Document Type

Article

Publication Date

2018

Abstract

Achieving safe and stable housing presents a profound and ongoing challenge for many people living in poverty. The challenges include housing that is substandard or unaffordable and continuing risks of eviction. For a growing number, these challenges prove too much, and they become homeless. In addition, housing-related challenges that are part of daily life for many poor people can influence their physical and mental health. Increased attention to the health impacts of inadequate, insecure, and unaffordable housing has prompted some – including public health experts, physicians, and sociologists studying housing – to urge that housing issues, and homelessness in particular, be addressed as a health problem. This article considers whether Medicaid should pay for supportive housing for some recipients. First, it briefly describes how state Medicaid programs already are permitted to use federal Medicaid funds in support of recipients’ shelter needs in three different contexts: (1) the mandatory nursing home benefit; (2) expanded home and community-based services (HCBS) programs for recipients needing long-term support and services (LTSS); and (3) initiatives to provide permanent supportive housing for homeless persons. After describing the ways that states currently are permitted to use federal Medicaid funds for supporting housing, the article interrogates the simultaneous permissibility of states’ paying for room and board for Medicaid recipients residing in nursing homes and impermissibility of paying rent for Medicaid recipients needing supportive housing. Using the concept of bundled payments, I argue that justice requires treating these populations similarly.

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