How Medicaid Expansion Reduces Homelessness
The Key to Ending Homelessness in our Communities
The number of homeless individuals and families continues to grow each year in Alaska. For many of them, supportive housing is the solution. Supportive housing combines affordable housing with rehabilitative and treatment services to help people who need it the most—chronically homeless alcoholics.
Supportive housing can improve health and lower health care costs for homeless individuals. Medicaid expansion will allow Medicaid resources to be used more effectively to address the health care needs of homeless individuals by creating increased access to rehabilitative and treatment services for all Alaskans. Medicaid Expansion would not pay for housing, but it would pay for the housing retention case management services, and clinical services and reform the Medicaid rate system to provide a mechanism to fund permanent supportive housing.
According to a recent report by the Henry J. Kaiser Family Foundation entitled, “Early Impacts of the Medicaid Expansion for the Homeless Population,” Medicaid expansion offers a significant opportunity to increase coverage and improve access to care for individuals experiencing homelessness, who historically have had high uninsured rates and often have multiple, complex physical and mental health needs. The report describes the following benefits for states that have expanded Medicaid:
The expansion has led to significant increases in coverage that are contributing to improved access to care and broader benefits for homeless individuals; participants and data from the study sites indicate that the Medicaid expansion has led to significant gains in coverage among the individuals they serve, and participants said individuals have reduced financial stress and improved access to other services, including disability benefits.
Providers reported having access to a broader array of treatment options as a result of Medicaid coverage gains among their patients; with these increased options, providers said they are better able to provide care based on the best courses of treatment rather than based on the availability of charity or discounted resources.
Gains in Medicaid revenue are facilitating strategic and operational improvements focused on quality, care coordination, and information technology; administrators indicated that Medicaid revenue gains supported staff increases and led to changing staff roles to meet increased administrative and billing needs.
A report from the Center for Health Care Strategies, Inc. states that, for many individuals with complex chronic health conditions, homelessness and housing instability can be the most significant impediments to health care access, often resulting in excessive utilization of expensive inpatient and crisis services.
For these individuals, supportive housing offers an evidence-based solution to improve health outcomes while reducing costs. By providing stable affordable housing coupled with “high touch” supports that connect people with chronic health challenges to a network of comprehensive primary and behavioral health services, supportive housing can help improve health, increase survival rates, foster mental health recovery, and reduce alcohol and drug use among formerly homeless individuals.
In the state of Washington, the Low Income Housing Alliance launched an effort to help homeless and housing service providers better understand their role in the state’s expansion of Medicaid services, and ways to use the expansion to help reduce homelessness. Washington is one of several states that approved the expansion under the Affordable Care Act. Housing advocates there are initiating efforts to leverage Medicaid funds to increase supportive housing services. Medicaid expansion and supportive housing providers are working together to reduce chronic homelessness. By combining affordable and permanent housing with case management, primary and mental health care, substance abuse treatment, and employment, the homeless population is achieving greater stability and independence.
“This is exciting work. Bringing together the affordable housing and health care worlds is complex, but it offers so much possibility to move our state further toward ending homelessness,” said Michele Thomas, Director of Policy and Advocacy for the Housing Alliance. “There is growing awareness in the health care world that having safe, affordable housing is a key determinant of health. Now is the time to jump in. I urge other organizations to gather your members and start exploring the possibilities that Medicaid expansion offers.”
Medicaid expansion will provide benefits to many individuals experiencing homelessness who are currently uninsured, such as the residents served at Karluk Manor, the inaugural Housing First facility in Alaska. Those who gain Medicaid coverage experience significant improvements in their ability to access care and manage their health conditions. Increasing coverage among the homeless population has the potential to reduce their health care costs and to provide a source of funding for their care. Just as Housing First has reduced emergency room use, so too, does Medicaid expansion, by improving access to mental health, substance abuse, and primary care.
Medicaid expansion provides the missing link between health care and supportive housing. National and local research demonstrates that supportive housing improves health outcomes and reduces health care and other system costs for people who experience homelessness. A supportive housing services benefit as part of expanded Medicaid in Alaska would get homeless people off the streets and out of emergency rooms, saving money, saving lives, and supporting recovery in our communities.