With a greater focus on health-related social needs (HRSNs) in Illinois, stakeholders are trying to figure out ways to implement services addressing those needs within the broader healthcare system. Experts discussed the challenges they face in providing HRSN services, like housing and food assistance, at the 2024 State of Reform Health Policy Conference last month.
The Greater Chicago Food Depository is one of eight food banks that is part of the Feeding Illinois network. Beth Kenefick, a senior policy advisor at the food bank, said staff have worked the past few years to figure out what their place is in addressing food insecurity as a HRSN.
Kenefick said it is important to look at HRSNs at the individual, community, and systems levels to ensure all the work they do is connected and helping people. Many communities are historically disinvested, so the depository’s research team used metrics to identify its top 40 priority communities that need the most support, she said.
At the systems level, Kenefick said she wants to look at the root causes of poverty to help end hunger, as many services only reach out to people after they become food insecure.
“Income, livable wages, [and] all of these things are necessary to help bring families and our neighbors into a place where they eventually don’t need us,” Kenefick said.
Kenefick also encouraged people to use federal assistance programs. Funding is a primary barrier in providing HRSN services, but federal programs are sometimes better-resourced. The Supplemental Nutrition Assistance Program (SNAP) provides around nine times more food than food banks. SNAP is highly underutilized in Illinois, Kenefick said, so it is important to ensure eligible people are enrolled in programs that can help them.
Lynda Schueler, CEO at Housing Forward, said housing is another HRSN intertwined with healthcare.
“You cannot address homelessness and housing insecurity without really addressing the healthcare needs of our population,” Schueler said.
Schueler discussed an experience she had around 10 years ago, when she pulled up to Housing Forward’s office at around 8 p.m. to retrieve some papers. When she arrived, a person at the office said they had been at the hospital, and the hospital called them a taxi to transport them to the office. However, that office is not where Housing Forward’s shelter is located.
Schueler then decided to drive the person to the shelter, and told Housing Forward’s board they needed to collect more data at intake to find out where people were coming from. They then began asking people coming into the shelter where they had been the night before, and what community they considered to be home.
“We looked at three years worth of data,” Schueler said. “Eleven percent over those three years had spent the previous night in a hospital setting.”
Housing Forward started a connection with Cook County Health in order to move services upstream because accepting people who had just been released from a hospital setting with medications into a temporary shelter was not in their best interest.
Cook County Health made an initial investment in some permanent supportive housing (PSH), and ultimately found it costs less money to invest in housing support than to continually care for and release people without stable housing.
Sendy Soto, chief homelessness officer of Chicago, said the city will be launching a five-year plan with stakeholders to determine how it can better service people in need of secure housing. The goal of the plan is to see what the city is doing well, and what it can do to improve.
Soto said another thing the city is beginning to do is bridge housing, a form of PSH. The community will also have on-site services, including clinical and nutrition support.
“We’re expecting to have maybe 40 people, and they would be staying for an average time of three to six months,” Soto said.
Dana Kelly, chief of staff at the Illinois Department of Healthcare and Family Services (HFS), said it is difficult to properly address HRSNs without involving Medicaid, which is why HFS applied for a HRSN-focused 1115 demonstration waiver.
HFS is working closely with the Centers for Medicare and Medicaid Services (CMS) to flesh out details of the waiver. Kelly said HFS expects CMS will approve the waiver soon.
“[The waiver] allows us to add services into Medicaid that would not normally be allowable under Medicaid. As a part of this, we are able to secure matching funding for those services, but we really have to, in some ways, take these untraditional services and kind of fit them into these rules and regulations of how we would normally achieve matching in the Medicaid program.”
— Kelly
Kelly said the agency eventually wants Medicaid to cover eight different HRSN benefits, including housing support, medical respite, reentry services, community reintegration, food and nutrition services, violence prevention and intervention, employment assistance, and non-medical transportation. In the beginning stages, HFS will focus mainly on housing supports, medical respite, and reentry services for people who have been institutionalized.
Once the waiver is approved, Kelly said there will be a long implementation process with CMS and the state’s Medicaid-managed care organizations.
Soto said community-based organizations (CBOs) have historically been important HRSN providers. She added that there are hundreds of CBOs running HRSN services, and the city works with them to bolster their system.
“It is really critical for us to work with community partners … They can meet people where they are at.”
— Soto
CBOs are also able to help non-citizens who may not be covered by many government-funded HRSN services. Soto said ensuring that HRSN services, such as nutrition, are culturally competent will allow people to be truly taken care of. A barrier to this, she said, is funding.
“We need to ensure that funding can be flexible and nimble to ensure we have enough meals to serve everybody,” Soto said.
Data collection is another primary barrier in providing more HRSN services, because health plans need data to prove success and savings to invest in services.
Kenefick said a person may need a medically-tailored food program, but if their family is also in need of food, organizations cannot collect reliable data to see if something like a food prescription is successful.
“The challenge we find is to actually see those impacts, we have to understand what is happening at the family level. And we know if there are children in the household and just the mother receives food, they’re going to give the food to their child, and then you’re not going to necessarily see the impact at the mother’s level because they weren’t eating that food, their child was. So as we think about measures, thinking about [the] design of those systems … We have to think about those realities.”
— Kenefick
Schueler said Housing Forward is interested in studying chronic homelessness and prioritizing getting affected individuals into PSH. However, approaching a health system about needing this resource is difficult without documentation, and data sharing has barriers.
Kelly said HFS has been collecting data on some of its other HRSN services, such as Illinois’ Healthcare Transformation Collaborative, which is proving to be successful. She also said the Medicaid waiver will require lots of data collection and evaluation with an academic partner to ensure its services are transmittable to Medicaid.