Medicaid expansion under the Affordable Care Act (ACA) will provide new insurance coverage to nearly all of the 1.2 million individuals who are homeless including an estimated 110,000 people who are chronically homeless and more likely to have chronic and complex health conditions. For these individuals, homelessness and housing instability can significantly impede health care access, often resulting in excessive use of expensive inpatient and emergency services. Stable affordable housing coupled with “high touch” supports that connect people with chronic health challenges to a network of comprehensive primary and behavioral health services can help improve health, increase survival rates, foster mental health recovery, and reduce alcohol and drug use among formerly homeless individuals.

This CHCS brief, coauthored with the Corporation for Supportive Housing (CSH) and supported by the Robert Wood Johnson Foundation, outlines the rationale for states to consider in designing Medicaid-financed, supportive housing-based care management services. To help states prepare for Medicaid expansion and anticipate the needs of this high-need population subset, the brief:

  • Outlines the potential benefits of care management linked to affordable housing;
  • Details the business case for using Medicaid to finance supportive housing-based services from the viewpoint of Medicaid as well as the supportive housing industry sector;
  • Highlights potential Medicaid authorities that states can use to fund supportive housing-based services; and
  • Raises considerations for policymakers to address in designing strategies that use Medicaid resources to provide supportive housing-based services.

See also a companion policy fact sheet that outlines opportunities to use Medicaid financing to link care management with supportive housing.