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

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.