Medicaid-Financed Services in Supportive Housing for High-Need Homeless Beneficiaries

Homelessness and housing instability are significant impediments to health care access and improved
health for people with complex conditions, often resulting in high utilization of expensive inpatient and crisis services. Supportive housing can improve their health outcomes while reducing costs.

By providing stable affordable housing coupled with “high touch” supports that engage and connect people with chronic health conditions to a network of comprehensive primary and behavioral health services, supportive housing can help increase survival rates; reduce inpatient utilization; foster mental health recovery; and reduce alcohol and drug use among formerly homeless individuals. With interagency support, state Medicaid programs could implement “high touch” case management
in supportive housing for low-income adults in 2014.

Key Points:

  • The Medicaid expansion under the Affordable Care Act will provide new insurance coverage to the estimated 1.2 million individuals in the United States who are homeless, including the roughly 110,000 who are chronically homelessness, and more likely to have chronic and complex health conditions.
  • Medicaid-financed care management in supportive housing for high-risk homeless Medicaid beneficiaries could yield a significant return on investment from reduced hospitalizations and emergency department use.
  • Growth in Medicaid managed care for these high-need individuals, particularly after 2014, will expand opportunities to capitalize on care management linked to supportive housing with the prospect for sharing associated savings across providers, health plans, and states.
  • States could consider designing Medicaid-financed, supportive housing-based care management services to improve care for at-risk beneficiaries while lowering costs associated with avoidable hospitalizations and other crisis services.