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NYS Health Dept Publishes Paper Explaining Its Housing-as-Healthcare Medicaid Funding

December 19, 2013

Nirav Shah

Listen here to a 10-minute interview with NYS health commish Nirav Shah about NYS Medicaid spending on housing as a healthcare preventive measure.

In the national medical community, New York State is getting more attention for its innovative use of Medicaid savings for supportive housing as a means of healthcare prevention for low-income and at-risk people.

The New England Journal of Medicine today published this article authored by Kelly Doran, Health Commissioner Dr. Nirav Shah, and Deputy Medicaid Director Elizabeth Misa regarding New York's innovative approach of making investments in supportive housing for high-risk homeless and unstably housed Medicaid recipients.

The article also contains a 10-minute audio interview with Dr. Shah in which he underlines some key points about research linking stable housing with better health outcomes, and how NYS has achieved this so far -- albeit limitedly:

  • Homeless people have mortality rates 2-3 times higher than non-homeless people.
  • The homeless population is also aging, heightening its health risks and needs.
  • Homeless people are among the 5 percent of the NYS population that use 50 percent of all health services. They have higher rates of ER visits, hospitalizations and outpatient services.
  • NYS Medicaid counts among the homeless those living in nursing homes who have no other homes to go back to.
  • Housing someone costs $50-$70 a day versus $222 for an ER visit, $217 daily for a nursing facility, $850 a day for drug or alcohol detox and $2200 for hospitalization.
  • Shah cites more than 20 studies showing a reduction in hospital and even incarceration costs among vulnerable people who were stably housed. He notes a well-known 2009 study finding that homeless people with HIV who were stably housed had lower mortality rates and higher levels of undetectable (hence, well-treated) HIV than those in the control group. He also cited research showing that stably housing people had lower rates of HIV risk behavior.

Shah discussed the fact that the federal Centers for Medicaid and Medicare Services (CMMS) denied NY's request to reinvest $750 million of its Medicaid redesign savings into housing. "The plan is back on the table," he said, but noted, "Unless we get this money, we'll make a very small dent in homelessness in New York."

Currently, said Shah, 4,500 New Yorkers would benefit by funds that NYS Medicaid has already put into supportive housing for risk groups including those with mental illness, addiction and HIV/AIDS. He also said that NYS has strong data-mining technology to correlate stable housing against health events such as ER visits, hospitalizations, and outpatient visits.

That's important. NYS needs to show the nation good data proving that stable housing leads to good health outcomes and cost savings if it's going to convince more states to invest Medicaid dollars toward supportive shelter.

This article was provided by Housing Works. It is a part of the publication Housing Works AIDS Issues Update. Visit Housing Works' website to find out more about their activities, publications and services.
See Also
More on U.S. Gov't Housing Assistance in Eastern States

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