A prescription for housing?
A pedestrian passes boarded up row houses in the Middle East neighborhood, three blocks north of Johns Hopkins University Medical School, on Dec. 2, 2003, in East Baltimore, Maryland. Alex Wong/Getty Images
Maryland is investing $5.4 million to help expand a promising pilot program that connects housing and health care statewide.
As homelessness rises to record levels, a Maryland pilot program is expanding statewide after showing promising results by focusing on the two-way link between health and housing.
The Assistance in Community Integration Services pilot’s housing-first approach, experts say, could further reduce health care expenditures and help people transition from homelessness to a stable home.
“In many cases, it’s high health needs and illnesses that are actually contributing to someone continuing to be homeless,” said Barbara DiPietro, senior director of policy at the National Health Care for the Homeless Council. “It’s very hard to get off the street if you’re really ill and have a lot of chronic conditions.”
Since 2018, the city of Baltimore and Cecil, Montgomery and Prince George’s counties have participated in the initiative. The jurisdictions, with the help of hospitals, have matched federal funds for the Medicaid program, which could total up to $7.2 million annually, according to the Maryland Department of Health.
But now, the state government is stepping in to help fund the initiative and expand it statewide. The state’s fiscal year 2025 budget approved in February includes $5.4 million to expand and support the pilot.
The Assistance in Community Integration Services program was authorized under the state’s Medicaid 1115 demonstration waiver, which allows states to pilot initiatives that aren’t traditionally covered by the federal health program. Maryland’s waiver was approved in 2017 and renewed in 2022. It offers eligible people services like housing assistance and case management. Participants can, for instance, receive housing vouchers, help coordinating medical care or substance use treatment, assistance with budgeting housing and living expenses, and other services.
To receive program benefits, individuals must meet certain criteria based on their housing and health needs. Individuals need, for instance, to be at risk of homelessness or institutionalization. They also need to have two or more chronic health conditions or experience repeated emergency department visits or hospital admissions, said Ryan Moran, deputy secretary of health care financing at Maryland’s Department of Health and the state’s Medicaid director.
With the program’s support, participants can spend less time dealing with housing and health issues, DiPietro said, and focus more of their daily lives on seeking employment and education opportunities, and, eventually, on leading independent lives.
And data shows the pilot is helping many do that. A 2023 report from Hilltop Institute at the University of Maryland Baltimore County found 77% of 615 program participants between 2018 and 2021 obtained stable housing. At the time of program enrollment, almost 80% of individuals were experiencing homelessness.
Plus, the report found that the number of participants with four or more emergency department visits declined 37% by the close of the study period. It also found a statistically significant decline in the average number of emergency department visits, avoidable emergency department visits and inpatient hospital admissions.
When the program received initial approval in 2017, state funding allowed up to 200 enrollees. That number grew to 900 in 2022, and Moran said officials hope to double that total moving forward.
“We are actively and fully committed to … ensuring that a rollout is statewide in every jurisdiction within Maryland,” he said.
The research “validated and clarified what we already knew,” Moran said.
But it also gave the state “data, and data is powerful in terms of using that as an opportunity [for officials] to say, ‘This is a worthwhile, long-term investment for the state … for individuals’ lives, and we know that Marylanders will be better off having been served through a program as innovative and novel as this one.’”
State funding will help make the program more sustainable, DiPietro said. With municipal governments balancing so many other priorities beyond housing and health care, she asked, “how long is a locally funded initiative likely to last?”
The state’s move to invest more into the Assistance in Community Integration Services program, Moran said, “is an endorsement recognizing and knowing that housing plays such a critical role in terms of one’s overall health.”
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