Eight States Lead the Way ā€“ Breaking the Path for Health and Housing System Integration

By its nature, path-breaking work is hard. But, in spite of the challenges, that is exactly what the states participating in the Medicaid-Housing Agency Partnership effort have been doing – breaking the path for future state-level integration of health, behavioral health, and housing systems to scale supportive housing to end chronic homelessness and to transition people from institutions back into communities.

In October, federal and national partners brought the eight participating states – California, Connecticut, Hawaii, Illinois, Kentucky, New Jersey, Nevada, and Oregon – back together in Washington, D.C., to wrap up six months of intensive program support. As a result of their hard work, all eight states were able to report plans to expand the stock and availability of supportive housing units, and the majority noted that they are seeking to optimize opportunities through their state Medicaid program to support housing stability and tenancy. State teams also further solidified important interagency partnerships and made plans to institutionalize their work through existing channels that will live beyond the program support offered by the federal partners. More assistance is available to them through the month of December.

Study after study has shown that supportive housing is an effective intervention for people with low incomes, complex health needs, and long histories of homelessness. Not only does it improve housing stability and health outcomes and reduce the use of crisis services, but supportive housing also lowers public costs.

Guidance issued by HHS last year on Medicaid-covered housing-related activities has been game changing for states. It clarifies the circumstances under which Medicaid can cover services like case management, rehabilitative services, services coordination, and coordination with other social supports, and then how to align those services with housing to create supportive housing. But, at the same time, we know that the majority of states need additional help to take advantage of these options and to break down the silos between their health care and housing agencies.

So last year, we and our partners at HHS, HUD, and a few key national organizations, set out to do just that — to provide direct support to help states strengthen collaboration between state Medicaid, housing, and behavioral health agencies, and to use existing authorities within their Medicaid plans to support case management and other services in supportive housing. The Medicaid-Housing Agency Partnership effort was launched in spring 2016. Since that time, participating states have worked intensively with a core team of experts to conduct gaps analyses and action planning focused on aligning these systems.

Our partners at National Governors Association have also been working with nine states — Alaska, Colorado, Connecticut, Kentucky, Michigan, New Mexico, Rhode Island, West Virginia, Wisconsin, and Wyoming —  plus Puerto Rico, to develop statewide plans to create or advance programs that improve outcomes and reduce public costs for Medicaid enrollees who are frequent users of crisis health services. Through their effort, they’ve developed Housing as Health Care: Road Map for States, which provides step-by-step guidance that supports state-level planning for increasing the role of housing in improving health outcomes and reducing the use of expensive health care services.

Path breaking may be hard, but this initiative has shown — and is continuing to show — that a real, lasting commitment to collaboration is the right path to success.