Connecting Health Care and Housing
The conditions in which people are born, grow, live, work, and age have such significant influence on an individual’s health that the World Health Organization calls them “social determinants of health” (SDOH). Local plans, with a depth of understanding about and connections to their communities, are finding creative solutions to better bridge the divide between health care delivery and SDOHs – with particular focus on housing, which is among the most pressing and complex of SDOHs to address within regulatory restrictions.
For individuals experiencing homelessness or housing insecurity – who struggle to meet basic needs like food and shelter — managing their overall health and seeking appropriate care can be a tremendous challenge. Federal Medicaid requirements prohibit the use of its funds for “hard“ housing costs like rent. So, California’s local health plans have developed other strategies to improve the connections between health and housing. Success stories include:
CalOptima’s Recuperative Care Pilot: This innovative pilot program was created in 2015 to address the health care needs of Orange County’s homeless population. To date, the plan has allocated $1 million so homeless members can go to a recuperative care setting rather than back to the street upon discharge from the hospital. Recuperative care centers offer temporary housing so patients can recover from an illness or injury in a clean and safe setting. These care centers also provide referrals to social services and case management, food and housing. Providing a pathway to recuperative care has resulted in fewer hospital readmissions and fewer avoidable emergency department visits. So far, more than 700 members have received recuperative care through the pilot. CalOptima continues to examine how to best serve its homeless population and is considering an additional investment in expanded recuperative care services.
Health Plan of San Mateo’s Community Care Settings Pilot: The Health Plan of San Mateo (HPSM) created the Community Care Settings Pilot (CCSP) in 2014 to reduce unnecessary institutionalizations for seniors and persons with disabilities residing in skilled nursing facilities (SNFs). This pilot focuses on helping individuals transition back to living independently and in the right setting through assisted living, residential care, senior housing or their own apartment with additional support and services provided by the health plan. Not only is community-based living more cost effective, it often is the most commonly expressed goal of the individuals. To-date, the plan has transitioned more than 200 members safely back into the community through its partnership with housing agency Brilliant Corners and the Institute on Aging and by providing intensive case management, housing and other services.
The results of the pilot are promising: 72% of CCSP members remain in the community; costs per member are 40% lower; and members report increased satisfaction
Inland Empire Health Plan’s Homeless Housing Initiative: Inland Empire Health Plan (IEHP) recently launched an initiative to help its homeless members in Riverside and San Bernardino counties access “permanent supportive housing” (PSH), which pairs housing and rental assistance programs with IEHP’s supportive services (e.g., intensive case management). The plan’s goal is to provide PSH and wrap-around case management services to 350 homeless members. While the program is starting as a pilot, IEHP hopes to demonstrate that it will improve members’ health and reduce medical costs, which will allow the plan to expand the initiative in the future.
Last year, LA Care committed unprecedented financial support, also in partnership with Brilliant Corners, to fund local efforts to secure housing for homeless in Los Angeles County. The Central California Alliance for Health (CCAH), serving Santa Cruz, Monterey and Merced counties, is addressing social determinants for their members. To date, they have dedicated $5.3 million to support construction of permanent supportive housing for Medi-Cal members with complex health and social needs. While the specific goals of each local initiative may be slightly different, all reflect the increasing focus on linking health care and housing in order to improve outcomes and reduced unnecessary cost.
As California continues to grapple with its escalating homelessness crisis, LHPC member plans will play a critical role in addressing this issue and its impacts in their respective communities. Moving forward, local plans intend to continue working with our partners to ensure the Medi-Cal program modernizes to support and promote the types of innovations that improve the SDOHs.