Connecting Permanent Supportive Housing to Health Care Delivery and Payment Systems: Opportunities and Challenges

Permanent supportive housing can be an integral part of new models of integrated care for people with complex health and social needs who experience homelessness or institutionalization, producing better outcomes and ending homelessness for vulnerable people, while also contributing to the more appropriate and less costly use of health care services. The expansion of Medicaid eligibility in most states and other changes in health care finance and delivery systems increase opportunities to pay for some of the costs of supportive housing services, but this will require overcoming challenges related to federal and state policies. Medicaid benefits may include behavioral health services that can help people with mental health disorders get and keep housing and achieve recovery goals. Primary care and behavioral health services can be integrated through partnerships that rely on two different Medicaid payment mechanisms. Medicaid managed care plans face incentives to invest in care coordination services that control hospital costs. Some states are exploring other ways to use Medicaid financing to pay for innovative supportive housing programs that can achieve offsetting savings.