CSDP Forum: New Frontiers in Coordinating Housing and Medicaid Services for People with Behavioral Health Conditions

An abundance of evidence links housing to better health—and lower health care costs—for people with serious mental illness or other behavioral health conditions. But finding and maintaining housing can be a challenge for this population.

Community-based services and supports, particularly those that provide coordination between housing and health services, are essential for helping people overcome this challenge. Yet these types of interventions—which require cross-system coordination—have not been widely adopted at the state level. Major obstacles include weak or non-existent partnerships between state Medicaid and housing agencies and the lack of a Medicaid-reimbursable mechanism for care coordination.

But recent policy changes are spurring innovation and systems change. The Affordable Care Act is creating opportunities for service integration, such as Medicaid health homes and accountable care organizations, which focus on better care coordination and “whole-person” health. The Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Housing and Urban Development (HUD) have collaborated on several initiatives that encourage states to adopt policies that will increase the availability of home- and community-based services as well as supportive housing. Payers, too, are moving away from fee-for-service structures toward bundled payment rates, global capitation, and pay-for-performance models that emphasize quality—rather than quantity—of care. These shifts have prompted state and local Medicaid officials to look for ways to better coordinate housing and health services for high-need, high-cost beneficiaries.

Mathematica’s Center for Studying Disability Policy held a policy forum to learn more about what state and federal partners are doing to coordinate and integrate health and housing services for people with behavioral health needs.

Speakers included Jonathan Brown, Carol Irvin, and Matthew Kehn from Mathematica and Jennifer Ho from HUD. They discussed:

• Why housing is an important part of efforts to treat high-need, high-cost Medicaid beneficiaries
• Challenges and lessons from the Money Follows the Person Demonstration’s efforts to improve the availability of supportive housing for Medicaid beneficiaries moving out of institutions
• Innovative state efforts to better coordinate health and housing services for people with behavioral health conditions
• Efforts led by HUD to partner with other federal agencies, such as CMS and the Substance Abuse and Mental Health Services Administration, to coordinate health and housing services