A reflection on: Housing as Health Care – New York’s Boundary-Crossing Experiment
Kelly M. Doran, M.D., M.H.S, Elizabeth J. Misa, M.P.A., and Nirav R. Shah, M.D., M.P.H. New England Journal of Medicine, December 19, 2013; 369:2374-2377. http://www.nejm.org/doi/full/10.1056/NEJMp1310121?query=TOC#.UrJVykxj81A.facebook#t=references
“For many patients, a prescription for housing or food is the most powerful one that a physician could write, with health effects far exceeding those of most medications” according the Doran, Misa and Shah, the authors of the article, Housing as Health Care – New York’s Boundary-Crossing Experiment. The authors are supportive of New York State’s efforts to show that social determinants of health (specifically supportive housing, but also access to healthy food, quality education, etc.) could ultimately lead to better health outcomes for more Americans AND reduce the overall cost of health care across the country.
New York State is certainly on the cutting edge of reforming health care spending. The state allocated $75 million of its state share of the Medicaid budget to supportive housing in 2012-2013. The 2013-2014 budget increases that amount to $86 million. Supportive housing is a model that pairs safe, stable housing opportunities with on-site social services to improve the health and quality of life of the recipients. The state’s intention is to recover this major investment and save money in the long run by targeting Medicaid recipients with the highest utilizations (read: costs).
Numerous studies support the state’s efforts to redeploy funding to community based services such as supportive housing. It has been found that many residents of nursing facilities do not actually need the level of care provided there, but have no other housing available to them. In addition, the authors of this report indicate that the daily Medicaid rate at a New York nursing facility is $217, compared to a rate of $50-70 per day in supportive housing.
Unfortunately, the federal government has not kept pace with these types of innovative trends in health care spending. The federal rules governing Medicaid do not allow for capital spending to fund supportive housing. In Medicaid’s view, housing is already being paid for through nursing facilities and other institutions. New York has thus far been unable to appeal this rule in order to continue funding their supportive housing initiative.
For now, Medicaid will continue to pay the inflated rates to institutions and maintain the status quo in regard to the quality of life of its recipients rather than to risk trusting the data and investing in programs that have huge potential to make their lives better. Think of the true costs of “business as usual”…think of all we could be doing instead!