With the expansion of Medicaid under the 2010 health care law, states have an unprecedented opportunity not just to improve people's health, but also to boost the effect of other federal safety-net programs.
In an era of tightening budgets, a few common-sense changes to housing policy could help federal programs improve the health of some of society's sickest and most vulnerable.
For vulnerable populations such as the elderly, people with disabilities and people with complex health needs, housing and health are intricately linked. People who have chronic illnesses or are frequently hospitalized could very likely have difficulty paying their rent on time and keeping up their homes, potentially leading to homelessness. Similarly, people without stable housing have more difficulty avoiding exposure to illness, eating nutritious foods and seeing doctors.
We will succeed in keeping some of society's most vulnerable housed and healthy only if we make efforts to have federal programs work in tandem.
For example, a woman with a severe chronic medical condition, such as Type 1 diabetes, who is struggling to make ends meet without a steady income may move from place to place when she can't afford rent or faces eviction. Without a consistent address or phone number, she can't communicate with her doctors, pharmacists or support services. As a result, her medical conditions won't be well-managed, leading to expensive medical treatment that could have been prevented.
When placed in stable, affordable housing, people are far more likely to maintain their health through regular access to care and benefits.
The bottom line? Those who might otherwise bounce from address to address stay healthier, and the limited resources devoted to both health and housing programs complement each other and are used more effectively.
How do we make this happen?
First, we must do more to connect the right individuals with the right housing.
Currently, someone who is older than 62, meets income eligibility and is in good health might be placed in Section 202 Housing - the program that provides housing subsidies for low-income elderly people - before someone who is more in need of the supportive services that are linked to this housing.
Facing a shortage of housing that has been made affordable for low-income people and is connected with services, we need to ensure the most vulnerable have access to it.
One way to do this is to develop citywide, countywide and statewide databases of available housing that is linked to services.
Second, the Housing and Urban Development Department has, up until recently, prohibited providers of subsidized housing from giving preference in housing according to type of disability, and this must change.
To ensure that health and housing programs can work together effectively, HUD administrators should have the flexibility to place people in housing that meets their specific needs.
Finally, in states that opt into the Medicaid expansion, administrators will be able to use the program's flexibility and newly expanded reach to connect the most vulnerable in society to the services they need.
For example, Medicaid often covers case management and care coordination through which participants receive referrals to services and more effective medical care. These services can help people with Medicaid coverage develop skills to locate and maintain housing, find employment training and receive assistance managing illness or addiction symptoms that could put their housing at risk.
With the right changes to housing policy, we can better ensure that the vital services provided by programs such as Medicaid are reaching people who are in homes that make it more likely that they can become healthier.
Let's start by making sure that the housing and health services that our society's most vulnerable depend on are provided comprehensively, effectively and in ways that make sense. The Medicaid expansion can be combined with key improvements to housing policy to do just that.
Jill Khadduri is a principal associate and senior fellow at Abt Associates. Gretchen Locke is a senior associate at Abt Associates.