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Publications in this section highlight the many ways in which affordable housing can help advance other important community objectives, such as good health, educational achievement, individual asset building, and economic development. The Center’s work in this area seeks both to clarify and document the benefits of affordable housing and to suggest ways to structure affordable housing to better achieve these broader goals.
Increasingly, states are focusing on implementing Medicaid reforms as part of the Affordable Care Act’s (ACA) goal to deliver high-quality care while containing health care costs. Some are authorizing a new kind of Medicaid health care delivery system, accountable care organizations (ACOs). ACOs are integrated health care delivery organizations that not only cover the cost of medical care like a health insurance company, but also offer care coordination for health and social services to address the complex health needs of patients. ACOs consist of networks of health care providers and organizations like hospitals and clinics that work together to coordinate the health care of members. Medicaid payment rates to ACOs are capitated, meaning there is a standard payment rate per member regardless of services utilized. In addition, ACOs keep a share of the savings achieved by spending less than the capitated rate. This is a strong incentive to contain health care spending by investing in preventative care and care coordination to improve the health of members and reduce the need for expensive acute care.
A major housing quality concern for affordable housing organizations is children’s exposure to lead, most often through lead-based paint in homes built prior to the 1980s. Lead exposure can lead to poisoning among young children which can result in behavioral problems and intellectual impairment. Children from low-income communities and communities of color are disproportionately affected by high lead levels in the home. Since 1989, Medicaid has required that all enrolled children have their blood tested for the presence of lead to discover whether they have elevated blood lead levels that could be harmful.
In 2012, New York State began reforming the way the state delivers and pays for health care for Medicaid beneficiaries in order to offer high-quality health care to low-income individuals at lower cost. The state is using a Section 1115 Medicaid demonstration waiver to adapt its Medicaid system in a way that will increase focus on community-level collaboration and care coordination. This shift is expected to both improve the health of Medicaid beneficiaries and reduce the use of hospitals to deliver basic care. These reforms are estimated to result in a $17.1 billion reduction in Medicaid expenditures over five years. The state is using $8 billion of the anticipated savings to invest in several initiatives that support the health and wellbeing of Medicaid beneficiaries. One of these is the Supportive Housing Initiative implemented by the Medicaid Redesign Team (MRT), a group of stakeholders and experts guiding the state Medicaid reform process. The Initiative, through capital funds and operating subsidies, constructs or rehabilitates supportive housing designed for high Medicaid utilizers.
New research from Children’s HealthWatch illustrates there is no safe level of homelessness. The timing (pre-natal, post-natal) and duration of homelessness (more or less than six months) compounds the risk of harmful child health outcomes. The younger and longer a child experiences homelessness, the greater the cumulative toll of negative health outcomes, which can have lifelong effects on the child, the family, and the community.
The paper explains how the Medicaid program works and key changes made by the Affordable Care Act (ACA) and prior health care reform efforts have altered the health care sector to focus more on prevention, care coordination, and the social needs of Medicaid beneficiaries. Some of the changes to the Medicaid program by the ACA and other reforms have created openings and incentives for health care organizations to collaborate with affordable housing providers to address the impact that housing has on the health of a low-income individuals. The report identifies these opportunities and describes promising programs and developments in different parts of the country. This report offers an overview of areas where the health and housing sectors overlap in the wake of Medicaid reform for affordable housing providers, healthy housing organizations, and advocates to discover ways in which they can pursue collaborations with health organizations.