The Washington Low Income Housing Alliance (the Housing Alliance), an NLIHC State Coalition Partner, has 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 alongside the District of Columbia that approved the expansion under the Affordable Care Act (ACA). Advocates now are gearing up efforts to leverage Medicaid funds to increase the supply of supportive housing.
Under the ACA, one-third of Washington’s population will be eligible for health care coverage through Medicaid expansion, 50% will be covered through employer-expanded benefits, and the remainder will pay for coverage through the state’s health care exchange. Medicaid expansion will add approximately 250,000 people 65 years and under to the state’s Medicaid rolls, in addition to 75,000 individuals who did not know they were eligible prior to the expansion.
The Housing Alliance has reached out to help state housing and homeless service providers understand how the expansion will benefit the individuals and families they serve. Providers have been encouraged to use their unique position to help eligible individuals enroll in the program. The Housing Alliance hosted several webinars to explain the basics of ACA and Medicaid expansion and enrollment. WLIHA also created a webpage that includes information about the expansion’s connection to supportive housing, the state’s federally funded network to help special needs populations enroll, and links to other important resources.
Often having severe and costly medical concerns, chronically homeless individuals have been heavy users of emergency health and criminal justice services. The state expects to save significant funds as these individuals will have fewer cost-associated barriers to health care. According to the Corporation for Supportive Housing (CSH), an NLIHC member, supportive housing results in decreased use of homeless shelters, hospitals, emergency rooms, jails and prisons. Advocates believe that Medicaid expansion and supportive housing can work together to reduce chronic homelessness in a deficit neutral way. This approach would be accomplished by combining affordable and permanent housing with case management, primary and mental health care, substance abuse treatment, employment, and other services that help people achieve stability and independence.
Although supportive housing is effective, there is pushback on its production because developers have reported difficulties in obtaining funding for services integral to the project. The Housing Alliance and its members, CSH, and state agencies are exploring ways to create a state Medicaid benefit for supportive housing services and direct the savings into the production or support of new homes.
The King County Department of Community and Human Services (KCDCHS) and CSH commissioned a 2011 case study that funded supportive housing through Medicaid. A Seattle supportive housing program was used to measure costs associated with treating formerly chronic homeless residents before and after they were housed. The study showed a significant reduction in public expenditures, primarily in Medicaid costs, once residents received the services. According to a 2013 joint report by KCDCHS, the Committee to End Homelessness in King County, and CSH, creating a supportive housing services benefit for homeless Medicaid beneficiaries could result in net state Medicaid savings of $1.28 million annually. Put another way, the state could save $1.51 in net Medicaid costs for every $1 spent on the benefit. Advocates suggest that direct Medicaid savings and other revenue generated by public crisis service savings be designated for supportive housing production.
Advocates hope to revise a 2011 House bill that would have appropriated $1 million for FY2012 and FY2013 solely for the production of supportive housing for chronically homeless individuals to improve public health and safety and reduce public spending, specifically related to Medicaid. Several state agencies objected to the concept, one reason why the legislation failed. However, the Housing Alliance reports that support is growing for the use of Medicaid funds or associated savings for supportive housing.
“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.”
For more information, contact Michele Thomas, Washington Low Income Housing Alliance, [email protected]