Sue Ducat
Director of Communications
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Melissa Blair
Robert Wood Johnson Foundation
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Medicaid and Permanent Supportive Housing

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation looks at a provision in the Affordable Care Act (ACA) that gives certain Medicaid enrollees improved access to housing. Research shows that a person’s housing status and his or her health are interconnected: Individuals who experience chronic homelessness are more likely to have high rates of chronic illness and substance abuse. The traditional model of addressing homelessness provides temporary housing—but more recent efforts have shifted to “housing first,” looking for more permanent housing not tied to success in treatment. Additionally, states can also use the new opportunities and tools provided by the ACA and other policy options to support individuals with disabilities living in community settings.

Topics covered by this policy brief include:

  • What’s the background? The brief traces the history of Medicaid’s involvement in supportive housing, which had its origins in a 1999 US Supreme Court decision, Olmstead v. L.C., 527 U.S. 581, that said that states must provide services for disabled individuals in the most integrated setting, helping to move the model of desired housing from temporary shelters to permanent housing. Studies of supportive housing in Los Angeles and New York, discussed in the brief, showed reduced Medicaid spending, which helped offset the costs of operating supportive housing programs as well maintain healthier residents.

  • What are the options? This section of the brief describes the various avenues available to states, as prescribed by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), to leverage Medicaid funding to support housing programs. Each state Medicaid program has its own agreement with CMS, and the brief notes which programs the states have the option of covering, from rehabilitation services to targeted case management. The brief also discusses some of the new Medicaid payment structures to help the states manage these new options.

  • What are states doing? To use Medicaid funds for supportive housing, states need to have expanded Medicaid eligibility as outlined by the ACA, something thirty-one states and the District of Columbia have done. In the nineteen states that have not expanded their Medicaid programs, chronically homeless individuals can only qualify for Medicaid if they have a disability that can be documented. The brief concludes by describing the programs the expansion states have undertaken.

About Health Policy Briefs

Health Policy Briefs are aimed at policy makers, congressional staffers, and others needing short, jargon-free explanations of health policy basics. The briefs, which are reviewed by experts in the field, include competing arguments on policy proposals and the relevant research supporting each perspective.

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About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at Read daily perspectives on Health Affairs Blog and customize the content you want to see in Health Affairs Alerts.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit Follow the Foundation on Twitter at or on Facebook at