People with substance use disorders (SUD) who are experiencing housing instability or homelessness are particularly at risk during the COVID-19 pandemic, leaving states challenged more than ever to identify effective housing strategies that can simultaneously address the complex treatment needs of people with SUD while also curbing the spread of COVID-19 in congregate settings.
Aided by an infusion of federal relief funds for housing and other support services, many states and cities are working to provide temporary housing to individuals experiencing or at risk of homelessness to keep them healthy and protected from COVID-19. But with difficult budget decisions ahead, it is important for states to consider the future implications of their short-term, emergency housing measures, and how to maximize government resources in the long-term.
Utilization of Rapid Re-Housing
Now more than ever, when homelessness is associated with high rates of coronavirus infection and renters are increasingly experiencing housing insecurity due to financial instability, housing assistance is critical in order to improve health outcomes and prevent individuals from living on the street or in crowded shelters. One way states are protecting individuals experiencing homelessness is through rapid re-housing, a program that provides individuals with tailored assistance packages and support, including short-term financial assistance, to help them move into housing quickly. Depending on the assistance and funding source, rapid re-housing can last up to two years.
Connecticut’s Department of Housing released guidance for housing providers to help expedite transitions into rapid re-housing. Ohio’s Franklin and Columbus counties also disseminated rapid re-housing guidance, including information on utilizing US Housing and Urban Development (HUD) waivers and providing case management services. Louisiana is using rapid re-housing to move individuals out of temporary hotel units and Rhode Island is prioritizing rapid re-housing for individuals who are currently homeless and awaiting placement in permanent supportive housing.
However, while studies indicate that only 10 percent of individuals in rapid re-housing programs return to homelessness, many do experience rental instability once their rapid re-housing assistance expires. In their guidance to homeless service providers during COVID-19, the Centers for Disease Control and Prevention encourages planning for ways to connect individuals experiencing homelessness with other housing opportunities after they leave temporary housing sites.
HUD’s Emergency Solutions Grant Program (ESG) is a common source of rapid re-housing funding. The Coronavirus Aid, Relief, and Economic Security Act (CARES) provided HUD with $4 billion in ESG funding, which the department began allocating to states in early April, and enables the expansion of rapid re-housing programs, among other housing initiatives.
In addition to ESG, state and local governments have access to a variety of other funding sources, including billions of dollars in allocations from the CARES act, which are designed to address housing needs during the pandemic. Both the ESG and Community Development Block Grant (CDBG) funding through CARES is being distributed in two waves, with the first wave released based on a FY 2020 allocation formula and the second wave, which has yet to be released, allocated to the highest-risk communities.
Encouraging an Equitable Approach to Resource Distribution
In order to guarantee that federal funding reaches the most at-risk individuals and is used in a cost-effective manner, ensuring the money is allocated equitably is critical. Communities of color and senior citizens are disproportionately affected by both COVID-19 and housing instability, and given the link between housing and health, supportive housing and rental assistance can improve health outcomes when used effectively. Because many housing assistance programs are locally run, rather than by the state, many cities are taking the lead and actively seeking ways to equitably allocate federal funding.
- The Chicago Continuum of Care (CoC) COVID-19 plan sets aside housing for individuals at high risk of serious illness due to COVID-19, as well as youth, those living on the street, and families. The Chicago CoC is also reviewing data to ensure that people of color are housed in rates proportional to their make-up of homeless individuals in Chicago, rather than by population numbers alone.
- In Seattle, the mayor promised to provide equitable access to rent assistance and noted that more than 70 percent of the rent support applications the city received came from people of color. The city is also working to help reduce barriers to housing assistance for seniors and non-English speaking residents.
In addition, HUD recently released a document detailing changes to coordinated entry prioritization for Continuums of Care as they respond to COVID-19. The guidance specifically notes the need to support individuals who are most vulnerable to COVID-19 and housing instability and calls on CoCs to consider the compounding effects of systemic inequities that contribute to high rates of homelessness among people of color when prioritizing housing assistance.
Increased Need for Supportive Services
In addition to using federal funds to support physical housing, states are also finding ways to ensure individuals experiencing homelessness receive other types of support services. Supportive housing combines housing assistance with wraparound services, such as behavioral and mental health services, substance use disorder treatment, and education and employment assistance. In addition to keeping individuals stably housed, supportive housing saves taxpayer money and reduces health care costs. The provision of wraparound services plays a critical role in helping individuals remain housed and healthy.
Given the extent of the public health emergency, there is an urgent need to help people access emergency housing and ensure they are simultaneously receiving critical health and support services. Coordinating case management and support services to ensure medication adherence and access to benefits, such as food stamps and health care coverage, can improve both health and housing outcomes. Some examples of support services that states can and are providing during the pandemic include:
- Connecting individuals living in temporary housing with federal nutrition services.
- Transitioning to telemedicine for substance use disorders treatment.
- Helping individuals released from institutional care, especially prisons, create a housing plan to avoid living on the street or in congregant areas, such as shelters.
- Utilizing HUD’s Continuum of Care Program to purchase cell phones and wireless plans in order to help individuals in shelters receive needed support services telephonically.
As states work to provide housing and supportive services to those in need, many questions and challenges arise:
- How can states optimally leverage and coordinate federal funds?
- How can states ensure that both newly homeless and chronically homeless individuals can access housing and supportive services in the future, after immediate funding and other resources expire?
With more people turning to rapid re-housing during COVID-19, state officials acknowledge that many individuals will require support not only during their transition into housing, but also after their short-term assistance expires, when they may need to transition to more permanent rental resources. Given the unprecedented loss in revenues to state coffers, most states anticipate deep budget cuts, which will make ensuring the sustainability of housing assistance even more difficult. As more individuals move into temporary housing, it will be critical for states to coordinate across health and housing agencies to maximize resources, housing stability, and positive health outcomes. Through its Health and Housing Institute, the National Academy for State Health Policy will continue to monitor and support states during this pandemic and beyond.
With few places to self-isolate, limited access to disinfectant supplies, and overcrowded shelters that reduce residents’ ability to physically distance themselves, individuals experiencing homelessness are at unique risk for COVID-19. Recent estimates suggest that up to 40 percent of homeless individuals, many of whom have underlying health conditions, may become infected.
As COVID-19 cases increase, states, with federal support, are adopting a variety of approaches to safeguard homeless individuals, including creating temporary shelters and renting hotel and motel rooms.
Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Department of Housing and Urban Development (HUD) appropriations help states build and operate emergency shelters, provide hotel and motel vouchers, and provide essential services to people experiencing homelessness.
Additionally, some states are requesting authorization under 1135 waivers to use Medicaid funding to assist individuals experiencing homelessness.
- Illinois and Oregon have applied for 1135 waivers to create new isolation and quarantine systems for those who cannot quarantine at home.
- Massachusetts requested federal funding to use hotels as temporary housing for individuals experiencing homelessness and to help cover the cost of sanitation products to keep the temporary housing clean.
- North Carolina asked to use Medicaid dollars to cover housing-related services, including temporary housing, housing application assistance and transfers, and moving expenses for homeless individuals who are ready to be discharged from hospitals.
Other state Medicaid offices are seeking flexibility to waive administrative requirements to address homelessness during the pandemic:
- Arkansas submitted an 1115 waiver application asking for the flexibility to use federal funding to cover temporary housing assistance for its high-risk homeless population.
- Washington State proposed targeted Medicaid funding to provide temporary shelter for homeless individuals who are currently under institutional care, so that hospitals can discharge these individuals and free up more space for COVID-19 patients.
In addition to using Medicaid authority, states are employing other resources to help individuals experiencing homelessness. In California, with a homeless population of nearly 130,000, Gov. Gavin Newsom dedicated $150 million to support local efforts to house individuals living on the street. In his April 3, 2020 address, Newsom outlined a plan to move individuals experiencing homelessness into temporary shelters, including hotels, motels, and travel trailers. The first phase of the plan, involving sheltering homeless patients testing positive for COVID-19, has already begun, with the state leasing 7,000 of 15,000 rooms needed. As of April 11, 2020, 1,813 of these rooms had been filled.
Washington State, hit early and hard by the virus, is also moving to open additional housing facilities for individuals experiencing homelessness. In mid-March, the Washington Department of Commerce announced that it was allocating $30 million to support the homeless population, with each county receiving $250,000, with the remainder distributed based on the county’s number of homeless individuals. Counties are using this funding to rent motel and hotel rooms and are focusing their efforts on individuals who have tested positive for COVID-19.
Kitsap County in western Washington recently opened two facilities to shelter homeless individuals who test positive for COVID-19 and those awaiting test results. In Seattle, the city’s Human Services Department, in partnership with other local public health departments, is working to expand shelter capacity by finding new spaces, such as the Seattle Center Exhibition Hall, to house residents from the city’s most crowded shelters. The department is also working on deploying hygiene and sanitation resources, such as public toilets and hand-washing stations, throughout the city. The Seattle Navigation Team is providing outreach to high-risk individuals experiencing homelessness to connect them to housing, sanitation kits, and medical treatment.
The Maine State Housing Authority, the Maine Department of Health and Human Services (DHHS), and the University of Southern Maine have teamed up to open a temporary shelter for homeless adults in a university gym. Located in Portland, the new shelter will house 50 individuals and alleviate some of the crowding in the city’s existing shelters to allow for physical distancing during the emergency. Individuals in the shelter are required to be screened for COVID-19 symptoms regularly and they receive food from the university’s food service contractor. Funding for supplies, including beds, comes from DHHS and MaineHousing. The University of Maine System also signed a memorandum of agreement with the Maine Emergency Management Agency that allows the system’s facilities, supplies, and employees to be used as needed to address the pandemic.
As the pandemic response continues to unfold, it will be critical to highlight how states use the flexibility granted under their new waivers, and whether and to what extent these dollars are used to address homelessness. Additionally, though 1135 waivers are only available for the duration of the public health emergency, states may identify new, creative ways to appropriately use Medicaid funding for supportive housing programs that combine rental subsidies with wrap-around services to help people stay stably housed. In California, for example, the governor hopes to continue to provide homeless services at the hotels and motels the state is renting out, and the current agreements allow for individuals to extend leases after the pandemic subsides.
As safe and stable housing clearly promote health, states and the federal government have both invested in programs that help historically disenfranchised individuals find housing and access health care and supportive services to improve equity. Though temporary during the pandemic, current state initiatives may generate new and valuable partnerships between the health and housing sectors. With the rise of COVID-19 and its health and economic consequences, it is more important than ever that health and housing sectors work in tandem to break down siloes and deploy resources in a coordinated way to meet the needs of those who experience homelessness.
On a single January night in 2018, approximately 553,000 people in the United States experienced homelessness, either sleeping on the street or in a variety of shelters, and those numbers have been gradually increasing since 2016. The risk of homeless also looms large for many who are housing insecure, including 25 percent of renters nationwide who spend more than half their income on housing.
Many states are encouraging the development and preservation of affordable housing – often combined with health and social services – to improve the lives and health of vulnerable individuals and families.
State policymakers know it is difficult for people without safe, stable homes to become and stay healthy, as evidence shows. Studies show that housing insecurity and homelessness are associated with poor health and premature death for adults, and pose risks for child health and development.
State budgets also benefit from improving health through housing: studies show that housing with supportive services can save states money by reducing hospital utilization for some populations. Housing First policies, which remove barriers such as sobriety or treatment requirements for people entering supportive housing, have also been linked to lower emergency department use and shelter costs.
This snapshot shows how state leaders across the nation are taking executive and legislative actions to improve health through housing.
Budget and Appropriations
- Hawaii Gov. David Ige signed a number of bills related to housing, including SB471 SD2 HD1 CD1, which appropriates over $10 million for each of the next two years for homelessness services, including outreach, rapid re-housing, and Housing First programs, and the state’s rent supplement program.
- Iowa Gov. Kim Reynolds signed bill SF 608, which appropriated funds for “housing and shelter-related programs.” (Sec. 3.1.b.5)
- It also appropriated $100,000 from the Iowa skilled worker and job creation fund to establish a “housing needs assessment grant program to provide small communities with hard data and housing-related information specific to the community being analyzed.” (Sec. 3.10.a)
- New York Gov. Andrew Cuomo announced that the enacted budget “continues the $20 billion, comprehensive five-year investment in affordable housing, supportive housing, and related services to provide New Yorkers with safe and secure housing.”
- Oregon Gov. Kate Brown proposed $50 million of bond funding for permanent supportive housing, which was passed by the legislature in HB 5005.
- Washington State Gov. Jay Inslee signed a capital budget that appropriated $175 million for the Housing Trust Fund program. The appropriation includes funds to build or preserve affordable housing, as well as funding for supportive housing for people with chronic mental illness (Sec. 1029(1)).
- Iowa Gov. Reynolds issued Executive Order 3 establishing the “Investing in Rural Iowa” task force to address rural housing needs, among other priorities. The task force’s initial recommendations include helping communities conduct housing needs assessments and making the Workforce Housing Tax Credit competitive – instead of first-come-first-served – and prioritizing small cities.
- Hawaii passed HB820 HD1 SD1 CD1, which requires the Hawaii Housing Finance and Development Corporation to study and formulate a plan for a program to “provide low-cost, high-density leasehold homes for sale to Hawaii residents on state-owned lands within a one-half mile radius of a public transit station.”
- Nevada’s AB 174, established the Nevada Interagency Advisory Council on Homelessness to Housing. Among other duties, the council will develop a strategic plan for addressing homelessness in the state. The council will include representatives from the departments of health and human services, corrections, housing, and veterans services, as well as sheriffs, judges, a state senator and assembly member, and a person who has experienced homelessness in the past.
- New York Gov. Cuomo signed the “Housing Stability and Tenant Protection act of 2019,” which provides fourteen days for tenants to pay their rent before being evicted, up from three days. It also prohibits landlords from evicting tenants for complaining about the need for repairs, among other provisions.
- Oregon Gov. Kate Brown signed SB 608 into law, which protects renters from no-cause evictions and limits rent increases.
- Washington Gov. Inslee signed SB 5600 into law, which provides more time for tenants to pay their rent before eviction. Previously, landlords were only required to provide three-days’ notice, but the new law increases it to 14 days.
In addition to legislation and executive action, state policymakers are using other policy tools and strategies to improve health, by helping people become and stay safely housed. For example:
- States produce Qualified Allocation Plans (QAPs) to guide the awarding of Low Income Housing Tax Credits to developers. States can award developers additional QAP points for including healthy housing features or otherwise aligning with state health and housing goals.
- While federal restrictions generally prohibit the use of federal Medicaid dollars for room and board, a number of states have incorporated tenancy supports and other housing-related services into their Medicaid waivers and State Plan Amendments.
- Pursuant to its Section 1115 demonstration, Oregon made housing a statewide priority for its Coordinated Care Organizations (CCOs), and contractually requires CCOs to address “housing-related services and supports, including supported housing.”
- A number of states include pre-tenancy supports and tenancy sustaining services in their Section 1115 demonstrations. For example, services in Illinois’s Behavioral Health Transformation Section 1115 demonstration provide assistance to individuals applying for housing, linkage to health and social services, and training and resources to help people manage their household and finances.
- Permanent Supportive Housing (PSH) programs combine rental assistance with supportive services for vulnerable, low-income populations. Supportive services can include help finding and securing an apartment, assistance with managing personal finances, interacting with landlords and neighbors, and facilitating connections to physical and behavioral health care.
These executive orders, laws, and policy strategies illustrate the many levers and tools states are using to improve health through housing. These actions have the potential to control health costs while enriching the lives of vulnerable people and families.
This report is part of a series exploring how state leaders can improve the upstream factors affecting health, such as healthy environments, early childhood education, and social equity. Additional resources for state leaders can be found in the Toolkit: Upstream Health Priorities for New Governors NASHP’s Housing and Health Resources for States.
Produced in partnership with the de Beaumont Foundation
States working to improve the health of people experiencing homelessness can match their Medicaid data with Homeless Management Information Systems (HMIS) data to track which populations are using housing services and which have the greatest unmet need. HMIS are databases that housing service providers and Continua of Care (CoCs) community and state agencies use to collect and aggregate demographic and service-use information for individuals and families experiencing and at risk of homelessness. Recently, the National Academy for State Health Policy’s Health and Housing Institute interviewed Connecticut Coalition to End Homelessness’ Director of HMIS and Strategic Analysis Brian Roccapriore and Connecticut Department of Housing’s Director of Individual and Family Support Programs Steve DiLella for their insights into the successes and challenges of HMIS-Medicaid data sharing in their state.
What is the history of Connecticut’s HMIS-Medicaid data sharing?
There is a long history in Connecticut of providing permanent supportive housing to homeless populations. Ten years ago, the Corporation for Supportive Housing helped with data matching for the most vulnerable people in the state. The first match between HMIS and state Medicaid data was for a re-entry program for the criminal justice population. They used that data-matching model to identify housing needs and ultimately to decrease costs for high-cost Medicaid users. This cost savings resulted from a substantial reduction in the utilization of health care and shelter systems. The Connecticut Coalition to End Homelessness received a federal Social Innovation Fund grant to house the 160,000 highest-cost Medicaid beneficiaries who use housing services. Once this grant was in place, the state experienced a decrease in high-cost medical services use, such as emergency departments, ambulances, behavioral health care, and hospitals, but also an increase in outpatient and medication usage. The state is currently trying to address some of this increase through a proposed Medicaid 1915(i) plan option.
Connecticut previously had 13 homeless CoCs, which used three different HMIS software systems and six to seven iterations of this software. About four years ago, the CoCs merged their systems into one platform that allows for a single release of information. This process proved challenging for the state, and officials faced a variety of issues. The most important part of addressing these setbacks was getting collective buy-in from providers to move to an open system. There was a great deal of conversation with the state attorney general’s office and the state’s hospital coalition over a year about what the release of information should look like — specifically, how restrictive it should be in terms of what to share and with whom. [The state’s current release of information authorization form can be viewed here.] The current release of information form now allows the state, with a client’s consent, to match data for housing and health opportunities.
Who approves data-matching requests, and who does the actual match?
In Connecticut, HMIS and Medicaid provided their data to a third party, New York University (NYU). NYU completed the actual matching process, and then the matched names went back to the state’s HMIS.
HMIS is guided by a steering committee with representatives from Coordinated Access Networks – referral systems that link people to housing services from all regions of the state. Whenever there is a request to obtain data from the HMIS, the committee must approve it.
Did you have to go through a process of defining appropriate data to be included in the data-use agreements?
There was a discovery period to see what was in each specific data warehouse and what was needed to match it. In Connecticut, each warehouse is unique in how it collects data and the data might not match well. We needed to be sure the data was similar enough to match and that it was collected in a uniform way. We had to look at data dictionaries to find common elements and had to define the requests to specify what specific data was needed, such as enrollment and length-of-stay data for emergency shelters, or transitional shelters, and Medicaid claims data.
How important are agency leadership and buy-in?
It’s important. Connecticut has a broad interagency council to increase supportive housing and we had buy-in from the Department of Social Services. This data sharing became a natural fit with the support of our leadership.
Did you seek input from the US Department of Housing and Urban Development (HUD)?
HUD officials recently said that some HMIS releases are too restrictive in the amount of information they can share.
We received HUD technical assistance on the initial release of information. The trend nationally is toward a more open-sharing model. People often default to “we cannot share information” in fear of violating the Health Insurance Portability and Accountability Act (HIPAA), when the true concern should be ensuring informed consent. In fact, the HIPAA Privacy Rule supports the secure sharing of information for a range of purposes, including improving patient and public health and health care quality.
What roadblocks did you encounter?
Most roadblocks we faced were from individual providers, who are protective of the people they serve. It was also hard to find time in the schedules of officials from the attorney general’s office and the Connecticut hospital association to discuss the work. It is important to start this process as early as possible.
Any additional advice you would like to share with states?
Start early, as this process moves slowly. Washington State has a warehouse of data that could be useful to look at. Allegheny County in Pennsylvania also has an impressive data warehouse. It’s important to ensure that there is someone to drive the process.
Strategic use of data can help states maximize and streamline their efforts to improve the health of state residents by addressing social and living conditions. Connecticut’s data-sharing work is an important example to other states similarly seeking to leverage data to improve health through housing.
This work is supported through NASHP’s Cooperative Agreement with the Health Resources and Services Administration (HRSA), grant #UD3OA22891.
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.
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
- 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.
Individuals experiencing homelessness are disproportionately impacted by chronic medical and behavioral health conditions, and many of these individuals lack health insurance or a usual source of care. State Medicaid agencies and safety net providers are important partners in meeting the medical, behavioral health, and social service needs of individuals and families experiencing homelessness. In this new issue brief, along with the companion summary, NASHP explores how states have leveraged a range of federal authorities and care models to increase access to housing-related services, including Section 1115 Demonstrations, home and community-based services waivers and state plan options, contracted managed care organizations, accountable care models, and the health home state plan option. For additional information and detail, please see the full issue. This work was funded through a cooperative agreement with the Health Resources and Services Administration.
States interested in improving population health and containing costs are increasingly examining the intersection of housing and health care. As numerous studies show, housing chronically homeless people can improve their health and save money for state and local governments.  This webinar offered participants an opportunity to learn about cross-agency levers states can use to meet the housing and health needs of homeless populations. The webinar also addressed the financing mechanisms, data infrastructure and strategic partnerships that facilitate the blending of health care and housing funding streams.
|12:30||Welcome and Introductions
Trish Riley, NASHP Executive Director
The overview will provide a primer on housing programs and identify intersections between state housing, behavioral health, and Medicaid programs.Peggy Bailey, Senior Policy Advisor, Corporation for Supportive Housing
During the panel portion of the webinar, the moderator will ask the panelists a number of questions related to housing and health care.Facilitator: Trish Riley, NASHP Executive DirectorPanelists:
Peggy Bailey, Senior Policy Advisor, Corporation for Supportive Housing
Chris DeMars, Director of Systems Innovation, Transformation Center, Oregon Health Authority
Elewechi Ndukwe, Program Policy Manager, Medicaid and CHIP Office of Policy, Texas Health & Human Services Commission
|1:30||Questions and Discussion
Trish Riley, NASHP Executive Director
Trish Riley, NASHP Executive Director
 https://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/october-november; https://shnny.org/research/integrating-housing-health/; https://jama.jamanetwork.com/article.aspx?articleid=183666https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046466/
Recent media reports have featured chronically homeless individuals who have improved their health and reduced their emergency department use thanks to one intervention:supportive housing. According to one federal agency, supportive housing is “an approach to subsidized housing that provides voluntary services for people with disabilities and chronic conditions to promote long-term stability, recovery and improved health.”
Some state policymakers are exploring the potential of supportive housing to reduce costs and improve the health of their homeless populations. Assisted by recent federal guidance, states are leveraging a variety of funding streams to pay for housing services and supports, including federal health care reform initiatives, Medicaid waivers, and private investment.
As states take increasingly innovative approaches to housing and health care, a number of questions arise: What do states need in order to explore housing services as a means to improving health and lowering costs for certain populations? Which funding streams are states leveraging, and what do they pay for? What will Medicaid pay for? How can states tailor their health and housing efforts to their state-specific circumstances?
To help states navigate these questions, NASHP’s State Refor(u)m offers the following resources:
- A national webinar, September 14, 2015, at 12:30pm EDT, featuring state officials from Texas and Oregon discussing their efforts to meet the housing and health needs of their homeless populations. Peggy Bailey, a national expert on supportive housing, will offer an overview of efforts to house and support vulnerable populations across the country. The panelists will explore the financing mechanisms, data infrastructure, and strategic partnerships needed to facilitate the blending of health care and housing funding streams. Click here to register for the webinar.
- A new NASHP State Refor(u)m chart of state strategies to support health through housing services looks at initiatives in 10 states. The chart identifies the initiatives’ funding mechanisms, covered services, target populations, and strategic partnerships. Links to state and federal documents, program descriptions, and other sources provide additional information. Special thanks to the Corporation for Supportive Housing, whose resources on Medicaid and housing were invaluable.
As more states view housing as integral to a culture of health, it will become even more important to share best practices and evidence of what works in other states. To that end, watch for additional NASHP projects on health and housing, as we bring our cross-agency Medicaid, public health, and behavioral health policy experience to bear on the pressing issues of health care and homelessness.
On October 19, 2015, NASHP convened a pre-conference meeting, “Improving Health, Lowering Costs: Translating Population Health into Effective State Policy,” supported by the Robert Wood Johnson Foundation. Materials from the pre-conference, which took an in-depth look at housing and other population health issues, are available here.
The preconference preceded the 28th Annual NASHP State Health Policy Conference,which featured a breakfast plenary with Douglas Jutte, MD, MPH, from the Build Healthy Places Network. The plenary explored efforts to integrate state health policy with housing and social supports to more fully address the social determinants of health. Click here for the conference agenda and materials.