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About Street roots. (Portland, OR) 1998-current | View Entire Issue (Aug. 19, 2016)
Street Roots • August 19-25, 2016 News considered a non-traditional part of health care delivery. The thinking goes, that any expenses that can help Medicaid patients maintain their health and stay out of the emergency room will keep costs down. Medicaid has already allowed Oregon’s CCOs to pay for air-conditioners and other similar non-medical services and to have more flexibility in how a CCOs’ budgets are spent. 'T'he hope is that the recently submitted J. waiver will be approved before the Obama administration ends in January. Once approved, Medicaid will begin reimbursing CCOs for an array of services that reduce barriers to housing. This includes case management to help people with mental illness navigate housing; help for people with substance abuse disorders to seek treatment and to have good relationships with a landlord; and paying for unresolved, past-due utility bills or other debts that can derail housing. It could also include retention services with individuals after they are housed to help address any challenges that may arise. The services would be targeted not only for people who are chronically homeless or threatened with homelessness, but also toward Medicaid patients who are transitioning out of jails or prisons, residential treatment centers, assisted living Knowing that housing is essential to health care, facilities, foster care and institutional settings such as hospitals and nursing Oregon providers are asking the feds to help pay for it homes. The supportive services covered under patients. The Oregon Health Authority is BY AMANDA WALDROUPE the waiver are the type of services that STAFF WRITER seeking a waiver from the Centers for housing advocates say are essential to Medicaid and the Medicare (CMS), the • ate last year, OnTrack, an addiction helping extremely impoverished people federal regulatory agency that regulates remain stably housed. treatment and recovery agency based Medicaid and Medicare, that would allow “The housing system has broken down so in Medford, considered buying a Oregon’s coordinated care organizations to much,” said Kenny LaPoint, the Oregon 15-unit apartment complex and turning the pay for supportive housing services that Housing and Community Service’s housing building into transitional housing for the help homeless or formerly homeless people, integrator. “To bring this in to provide organization’s clients and their families. as well as people with severe mental services brings stability in the funding The building was dilapidated; the illnesses and substance abuse addictions, stream.” foundation was seriously damaged after a get into and stay in housing. “This would have a huge impact,” said creek bordering the property flooded. The Those who provide supportive services to Rachel Post, Central City Concern’s public costs to repair the building to make it homeless or formerly homeless people say policy director. “It would acknowledge that habitable made purchasing the property the change would be a boon for an housing is the most important social nearly impossible. affordable housing system that is being determinant of health.” AllCare CCO, the coordinated care decimated by rising rents. Medicaid Social determinants of health are the organization that provides care to people providers say paying for housing-related factors in a person’s life that directly covered by Medicaid in Curry, Jackson and services is essential to saving hundreds of impacts their health, such as a person’s Josephine counties, footed the bill. thousands of dollars. housing, their education, the physical “We wanted to make sure they could get environment in which they live, their access over the hump,” Josh Balloch, AllCare’s vice to transportation and their socio-economic president for governmental relations and he federal waiver is the latest step status. health policy, said. coordinated care organizations — also Post, LaPoint and others say that housing, The money came from AllCare’s known as CCOs — have taken to be able to and remaining stably housed, is the most administrative budget, which makes up 8 flexibly spend Medicaid dollars on services important factor in staying healthy. percent of its total budget and some of that may not necessarily happen in a “If you don’t meet basic needs, then which is used as “community benefit” doctor’s office but nonetheless keep people are not able to engage in meaningful money — money that AllCare can spend patients healthy. treatment,” said Kevin Campbell, executive flexibly on non-medical services that help Since the Oregon Legislature created director of Greater Oregon Behavioral its patients stay healthy. CCOs in 2011, they have been tasked with Healthcare, Inc., a member of the Eastern The federal government will not coordinating and integrating the primary, Oregon Coordinated Care Organization. “If reimburse AllCare for the expenditure, as mental and dental health care of the we are able to integrate housing into their the government does for AllCare’s medical 100,000 Oregonians who are covered by care, then that gives us a much better and health-related expenses. Services Medicaid, the federal program that provides chance to ensure that they can stay in their related to housing — whether to rehab a health care for people living in poverty. community and participate in treatment.” building, the case management that helps a CCOs are also expected to provide that Historically, health care providers and mentally ill person navigate the rental integrated, coordinated care at a lower cost systems have been reluctant to spend any applications, or retention services that keep to patients and the state, focusing on money on housing or housing-related people housed — are not considered primary care and other preventive services services. “They don’t want to pay for bricks services that Medicaid can pay for. that reduce the necessity of emergency and mortar,” Post said. “They feel that’s the That could soon change in Oregon, room visits and other high-cost services. federal government’s responsibility. But the freeing up funds to house its most It has led CCOs to fund pilot projects and feds don’t have the political will to finance vulnerable, high-need and expensive experiment with services and programs B T Page 7 (housing and supportive services) to the degree that it needs to be financed.” Research is beginning to clearly show that a person’s housing and their health are integrally connected. Earlier this year, the Center for Outcomes Research and Education (CORE), a Portland-based research group, released a study showing that Medicaid expenditures drop substantially if patients live in stable, affordable housing. The study partnered with Health Share of Oregon, the largest coordinated care organization in the Portland metro area, and analyzed claims data, between January 2011 and June 2015, of 1,625 individuals who moved into affordable housing during that period of time and were also covered by Medicaid. Medicaid expenditures by those individuals decreased, on average, by 12 percent. Patients who lived in permanent supportive housing — housing that is connected with case management and access to mental health or substance abuse treatment — decreased by 14 percent. The costs of Medicaid patients who were seniors and disabled declined the most, by 16 percent. Emergency room visits declined by 18 percent and outpatient primary care fell also, by 20 percent. The study concluded that “health care experiences” of the 1,625 patients in the study “changed dramatically” as a result of moving into affordable housing. The study recommends that “states, localities and (coordinated care organizations) should invest resources such asr Medicaid'm■ —" — housing solutions” and 'thatMedfrcaidddllzfr^ should be spent on resident service coordinators and other housing services. “As this study shows,” the report reads, “stable housing plus health-related services can yield significant cost savings and improve resident health.” ome CCOs are already investing in housing-related services. In addition to the apartment complex AllCare provided funding to, the southern Oregon CCO also gave funds to the Josephine County Sobering Center, where people with substance abuse issues can stay for up to three days to detox. “It’s emergency housing,” Balloch says. “But it’s not jail.” AllCare gave funds to Hearts with a Mission, a homeless youth agency in Jackson County, to help fund a new shelter for homeless youth. AllCare also gave $100,000 in grant funding to Curry County to fund a research project that will identify ways to address housing needs along the southern Oregon coast. Balloch says the vacancy rates in Jackson and Josephine County are close to zero percent — meaning that there are virtually no apartments or homes available for rent The people who face the most pressure, when it comes to finding housing, are the poorest, those with the highest barriers, and the sickest, he said. “Housing keeps coming up over and over again” as a major issue for AllCare’s patients, Balloch said. “There’s such a need, I don’t know there’s enough that we can do.” Campbell tells a story about a homeless S See HEALTH, page 13
