Tackling Health Challenges among Individuals with Housing Needs
Despite advances in American society, the United States still struggles with the issue of homelessness. This issue is one that can be found throughout the country, from veterans returning home after serving their country to people residing in urban areas to those in small towns across rural America who are struggling to survive. On any given night, approximately 580,000 people experienced homelessness across the United States. The homeless population predominately consists of those in transition, with only 15 percent chronically homeless. Within the overall homeless population are adults, families, unaccompanied youth, and veterans.
People experiencing homelessness frequently have multiple and complex health issues that can be exacerbated by unstable living conditions and lack of access to consistent, uninterrupted healthcare. In facing these challenges, individuals in unstable housing situations are more likely to need costly crisis services, have longer hospital stays, and have higher hospital readmission rates after being discharged.
Housing Instability: A Barrier to Better Healthcare
Research shows that homeless adults – many of whom are Medicaid-eligible— are more likely than those with secure housing to have one or multiple chronic conditions including:
* Substance use disorders
* Heart disease
* Severe Mental Illness (SMI)
Similarly, compared to low-income children with stable housing, children who are homeless or are in an unstable housing situation have shown higher rates of acute and chronic health issues including: increased prevalence and severity of asthma, higher rates of injuries, and increased risk of abuse, exposure to violence, and psychological trauma.
Under these circumstances, the inability to seek care and/or other barriers can result in the use of high-cost crisis services for adults and children alike. Such crisis services might be otherwise rendered unnecessary when health and social needs like housing are consistently met. Helping individuals remain in housing and enhancing the connection between housing and healthcare may improve access to care, increase continuity of care, and lead to better health outcomes.
The Role of Medicaid in Improving the Health of Individuals with Housing Needs
Medicaid cannot directly fund housing. Even so, the program provides opportunities for housing-related services, shifting care into home settings, and facilitating access to other services that affect health. Medicaid provides a number of avenues to bring healthcare services into housing environments – including the Home and Community-Based Services (HCBS) 1915(i) State Plan Optional Benefit, 1115 Waiver, and Money Follows the Person Rebalancing Demonstration. Despite these initiatives, several gaps remain. They include:
* Limited Coverage – A number of the existing programs are limited to disabled or elderly individuals as well as those with certain behavioral health needs – leaving a significant number of Medicaid beneficiaries uncovered.
* Lack of Funding – The proactive outreach, patient engagement, and enrollment facilitation necessary for supportive housing are not currently funded by Medicaid.
* Lack of Coordination – While Medicaid-eligible beneficiaries often receive other state and federal housing support services, few, if any, mechanisms exist to coordinate these services or connect their recipients with healthcare.
Many of the available housing services are fragmented across various programs – government and non-profit alike – making it challenging to undertake a coordinated, proactive approach.
How SilverSummit Healthplan is Responding
SilverSummit Healthplan is a managed care organization in Nevada that exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. SilverSummit Healthplan is a wholly-owned subsidiary of Centene Corporation. Centene constantly strives to improve care, using innovative approaches to meet our Medicaid members’ healthcare needs. We understand that social and environmental factors, including housing, can play a significant role in furthering access to care, strengthening adherence to treatment, and improving health outcomes.
Recognizing that being homeless is an additional burden for individuals with behavioral health and substance use disorder issues, Centene has turned to Cenpatico, our managed behavioral health organization, for solutions. For example, in Illinois, Cenpatico has partnered with
Thresholds, a provider organization that takes a multidisciplinary approach to administering care. Cenpatico and Thresholds leverage a comprehensive team consisting of a psychiatrist, a psychotherapist, nurses, and community support specialists, to engage and manage the healthcare of a small subset of high-risk, Medicaid members facing behavioral health and other challenges. The care team is accountable for coordinating care for this vulnerable population, which can require connecting members with stable housing.
By working together, key stakeholders such as health plans, providers, along with state and federal governments, can not only improve the level of housing stability for vulnerable groups, but also potentially lower unnecessary hospitalizations, increase care continuity, and ultimately improve overall health outcomes.
Sources: This document cites material from The U.S. Department of Housing and Urban Development, Office of Community Planning and Development, Substance Abuse and Mental Health Service Administration, National Alliance to End Homelessness, Kaiser Family Foundation, Corporation for Supportive Housing (CSH), The U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy, Public Health Reports, Medical Care, Journal of Urban Health, Pediatrics, Pediatric Review, and Journal of Pediatric Health Care.
Cenpatico Behavioral Health LLC, a part of the Envolve PeopleCare family of companies.