Some states have begun a novel experiment: diverting health care funds for housing assistance.
States are plowing billions of dollars into a high-stakes health care experiment that’s exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans.
At last count nearly 40% of states – 19 so far – are diverting funds from Medicaid into housing assistance. The Biden Administration is encouraging others to follow. Including those in the pipeline, nearly half of states are experimenting with using Medicaid funds for housing assistance to some degree.
California is going the biggest, pumping $12 billion into an ambitious Medicaid initiative largely to help homeless patients find housing, pay for it, and avoid eviction. Arizona is allocating $550 million in Medicaid funding primarily to cover six months of rent for homeless people. Oregon is spending more than $1 billion on services such as emergency rental assistance for patients facing homelessness. Even ruby-red Arkansas will dedicate nearly $100 million partly to house its neediest.
There is little agreement – perhaps the word delusions is a better description – about whether this will provide a long-term fix, or even a temporary one. Is housing synonymous with health care? Does housing even directly affect health status? If Medicaid is to remain a health entitlement for the poor these are important questions.
As people languish on the streets, often struggling with addiction, severe mental illness, and untreated chronic diseases, health care officials and political leaders are turning to health insurance money for relief. They argue that housing aid will improve health and save taxpayer money by keeping people out of institutions such as nursing homes, hospitals, and jails.
But evidence supporting this argument is mixed.
Experiments so far have found housing services for the homeless are more of a band aid than a cure-all. Most rental assistance programs are time limited to six months and are only available once in a lifetime (literally, not figuratively). Some advocates worry Medicaid beneficiaries already experience too many barriers to care without diverting resources for housing. Others worry about whether housing assistance is the best use of scarce resources.
Sherry Glied, a professor at New York University and former Obama administration official who is an expert in health care economics, warned in a recent health policy analysis of mission creep in health care. She cautioned that health care institutions getting into the business of social services could be a “dangerous distraction.”
“Providing people with food or housing is pretty far removed from the core mission of health care,” she told KFF Health News.
State Medicaid programs fund about two-thirds of nursing home care and a significant proportion of home care. Medicare does not fund long-term care other than a limited number of days while Medicare patients recuperate after hospital stays or convalesce after procedures. Nursing home care (often in a skilled nursing facility when treating convalescing seniors) is cheaper than remaining in a hospital when seniors are too ill to return home immediately. But what about chronically ill homeless people who cycle in and out of emergency rooms? In some experiments housing reduced ER visits and other care, but does not eliminate it to any significant degree. That blurs the lines between health and housing but neither one is a fix for the other. This is where it gets scary listening to the excuses made for calling housing assistance health care.
…states say they’re committed — even if their initiatives don’t pass a traditional cost-benefit analysis.
“The singular focus on a financial return on investment is not as clear as it was previously,” said Cindy Mann, a federal Medicaid director under Obama.
“States are just seeing how little sense it makes to treat people and then release them back to the streets without the support they need.”
Another problem I see is that health care agencies are not necessarily experts in housing. In addition, their solutions are not groundbreaking, unless you consider giving money to homeless people for a limited time groundbreaking. It runs the risk of creating a very costly entitlement similar to nursing home care years before people are actually incapable of caring for themselves. Housing requires different solutions that health care. Mission creep is an apt description.
The entire article is worth reading. It’s also somewhat infuriating: Is Housing Health Care? State Medicaid Programs Increasingly Say ‘Yes’