Health is the way a person interacts with their environment. A person’s environment includes where they live, the quality of the home, the air, and access to nutritious food. These all influence a person’s opportunities to achieve health and affect the rates of life expectancy, infant mortality, and rates of chronic disease.
One of the most influential public health factors for a person’s environment is where they live. An individual’s access to housing and the conditions of that housing can be a direct determinant of their health. Health and Housing are deeply intertwined. Having no housing options as well as housing that exposes occupants to unsanitary and hazardous living conditions can directly impact an individual’s susceptibility to illness.
Previously allowing Medicaid funds to be used towards paying The Centers for Medicare & Medicaid Services (CMS) for housing expenses was prohibited but recently, issued new guidance on Medicaid Waivers giving states the flexibility to use Medicaid dollars to support housing expenses including rent and temporary housing. CMS approved section 1115 which allows states to choose to use some of their Medicaid funds towards time-limited housing and nutrition services.
In November 2023, CMS reiterated its HRSN waiver policy outlining that the program includes coverage for “Housing” and “Nutrition”. The program included things such as short-term and post-transition housing for up to six months, people at risk of homelessness, and youth transitioning out of the welfare system. Other housing assistance in the waiver includes pre-tenancy and tenancy sustaining services, tenant rights education, and eviction prevention costs including security deposit, utility fees, moving, relocation, application expenses, and inspection fees.
As well as obtaining housing, the funds can also be used to improve housing. The quality of a home can directly impact an occupant’s health. Things such as mold, inadequate plumbing, heat, and air conditioning can cause health issues for those living in these conditions. Additionally, fixing these issues can be expensive. The Section 1115 Waiver also allows funds to be used towards modifications to one’s home environment including air conditioners, heaters, air filtration devices, generators, carpet replacement, ventilation improvements, and mold and pest removal. These improvements would lead to improved health conditions and mitigate the need for hospital visits and medications related to illnesses caused by unhealthy living conditions.
As of March 2024, at least 18 states had approved Section 1115 Medicaid demonstration waivers for housing-related services with eight states recently approved under the housing-related social needs waiver framework. Hopefully, more states will choose to use their Medicaid funds towards housing assistance for their citizens. This will directly improve the health conditions of its beneficiaries, contributing to the stability of the healthcare system overall.