Medicaid study reinforces that housing is health care

November 2, 2018 Timothy Zaricznyj, Ed.D.

Safe, affordable housing resulted in a dramatic drop in use of Medicaid-covered acute and emergency services.

The family of organizations that comprise Providence St. Joseph Health are privileged to include the hard-working scientists and professionals at the Providence Center for Outcomes Research and Education whose 2016 publication, “Health in Housing: Exploring the Intersection Between Housing & Health Care,” found that Medicaid costs decrease significantly when people with very low incomes gain access to safe, affordable housing.

Study findings align with experience of supportive housing leaders        

I was excited to speak recently with CORE Director Bill Wright, Ph.D., and Research Scientist Keri Vartanian, Ph.D., about their well-received study, and explore where their findings reinforced my day-to-day experience operating our 16 Providence Supportive Housing programs in Washington, Oregon and California. Our management teams and service coordinators are always ready with stories and anecdotes about our residents and how our supportive housing model enables them to avoid crises related to undetected diagnoses or unrecognized symptoms.

Medicaid costs drop one year after move-in

CORE’s “Health and Housing” study found that when Medicaid-covered residents moved into affordable housing programs like ours, both their health care utilization and expenditures changed dramatically. In the year after moving in, outpatient primary care utilization increased 20 percent, while emergency department use fell by 18 percent and inpatient care declined 15 percent. Medicaid health care expenditures for these residents declined by 12 percent. 

Residents increase use of primary, preventive care

When I spoke with Bill and Keri about their study of 145 affordable housing communities, Keri noted that a significant finding was that “there wasn’t just a blanket decrease in use of care that led to savings. We, in fact, saw an increase in engagement with the kind of primary and preventive care that you really want to see people using, while at the same time we saw a dramatic drop in their use of acute care and emergency services.” Bottom line?  People with low-incomes residing in safe and affordable supportive housing environments show greater and more appropriate health care utilization and decreased cost. 

Impact of supportive housing is remarkable

Bill pointed out that the size of the effect that housing has on health is remarkable. Even health care programs that are specifically designed to reduce health care costs while delivering care that is as good or better, he said, seldom achieve the same level of impact that is documented in the CORE study. He noted that, in the CORE study, “these weren’t people accepted into housing programs specifically to reduce their medical expenditures. They were just housed. So the idea that doing social good and helping to meet some basic needs could align with an improved business case … was really exciting for me and I think could be a powerful transformational lever going forward.” 

Successful health care reform includes housing security

Bill says he and his team are observing the interconnectedness of systems and sectors that span our society, and that housing functions as an important “fulcrum,” with impacts that ripple outward in myriad ways. As we at Providence St. Joseph Health affirm our commitment to serving those who are poor and vulnerable in our communities, it remains essential that we continue to reach beyond the four walls of our hospitals and medical office buildings to effect lasting change. We also urge policymakers to take note of the CORE study’s findings and its implications. If health care reform is to be successful, it must include attention to housing insecurity and homelessness as a critical social determinant of health.

This blog post is the third in a series about housing and health authored by Timothy Zaricznyj. The next will explore the connections between mental health and homeless and how supportive housing programs such as ours are addressing the mental health needs of residents.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

About the Author

Timothy Zaricznyj, Ed.D.

Timothy Zaricznyj, Ed.D., is director of housing for Providence St. Joseph Health. He leads 16 affordable housing programs in Washington, Oregon and California. Zaricznyj holds a doctorate in education from the University of San Francisco for which he published the dissertation “Righting Home, A Critical Hermeneutic Study of Home, Homelessness and the Spaces In Between.”

More Content by Timothy Zaricznyj, Ed.D.

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