As part of the National Academy for State Health Policy’s (NASHP) health and housing institute, officials from five states (IL, LA, NY, OR, and TX) met with other policymakers at #NASHPCONF18 to share how they work across agency siloes to improve health and housing for vulnerable populations, including those experiencing homelessness, struggling with behavioral health or substance use disorders, or transitioning out of institutions.

States are working to partner across agencies to strengthen services that can help vulnerable populations become and remain successful tenants, such as helping with completing leasing forms, budgeting, interacting with landlords, or navigating personal crises that could jeopardize their living arrangements. States are also exploring ways to weave health and housing priorities into the very fabric of state health transformation initiatives, such as requiring or encouraging accountable health entities or Medicaid managed care plans to provide housing-related services and supports. States are using their policy levers to spur development of more affordable housing initiatives through public-private partnerships or increasing state fees to support affordable housing programs.

State health and housing policymakers, including those participating in the Health Resources and Services Administration-supported NASHP institute, shared their progress toward health and housing goals, discussed cross-sector data strategies, and explored federal policy priorities during #NASHPCONF18.

Cross-Sector Collaboration

The state teams participating in the discussion themselves exemplified cross-sector collaboration, with representatives from:

• Affordable housing
• Aging and adult services
• Developmental disabilities
• Health/public health
• Homes and community renewal
• Housing and community services
• Housing development
• Human services
• Medicaid
• Mental health

With both housing and health sectors represented, state teams were able to candidly discuss the responsibilities of each sector. On the housing side, state officials and partners explained they generally work to maximize available housing units, manage waiting lists, work with landlords, and administer subsidy programs. State health officials said they often oversee the housing- and health-related services that help keep people stably housed. While the responsibilities of each sector often overlap, the ability to develop and maintain clear cross-agency communication allows each sector to play to its strengths and maximize resources and staff capacity.

Harnessing the Power of Shared Data and Goals

The five state health and housing teams share some common goals, such as capitalizing on insights and efficiencies gained from shared or integrated data to improve health through health and housing initiatives. For example, states are working to match Medicaid claims data with data from state Homeless Management Information Systems (HMIS) to map changes in emergency department use after previously homeless people are housed, in order to make the business case for investing in housing initiatives. States are also working to match HMIS and Medicaid data to identify and help the highest utilizers of emergency departments. A number of states are working to compile and integrate data from Medicaid, public health, justice, and homelessness systems to create a more complete picture of the social conditions and unmet needs that affect the health of vulnerable groups.

While states share many health and housing goals, individual states may focus on different populations. For instance, some states focus on housing people transitioning from long-term care or other institutional settings, such as through the Money Follows the Person program, while others prioritize housing people experiencing homelessness. States may also concentrate on the housing and service needs of people with behavioral health needs or substance use disorders, rural residents, or families with children. Despite the different populations of interest, some common state goals include:

• Make more effective use of data by:
  • Creating and implementing agreements to share data across mental health, intellectual/developmental disability, Medicaid, and homeless systems;
  • Developing data-matching systems to help with hot-spotting and managing wait lists, such as developing a vulnerability score that prioritizes people on housing waiting lists based on their use of shelters, jails, and emergency services;
  • Using data from managed care organizations to track the interaction between Medicaid, health care, and housing programs; and
  • Analyzing data across systems to demonstrate the return on investment (ROI) of health and housing programs.
• Explore capital investment strategies for healthy affordable housing acquisitions and/or development;
• Develop pilot programs to leverage health systems as housing referral sources;
• Facilitate meaningful partnerships between accountable care and housing entities in local communities to support investment in housing-related services and supports; and
• Test the impact of integrated housing and tenancy support services on emergency department usage.

Over the next two years, the five state teams in the health and housing institute will continue to work toward stably housing vulnerable people and providing the services they need to live healthy lives in their communities. While individual state goals differ, they often build on progress made during past technical assistance opportunities, such as the Centers for Medicare & Medicaid Services Innovation Accelerator Program. As the health and housing institute advances, states’ successes and lessons learned will be featured at future NASHP conferences and at its health and housing resources page at NASHP.org.

The health and housing institute is supported through NASHP’s Cooperative Agreement with the Health Resources and Services Administration (HRSA), grant #UD3OA22891, National Organizations of State and Local Officials. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.