Medicaid: SDOH, Most Def. Direct Involvement in Housing? Don't Go There.

Health care is a big enough job, say progressive think tankers
Peter Wehrwein

Medicaid programs and managed care organizations can (and should) coordinate, refer, and otherwise support housing for low-income people.

But they should not get into the business of directly providing or paying for housing, in the opinion of Hannah Katch and Peggy Bailey of the Center on Budget and Policy Priorities, a progressive think tank.

“Medicaid can’t fill the vast unmet need for affordable housing without shortchanging health care,” Katch and Bailey wrote in a Health Affairs blog post.

The post has a bulleted list of four reasons that Medicaid just shouldn’t go there when it comes to direct involvement in housing.

  • Too big a gap. Only 25% of low-income households who need it federal housing assistance get it. Medicaid programs can’t make up that difference.
  • Health care is a big enough job. Before taking on housing, Medicaid programs should work on making dental, vision, and behavioral health care available, they say. Katch and Bailey also mention low payments to providers for basic health services, which has the effect of limiting choice and access for people covered by Medicaid.
  • No housing experience on the resume. “Medicaid programs don’t have the capacity or expertise to manage housing stock, inspect units for safety, or pay people’s rent,” wrote Katch and Bailey.
  • Housing instability could be an unintended consequence. If housing is tied to Medicaid eligibility, people’s housing might be threatened if their income improves and that improvement means they make too much money to remain eligible for Medicaid.

Katch and Bailey are not against addressing health issues through SDOH efforts; in fact, they praise “cross-sector advocacy” and want to see health and housing organizations working together. But being a landlord or a developer is different matter.