Implementation Challenges to Addressing Housing Needs in Medicaid Demonstration Waivers

This project examines the first four states winning approval for Section 1115 waivers that feature housing supports, with the assumption that these supports can help contain Medicaid costs by reducing avoidable hospital use and placements in expensive institutional settings. To identify the implementation paths and challenges to addressing stable housing within Medicaid waivers, the project’s analysis addresses four questions: 1) What implementation challenges have states and localities encountered as they have sought to integrate housing into effective care coordination?; 2) What strategies have they used to meet these challenges and with what success?; 3) Given that the four state waivers vary in their designs and structures, do certain approaches kindle fewer implementation problems?; and 4) What lessons do these cases provide for Medicaid officials interested in pursuing initiatives addressing housing and related social determinants of health?