Addressing housing-related social needs for Medicaid beneficiaries: a qualitative assessment of Maryland's Medicaid §1115 waiver program.
1115 Waiver
Homelessness
Housing Instability
Housing Programs
Maryland
Medicaid
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
18 Sep 2023
18 Sep 2023
Historique:
received:
22
02
2023
accepted:
01
09
2023
medline:
19
9
2023
pubmed:
18
9
2023
entrez:
17
9
2023
Statut:
epublish
Résumé
While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland's pilot program initiative - Assistance in Community Integration Services (ACIS). The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity's administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers. A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs. The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing.
Sections du résumé
BACKGROUND
BACKGROUND
While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland's pilot program initiative - Assistance in Community Integration Services (ACIS).
METHODS
METHODS
The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity's administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers.
RESULTS
RESULTS
A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs.
CONCLUSIONS
CONCLUSIONS
The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing.
Identifiants
pubmed: 37718457
doi: 10.1186/s12913-023-10001-z
pii: 10.1186/s12913-023-10001-z
pmc: PMC10506275
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
999Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
HUD 2021 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations.; 2022. https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2021.pdf .
American Housing Survey (AHS) - AHS table creator. United States Census Bureau. https://www.census.gov/programs-surveys/ahs/data/interactive/ahstablecreator.html . Published October 4, 2022. Accessed 20 Aug 2022.
Schaeffer K. Key facts about housing affordability in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/03/23/key-facts-about-housing-affordability-in-the-u-s/#:~:text=In%202020%2C%2046%25%20of%20American,from%20the%20U.S.%20Census%20Bureau . Published March 23, 2022. Accessed 20 Aug 2022.
Maness DL, Khan M. Care of the Homeless: An Overview. Am Fam Physician. 2014;89(8):634–40.
pubmed: 24784122
Auerswald CL, Lin JS, Parriott A. Six-year Mortality in a Street-recruited Cohort of Homeless Youth in San Francisco, California. PeerJ. 2016;4:e1909. https://doi.org/10.7717/peerj.1909 .
doi: 10.7717/peerj.1909
pmcid: 4841235
pubmed: 27114873
Bensken WP, Krieger NI, Berg KA, Einstadter D, Dalton JE, Perzynski AT. Health Status and Chronic Disease Burden of the Homeless Population: An Analysis of Two Decades of Multi-Institutional Electronic Medical Records. J Health Care Poor Underserved. 2021;32(3):1619–34. https://doi.org/10.1353/hpu.2021.0153 .
doi: 10.1353/hpu.2021.0153
pmcid: 8477616
pubmed: 34421052
Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol. 2018;71(22):2585–97. https://doi.org/10.1016/j.jacc.2018.02.077 .
doi: 10.1016/j.jacc.2018.02.077
pubmed: 29852981
Mejia-Lancheros C, Lachaud J, Nisenbaum R, et al. Dental Problems and Chronic Diseases in Mentally Ill Homeless Adults: A Cross-sectional Study. BMC Public Health. 2020;20(1):419. https://doi.org/10.1186/s12889-020-08499-7 .
doi: 10.1186/s12889-020-08499-7
pmcid: 7106680
pubmed: 32228526
Sutherland H, Ali M, Rosenoff E. Individuals Experiencing Homelessness are Likely to Have Medical Conditions Associated with Severe Illness from COVID-19 Issue Brief. ASPE. https://aspe.hhs.gov/reports/individuals-experiencing-homelessness-are-likely-have-medical-conditions-associated-severe-illness-0 . Accessed 8 Apr 2022.
Zuniga J, Thurman W, Jang DE. Multiple Chronic Conditions and Accelerated Aging in People Experiencing Homelessness. Innov Aging. 2019;3(Suppl 1):S784–5. https://doi.org/10.1093/geroni/igz038.2885 .
doi: 10.1093/geroni/igz038.2885
pmcid: 6846801
Doran KM, Rahai N, McCormack RP, et al. Substance Use and Homelessness Among Emergency Department Patients. Drug Alcohol Depend. 2018;188:328–33. https://doi.org/10.1016/j.drugalcdep.2018.04.021 .
doi: 10.1016/j.drugalcdep.2018.04.021
pmcid: 6478031
pubmed: 29852450
Lee KH, Jun JS, Kim YJ, et al. Mental Health, Substance Abuse, and Suicide Among Homeless Adults. J Evid-Inf Soc Work. 2017;14(4):229–42. https://doi.org/10.1080/23761407.2017.1316221 .
doi: 10.1080/23761407.2017.1316221
pubmed: 28678621
Merscham C, Van Leeuwen JM, McGuire M. Mental Health and Substance Abuse Indicators Among Homeless Youth in Denver. Colorado Child Welfare. 2009;88(2):93–110.
pubmed: 19777794
Kim MM, Ford JD, Howard DL, Bradford DW. Assessing Trauma, Substance Abuse, and Mental Health in a Sample of Homeless Men. Health Soc Work. 2010;35(1):39–48. https://doi.org/10.1093/hsw/35.1.39 .
doi: 10.1093/hsw/35.1.39
pubmed: 20218452
Lin WC, Bharel M, Zhang J, O’Connell E, Clark R. Frequent Emergency Department Visits Among Homeless People With Medicaid: Implications for Medicaid Expansion. Am J Public Health. 2015;105(S):716–22.
doi: 10.2105/AJPH.2015.302693
About Section 1115 Demonstrations | Medicaid. https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations/index.html . Accessed 8 Apr 2022.
Atkeson A. How States Use Federal Medicaid Authorities to Finance Housing-Related Services. The National Academy for State Health Policy. https://www.nashp.org/how-states-use-federal-medicaid-authorities-to-finance-housing-related-services/ .
Thompson FJ, Cantor JC, Farnham J, Gusmano MK, Tiderington E. Medicaid Demonstration Waivers with Housing Supports: An Interim Assessment. Rutgers Center for State Health Policy, July 2019. http://www.cshp.rutgers.edu/Downloads/11550.pdf .
Assistance in Community Integration Services Pilot. Maryland Department of Health, https://health.maryland.gov/mmcp/Pages/Assistance-in-Community-Integration-Services-Pilot.aspx .
Application Package for Assistance in Community Integration Services (ACIS) Pilot Program. Maryland Department of Health, https://health.maryland.gov/mmcp/Documents/HealthChoice%20Community%20Pilots/ACIS%20Pilot%20Application_FIN_8.2.17.pdf .
Statewide Integrated Health Improvement Strategy. The Maryland Health Services Cost Review Commission. (n.d.). https://hscrc.maryland.gov/Pages/Statewide-Integrated-Health-Improvement-Strategy-.aspx . Accessed 15 Nov 2022.
Emergency Rental Assistance Program. U.S. Department of the Treasury, January 7, 2021. https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/emergency-rental-assistance-program .
Quinton, S. More States See Zoning as Lever to Lower Housing Costs. The Pew Charitable Trusts, January 30, 2020. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/01/30/more-states-see-zoning-as-lever-to-lower-housing-costs .
Hotels to Housing Case Studies. National Alliance to End Homelessness, December 2, 2021. https://endhomelessness.org/resource/hotels-to-housing-case-studies/ .
Levin, M. Converting a Motel to Homeless Housing, Step by Step. CalMatters, June 9, 2020. https://calmatters.org/housing/2020/06/motel-conversion-homeless-housing-california/ .
Colburn G, Aldern CP. Homelessness Is a Housing Problem. University of California Press, 2022.
CMS, Addressing Health-Related Social Needs in Medicaid. 2022. https://www.medicaid.gov/health-related-social-needs/index.html .