Day 44 – Medicaid at 50: State Highlight: New York

Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up the the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.

I feel about housing the way Emma feels about California. Housing affects health in so many ways! Substandard housing is linked with asthma morbidity in children (here is a recent study on this), and it’s not good for adults either. It’s really hard to take care of a patient who doesn’t have a stable residence, especially if they have complicated medical issues – where do you discharge them after a hospitalization? How do you follow up? How do you contact them with results or reminders?

The health system ends up being the payer of last resort for holes in the social safety net, which is expensive and doesn’t get at root causes of poor health and high utilization. High-need, high-cost patients with complex medical and psychosocial needs can end up bouncing between hospitals, shelters, and jails. Behold, New York’s latest 1115 waiver, which allocated $75 million for supportive housing. The logic is this:

New York Medicaid payments for nursing-facility stays are $217 per day, as compared with costs of $50 to $70 per day for supportive housing. Furthermore, preventing even a few inpatient hospitalizations, at $2,219 per day, could pay for many days of supportive housing.

Housing policy is a whole other (very intriguing) topic for inquiry, but I think there is a lot of untapped potential for collaboration between Medicaid + housing programs and policy (HUD/VASH is a collaborative with the VA and a good example of supportive housing specifically for veterans).

I look forward to following New York’s progress, and hope that the promise of supportive housing can be realized for the neediest Medicaid patients.

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