Online Program

Responding to Health Home Members who have No Home: The New York State Medicaid Supportive Housing Health Home Pilot

Monday, November 2, 2015

Emmanuella Asabor, MPhil, Department of Emergency Medicine, New York University School of Medicine, New York, NY
Elizabeth Misa, MPA, Office of Health Insurance Programs, New York State Department of Health, Albany, NY
Henie Lustgarten, MUP, Montefiore Medical Center, Bronx, NY
Pascale Leone, MPP, Corporation for Supportive Housing, New York, NY
Kristin Miller, MSW, Corporation for Supportive Housing, New York, NY
Kelly Doran, MD, MHS, Departments of Emergency Medicine and Population Health, New York University School of Medicine, New York, NY
Providing quality and effective care to high-need individuals continues to challenge the health system in the United States. Health Homes (HHs) have been proposed as one solution and were included in the Affordable Care Act. HHs provide comprehensive care management to high-need patients, coordinating services including health promotion, transitional care from inpatient hospitalizations, family support, and linkage to social services for individuals with multiple chronic conditions. Sixteen states have implemented HHs, enrolling over one million Americans. Though HHs serve high-risk patients, little attention has been paid to the social factors that impact the health of HH members. In New York State (NYS), unified Department of Health (DOH) Functional Assessment forms are completed for all HH members and include the question “are you homeless?” For this question, DOH instructs that “‘having a home’  means having one’s own residence that one has access to at any time” and specifies that “being in a shelter or ‘couch surfing’ would be considered homeless.” The Bronx Health and Housing Consortium and the Corporation for Supportive Housing (CSH) examined responses to this question for selected HHs in New York City (NYC) and found high rates of homelessness. Health and Hospitals Corporation, NYC’s large public hospital system, reported that 7% of its Health Home members were homeless. The Bronx Health Home reported that 7% of 4,546 HH members were homeless, and the Bronx Accountable Healthcare Network reported that 14% of 5,072 members were homeless. One HH, Community Care Management Partners, reported an even larger degree of homelessness, 39% of 10,053 members across NYC. Recognizing this need, NYS DOH initiated the Medicaid HH Supportive Housing pilot. Funded through a reinvestment of NYS Medicaid savings, this pilot will provide $8 million over 2 years for rental subsidies and support services for homeless HH members. Ten providers throughout NYS were each awarded $400,000 to serve over 350 HH members beginning in 2015. Through this pilot, we hope to identify best practices for targeting homeless HH members, improving their health outcomes, and curbing healthcare costs. Given the importance of stable housing for successful care coordination, HHs in other states should consider screening for homelessness and devising strategies that connect affected members to appropriate resources. HHs must address all of the factors that impede improved health – including social factors such as homelessness – if they are to fulfill their mandate.

Learning Areas:

Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health administration or related administration
Public health or related public policy

Learning Objectives:
Assess the prevalence of homelessness among New York Health Home members. Identify potential strategies to improve health outcomes and curb costs among homeless Health Homes members.

Keyword(s): Medicaid, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am one of the co-authors of the abstract and have done significant work on the care coordination practices of Health Home care coordinators and supportive housing providers. A study I worked on assisted with the development of the pilot program covered in the poster session.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.