Using Medicaid to Fund Supportive Services
What is Medicaid Today?
Medicaid is a partnership between states and the Federal Government providing health care coverage to low-income families with dependent children, pregnant women, children, and aged, blind and disabled individuals. States have considerable flexibility in structuring their Medicaid programs within broad Federal guidelines governing eligibility, provider payment levels, and benefits. As a result, Medicaid programs vary widely from state to state. Medicaid is the primary mainstream healthcare benefit that many people experiencing homelessness can access to obtain medical care, and it is a key benefit to help these individuals exit homelessness.
There are several existing ways in which Medicaid is used to help people with disabilities exit homelessness and support them in housing, including Federally Qualified Health Centers, Targeted Case Management, the Medicaid Rehabilitation Option—which includes Assertive Community Treatment, and Home and Community-Based Services Waivers.
Improving access to Medicaid and other mainstream benefits for eligible individuals is one of the objectives of Opening Doors, as people with unmet medical needs and/or high medical bills have more trouble maintaining employment and stability and are more likely to face homelessness.
Medicaid Expansion under the Affordable Care Act
To provide some perspective on the size of the Medicaid program, currently many services in supportive housing are paid for out of the $1.68 billion in HUD Homeless Assistance Grants. Comparatively, the 2010 federal Medicaid expenditure was $275 billion - with the total expenditure even higher because states contribute their own funding to this program as well.
The passage of the Affordable Care Act will make nearly all people living below 133 percent of the Federal poverty level eligible for Medicaid beginning in 2014, regardless of family composition or disability status. In addition to coverage expansions, the ACA makes substantive changes that will help Medicaid enrollees, such as individuals experiencing chronic homelessness, gain improved access to coordinated home and community-based services and supports through the existing vehicles listed above. The Affordable Care Act also presents new opportunities, including medical homes or health homes, Accountable Care Organizations, expansion of Federally Qualified Health Centers, incentives to integrate primary and behavioral health care, and new Home and Community-Based Service options.
When states expand Medicaid, some of which are doing this already and all will do by 2014, it is imperative that people working to end homelessness develop strategies to ensure people experiencing homelessness are quickly enrolled to get improved access to health care.
Resources
USICH published a newsletter in 2010 that provides a quick overview of how to begin thinking about the role of Medicaid in ending homelessness.
For basic information about the federal Medicaid Program, start here
A Primer on How to Use Medicaid to Assist Persons who are Homeless was published in 2007 by HHS and goes into great detail on Medicaid for this population.
A Primer on Understanding Medicaid Home and Community Services was published in 2010 by HHS and gives greater detail into providing Medicaid services in resedential settings like permanent supportive housing.
Read HHS' Report on Medicaid and Permanent Supportive Housing for the Chronically Homeless, which shares ways communities are using Medicaid and PSH to drive success.
HHS also released HHS Tools to Help States Lower Medicaid Costs while Improving Care, a resource for organizations and states concerned with reigning in Medicaid costs.
