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
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(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
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See HEALTH, page 13