States turn to Medicaid to tackle housing insecurity
A pedestrian walks past an encampment of tents in Portland, Oregon, on Jan. 24, 2024 PATRICK T. FALLON/AFP via Getty Images
Section 1115 Medicaid waivers can help states reduce health inequities by covering housing costs and providing meal support for vulnerable populations.
Nebraska recently announced its plans to establish two new medical respite centers for discharged hospital patients experiencing homelessness, California is working to increase incarcerated individuals’ access to addiction medication and Massachusetts wants to provide temporary housing for new migrants.
Supporting those states’ initiatives are Section 1115 Medicaid waivers, which authorize states to pursue experimental projects that aim to improve health outcomes for disadvantaged populations. An increasing number of states are using the waivers to get Medicaid participants into stable, affordable housing.
Medicaid coverage traditionally does not apply to services like room and board assistance, but the federal government has increasingly recognized that health-related social needs, particularly housing instability and nutrition insecurity, have a negative impact on health outcomes, said Elizabeth Hinton, an associate director with KFF's Program on Medicaid and the Uninsured. People often have an even harder time maintaining their health when they're busy trying to find food and shelter.
In December 2022, the Centers for Medicare and Medicaid Services, or CMS, launched the 1115 demonstration waiver program for states to expand their use of Medicaid funding. With a waiver, states can provide Medicaid enrollees with evidence-based housing and nutrition services as a way to reduce health disparities and improve equity, Hinton said. The waivers are usually approved for an initial five years.
At least eight states have received approval for Section 1115 waivers under the Biden administration’s health-related social needs framework as of February, including Arizona, Arkansas, California, Massachusetts, New York, New Jersey, Oregon and Washington.
States use the waivers to target vulnerable populations, Hinton said, such as people experiencing homelessness, substance use disorders or mental or behavioral health complications. In Massachusetts and New York, the 1115 waivers allow the states to expand meal and nutrition services for households with a pregnant person or a high-risk child.
With the waivers, for instance, states can cover enrollees’ rent or temporary housing costs as well as three daily meals for up to six months. As of last month, four states—Arizona, New York, Oregon and Washington—are approved to use their waiver for such services.
Nevada is the latest state to join that list, receiving approval last week to pilot the expansion of housing and supportive services for Medicaid enrollees. The waiver will help Nevada provide temporary housing to an estimated 20,300 residents and pay for beneficiaries’ rent, utilities and meals. The state will also use funds for case management, housing transition services and housing-related deposits.
To ensure budget neutrality, initiatives must not exceed 3% of the federal government’s total Medicaid spending. In other words, the cost of states’ waiver demonstrations cannot exceed the Medicaid costs that would’ve been incurred without the waiver, Hinton said. Waiver demonstrations also cannot supplant existing benefits programs, such as the Supplemental Nutrition Assistance Program, meaning states must coordinate with other social services providers.
Participating states submit implementation plans and protocols to CMS for approval and provide quarterly and annual monitoring reports that evaluate the operationalization, utilization and quality of services delivered under the waiver.
Oregon, for instance, submitted an implementation plan last month that outlines how it will use the waiver to provide enrollees at risk of homelessness with housing navigation services, coverage of moving costs and assistance with home accessibility modifications.
“It’s important to note that these are complicated initiatives,” Hinton said. States that have been working on addressing health-related social needs are building from prior waiver approvals, she said. “They’re just taking full advantage of what the Biden administration is now allowing states to do.”
NEXT STORY: Longtime state senator announces plans to retire