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By Athena Mandros

Housing is big news in the health care field these days. On May 18, Kaiser Permanente announced they are investing $200 million in housing projects with a financial return with the goal of being able to support more projects in the future (see Kaiser Permanente to commit $200 million to help communities reduce homelessness and Total Health Begins in Our Communities).

While the Kaiser Permanente announcement is significant in the amount of money being offered, other health plans are partnering with community organizations to finance housing projects (see Partnership Begins Work on Denver Affordable Housing Project, AHIP 2017: Blue Shield, UPMC, Kaiser share how they’re tackling social determinants of health, and AmeriHealth Caritas Invests $150K in Housing and Support Services in 2nd Phase of Its $250K Investment Commitment to Improve Health Outcomes).

The move by health plans to support housing initiatives is based on studies that link housing insecurity and health care costs and outcomes. For example, A 2016 study conducted by the Center for Outcomes Research and Education (CORE) found housing reduced overall health care expenditures by 12% ($48 dollar per month) for Medicaid recipients (see Study Finds Affordable Housing Reduces Health Care Costs). And a study of chronically homeless individuals in Massachusetts found that after housing, costs fell $8,603 per consumer (see Housing is the Best Medicine: Supportive Housing and the Social Determinants of Health). Additionally, stable housing can improve access to health care services (see Study Links Stable Housing With Better Healthcare Access); and reduce hospitalizations, length of hospital stays, and emergency department visits (see Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial and Impact of permanent supportive housing on the use of acute care health services by homeless adults).

Currently, the federal government operates three major programs that provide housing support, as well as a few smaller ones. Spending on those programs totaled $44.7 billion in FY2016. This is an increase of 11.2% from FY2009, when spending was $40.2 billion. When adjusting for inflation, spending on housing programs has remained essentially stagnant, decreasing less than 1%. While spending has remained relatively stable, the number of individuals receiving services has increased. In 2016, 9.5 million individuals received housing assistance (2.9% of the U.S. population). Comparatively, in 2010, 8.4 million individuals received housing assistance, representing 2.7% of the U.S. population.

The three major federal programs that provide over 80% of all housing support for low-income individuals and families include:

  1. Public housing – Provides federal subsidies to families that live in publicly-owned and operated units and/or buildings. If the family moves from the publicly-owned building, they will lose their housing subsidy.
  2. Project-based rental assistance – Provides rental subsidies for designated units that are privately-owned. If the family moves from the unit, the subsidy is lost.
  3. Tenant-based rental assistance (also known as housing choice vouchers) – Provides vouchers to low-income families to subsidize rent in privately-owned apartments or houses. The family does not lose the voucher if they choose to move.

In general to be eligible for housing assistance programs, individuals must have income below 80% the area median income (AMI) (see the AMI where you live). While individuals may have income up to 80% of the AMI, all programs prioritize individuals at lower thresholds. Additionally, individual public housing authorities may place additional restrictions on access to housing or prioritize different populations (i.e., those with a disability or those with children). To connect consumers with housing or to learn about the specific qualifications in your area check out PHA Contact Information to find information about each state’s local housing authority.

There also a few smaller programs that provide housing assistance specifically for complex consumer populations. Section 811 housing provides housing to very low-income individuals or households (30% of the area median income or below), where at least one person between the ages of 18-62 has a long-term disability and requires home and community based services (HCBS). Spending on Section 811 housing totaled $200 million in FY2016 – 0.4% of all housing assistance funding. Section 202 provides housing assistance to very low income individuals or households (50% or less of the area’s median income) where at least one person is over the age of 62. Spending on Section 202 housing totaled $700 million in FY2016 – 1.5% of all housing assistance funding.

Additionally, supportive housing programs are utilized to provide housing for consumers with chronic conditions. However, supportive housing is a model of housing and not a unified government program or funding stream. Therefore, organizations that provide supportive housing must coordinate multiple funding streams for different components of the program, with federal housing assistance programs covering some component of housing, Medicaid covering health care services, and state programs funding other social supports. (For more information on supportive housing, see How Are Permanent Supportive Housing Initiatives Funded?: An OPEN MINDS Market Intelligence Report.)

Looking ahead… The Trump administration proposed legislation related to housing assistance programs for low-income individuals that would to raise the minimum rent for all housing situations, impose work requirements, and increase rent for the elderly and disabled after six months. While the legislation is unlikely to pass in its current form, it is part of a larger move to make housing programs more of a short-term benefit rather than a long-term assistance program (see HUD Floats a Plan Intended to Reduce Reliance on Housing Assistance).

For more on housing assistance programs see U.S. Spending On Housing Assistance Programs: $44.7 Billion In 2016. For executive teams of provider organizations that are considering starting a housing program, working with health plans or integrated delivery networks to address social determinants of health as part of a value-based reimbursement model, or thinking about how to connect their consumers with social supports, this report provides an essential break down of the major housing programs and who is eligible for each program. The report also includes information to assess the current housing assistance market including spending trends, trends in individuals who receive assistance, and information by state on the number of housing units and people receiving services.

For more on this topic, join us at The 2018 OPEN MINDS Management Best Practices Institute for the keynote address Integration, The End Of The Carve-Out & The Importance Of Financing – The Health Plan Role In Facilitating “Whole Person” Care, led by Devan J. Cross, President, MHN, A Subsidiary of Centene.

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