Shelterforce Examines Using Medicaid Dollars for Housing

Medicaid Waiver in North Carolina Paves the Way For Housing as Healthcare

A February 2019 article in Shelterforce discusses using Medicaid funding to directly subsidize housing. North Carolina is an example of a state that just got a waiver to use Medicaid funding for housing. And other parts of the country are developing “Housing as Healthcare” projects using Medicaid funding.

“What if we provided solutions for the whole person, including addressing housing, nutrition, and other social needs? What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea . . . I want you to stay tuned to what CMMI [the Center for Medicare and Medicaid Innovation] is up to,” said Azar in a November 2018 speech to the Hatch Foundation.


Alex Azar, is President Trump’s secretary of the U.S. Department of Health and Human Services (HHS)

Azar’s comments speak to something many homeless service providers have known for years, that funding could be used to keep someone housed rather than have that person face homelessness. Or funding could be used help someone with a chronic illness stabilize their health rather than have that person cycle in and out of expensive emergency department care.

Shelterforce reports that, later that same day of his speech to the Hatch Foundation, he (Azar) gave a speech to the Commonwealth Fund with a similarly intriguing message.

“We are actively exploring how we could experiment with actually paying for non-health services, like housing and nutrition—an integrated, individually driven approach to health and human services on a scale that has never before been tried in the United States,” he (Azar) said.

Could New Jersey use Medicaid funding to directly subsidize housing? North Carolina provides New Jersey and other states with an example.

In October 2018, the Center for Medicaid and Medicare Services (CMS) approved a Medicaid waiver for North Carolina. Among other important things the waiver could provide an avenue for states to use Medicaid funding to directly pay for housing, something which is not allowed under the Social Security Act.

North Carolina will launch two to four pilot projects over the next five years. Each pilot will be implemented working with human service organizations. In addition, for paying for housing-related services, the waiver allows Medicaid funds used in the pilots to be used for one-time payments for security deposits and first month’s rent. The funding can also be used for post-hospitalization housing for up to six months. The post-hospitalization housing follows the model that “housing is healthcare.”

Experts in the housing and healthcare fields will be watching to see if the waivers save money.
Click here to read “Medicaid Dollars for Housing?” in Shelterforce.