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Medicaid Expansion’s Role in Helping Homeless


  • Barriers can prevent Medicaid funds from financing PSH services
  • Abt studied how programs and government partners can overcome obstacles
  • We concluded many providers and innovative models are effective
The Challenge

The expansion of Medicaid under the Affordable Care Act meant that many more people were eligible for the health program for low-income people. They include the chronically homeless and tenants in permanent supportive housing (PSH)--subsidized housing for formerly homeless people with disabilities and chronic health conditions. Though the programs serve the same communities, barriers can prevent the use of expanded Medicaid funding to finance PSH services. 

The Approach

Under a contract with the Department of Health and Human Services, Abt studied how PSH programs and their government partners can overcome obstacles to using Medicaid to fund services in PSH. We also assessed the required systems changes, and which program models are most cost-effective and likely to be sustainable. The study analyzed pioneering approaches several states and counties use, and the important role of innovative care models used by managed-care organizations and accountable-care organizations.

The Results

The observed strategies included:

  • Helping PSH tenants enroll in Medicaid and access Medicaid-covered mental health and behavioral health services
  • Developing partnerships between PSH providers and community-based health centers to reach PSH tenants and help ensure consistent access to coordinated care
  • Adapting state Medicaid plans and using federal waivers to expand health coverage and address service gaps for people experiencing homelessness or who were once homeless and now live in PSH

The study concluded that many types of Medicaid providers and innovative models for care – managed care organizations, health centers, behavioral health providers, and Accountable Care Organizations – are playing important roles.