#SeaHomeless: Washington’s Medicaid waiver aims to help homeless, jobless

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Funding for supportive housing services is drawing closer to integration to Medicaid in Washington State.

Last August, Washington state submitted a Medicaid 1115 transformation waiver to the Centers for Medicare and Medicaid (CMS).

The waiver has three prongs, or initiatives, designed to improve Medicaid in Washington: (1) transformation projects; (2) long-term services and supports; and (3) supportive housing and supportive employment.

It’s well known throughout the health care community that homelessness, joblessness, and poor health are inextricably linked.

The Washington State Commerce Department most recently reported that nearly 18,000 persons were homeless on one night in January 2013, and 11 percent of those people were chronically homeless.

In 2012, the Washington Low Income Housing Alliance (WLIHA) found that more than 14,000 Medicaid beneficiaries with “any housing needs” had average annual health care costs of $29,584 per person. Of this number, 1,412 people incurred an average of $107,959 in medical bills.

This third prong of Washington’s Medicaid waiver, therefore, represents a bold new opportunity to help the state’s most vulnerable population while also reining in the cost of care.


Currently, not everyone in Washington who is Medicaid-eligible and needs supportive housing can get it, according to a 2014 white paper by WLIHA.

Under its new Medicaid waiver, the Washington State Health Care Authority (HCA) is proposing to create a targeted supportive housing services benefit for eligible Medicaid beneficiaries.

There’s already been some movement on the ground.

Harborview Medical Center has partnered with the Downtown Emergency Services Center in Seattle to provide supportive housing for medically fragile homeless individuals who have been discharged from the hospital.

Washington’s waiver provides the chance expand these types of models throughout the state.

“The fact that many of our communities are already working on this connection has made the collaboration between housing and health care much easier to initiate,” said Jon Brumbach, a senior health policy analyst with the HCA.

In May, HCA and the Washington State Department of Social and Health Services also helped facilitate a Medicaid training on supportive housing hosted by WLIHA at which only between 30-50 people were expected to attend.

Instead, more than 175 people representing housing providers, health care providers and other stakeholders showed up.

“The level of stakeholder engagement has been really impressive,” Brumbach said.

HCA is quick to stress that this benefit would not include payment for room and board — rather, the waiver would be used to pay for services that help Medicaid beneficiaries find and keep housing. And as part of Medicaid, state dollars would be matched by money from the federal government.


It’s also hard to keep a roof over your head without a job.

With this in mind, HCA is also proposing to provide employment services to Medicaid-eligible beneficiaries who have physical, behavioral, or long-term service needs.

These services would include job coaching and training, help with employer relations, and assistance with job placement.

According to its Medicaid waiver fact sheet, HCA proposes to:

  • Help individuals stay engaged in the labor market, specifically targeting those enrolled in the Aged, Blind, and Disabled program, or have the potential to be enrolled in the Housing & Essential Needs program.
  • Prevent the escalation of the need for behavioral health services by helping individuals with severe and persistent mental illness and substance use disorders.
  • Support those with significant long-term services and support needs, specifically individuals with traumatic injury and physical disabilities.
  • Support vulnerable youth and young adults; specifically working age youth with a behavioral health diagnosis.

Similar to the supportive housing benefit, these services would be for individuals with medical needs. HCA says it anticipates a caseload for supported employment benefits of about 3,000 individuals per month.

Brumbach added more logic to the policy integration.

“We believe, and research shows, that  incorporating supportive housing, as well as supported employment, benefits into the 1115 waiver will help reduce the use of intensive services, improve population health outcomes, and will help bend the cost curve below national trends.”