homelessness through permanent supportive housing should be part of their strategy.  

 

  • Last week, HUD invited Dr. Jeffrey Brenner of the Camden Coalition of Health Care Providers to discuss his groundbreaking “hot spotting” work, through which he found that the highest cost users of health care services in the city of Camden were living in HUD-assisted housing or experiencing significant housing challenges and homelessness. Through this work, he discovered that in order to improve the health of people with complex health needs and lower costs, health care must also address housing and social circumstances. “Many of the patients we identified are the same chronically homeless people you have been working to house,” Dr. Brenner explained. For these individuals, he added, “housing is the best pill.”
  • In their guest blog, Dr. Kelly M. Doran and Dr. Roberta Capp discuss their research that found significant rates of homelessness among emergency department and hospital “super users.” For these individuals, they argue, the traditional tools used by the health care system, like care coordination and patient navigation, will be inadequate to contain costs and achieve better health.  Instead, the authors note that “supportive housing should be considered a critical element of any effort to reduce frequent hospital use for patients who are homeless.” 
  • The National Governors Association (NGA) Center on Best Practices recently launched the Developing State-Level Capacity to Support Super-Utilizers policy academy to improve the State-level response to Medicaid “super-utilizers”—the small subset of beneficiaries that consume a disproportionate share of Medicaid costs. Six states, including Alaska, Colorado, Kentucky, New Mexico, West Virginia, and Wisconsin, along with the territory of Puerto Rico, were selected to participate. At the launch of the policy academy, participating states and national experts recognized how homelessness and housing crises contribute to frequent emergency room visits and hospitalizations. In February, at NGA’s request, HUD and USICH provided a training session to participating state teams on permanent supportive housing.