Medicaid waivers help states pilot solutions to health, housing disparities
Keith Mitchell, Jr., 47, L, speaks with fellow homeless shelter resident, Ben Ralston, 52, at the Siena Francis House in Omaha, Nebraska, on Wednesday, May 2, 2018. Jahi Chikwendiu/The Washington Post via Getty Images
If approved, Nebraska’s Section 1115 Medicaid waiver would help finance two medical respite centers, or post-hospital recovery centers, for individuals experiencing homelessness.
When the pandemic hit, health care inequities became too obvious for policymakers to ignore, sparking increased attention on ways to mitigate the gap between vulnerable populations, particularly those without a home, and essential health services.
But adjusting health care services to meet society’s rapidly changing needs is a risky business, and states might hesitate to make changes without reassurance that it’ll be worth the time and money in the end.
That’s why several states have turned to Section 1115 Medicaid waivers, which they can use to test new ways to deliver and pay for health care services for Medicaid recipients. “The 1115 waiver is a demonstration waiver that basically says, ‘We’re going to use this period of time to try something different with our Medicaid dollars and see what type of impact it has,” said Julia Dobbins, director of programs and services at the National Institute for Medical Respite Care.
The waivers are helping states pilot programs like medical respite centers, she said. These facilities provide temporary shelter for unhoused individuals who were recently discharged from a hospital but still require low-level care, such as physical therapy or wound dressing.
Typically, a patient leaving the hospital who still needs additional care goes to a long-term care or assisted living facility. But many unhoused individuals do not qualify for those options, so they return to the streets or a homeless shelter.
“If [people] don't have a home to be discharged to, people don't have a safe place to recover,” Dobbins said. Without the ability to manage their health conditions after being discharged, individuals are unlikely to make a full, sustainable recovery. That increases the risk of having to return to the hospital, racking up medical costs and taking a bed and services from someone who may need them more. By keeping patients from returning to the hospital, the centers can also reduce the burden of unpaid medical bills for hospitals, the price of which often falls on taxpayers.
As of January, four states—California, New York, North Carolina and Washington—have received federal approval for Medicaid 1115 waivers and are currently piloting or developing respite center programs, according to the National Institute for Medical Respite Care. At least 10 other states are in the process of applying for a waiver or are awaiting approval.
Besides helping patients with their recuperation, respite centers also provide wraparound services, such as transportation assistance. They can also assist with finding and transitioning to more stable or affordable housing, said Margaret Woeppel, vice president of data, quality and workforce at the Nebraska Hospital Association.
Last year, Nebraska saw about 5,500 hospital discharges of people experiencing homelessness, she said.
That’s why the association is supporting an effort to pilot medical respite centers in Omaha and Lincoln for individuals experiencing homelessness.
In January, lawmakers introduced Legislative Bill 905, which calls for the Nebraska Department of Health and Human Services to apply to the Centers for Medicare and Medicaid for a Section 1115 Medicaid waiver by Oct. 31, 2025, said Linda Twomey, CEO of Siena Francis House, the largest homeless shelter in Omaha. If approved, the waiver would reimburse 90% of costs for the respite center program.
The potential savings from the centers are significant, as respite care costs about $200 a day, while a daily hospital stay costs closer to $2,000, according to bill sponsor Sen. Merv Riepe.
The bill also requires DHHS to submit an annual report to the legislature documenting the number of individuals served at each facility, the cost of the program and reductions in health care costs under program implementation.
The Siena Francis House plans to establish a 25-bed respite center at its facility, which will require about $100,000 in modifications, Twomey said. The Lincoln-based facility’s location is yet to be determined.
NEXT STORY: Report shows Ohio one of many states still prosecuting ‘HIV-related’ crimes