Jami Snyder, who oversees Arizona’s Medicaid and CHIP program, says the state has seen improved health outcomes among patients who have received supportive housing funding from the state. In its 1115 Medicaid waiver renewal request to CMS, Arizona is asking for federal matching funds to extend that type of housing support.
On June 28 Snyder sat down with the National Committee for Quality Assurance (NCQA) President Margaret (Peggy) O’Kane to discuss Arizona’s recent strategic direction and quality improvement initiatives. She oversees an agency that provides acute, behavioral health, and long-term care services and supports to more than 2.3 million Arizona residents at an annual cost of $18 billion.
Snyder said the data on the impact of supportive housing is impressive. Over the last 11 years, the state Medicaid program in Arizona has received about $27 million in funding annually to provide rental subsidies to members. They are able to serve approximately 2,500 individuals each year with those rental subsidies.
“What we know from our data is that it’s really two things: It’s housing paired with Medicaid compensable wraparound supports — that’s what will ensure that an individual is able to stabilize,” she said. “We have some really good data on hand to demonstrate how we can move the needle on health outcomes when we stabilize someone in housing for six months or more. Our 2020 data demonstrated that for those that we house for six months or more with permanent supportive housing — rental subsidies paired with wraparound supports — we saw a 31 percent reduction in ED utilization, a 44 percent reduction in inpatient admits and a savings of over $5,500 per member per month.”
She said they talked with CMS about funding transitional housing through the 1115 waiver. “The data shows us that we can be more impactful when we house someone long term than we can with perhaps any other clinical intervention,” she adds, “so there’s a very compelling case to be made from my perspective. We are asking them essentially to match that state contribution of $27 million, with a standard federal match rate each year to extend certain supports that we’ve traditionally only offered to our long-term care population, like home modifications. We know that there are a lot of individuals outside of our long-term care population who need basic home modifications, in order to be successful in an independent living setting. We also want to be able to reimburse for services when an individual is preparing to leave a correctional setting. We want to be able to reimburse for those care coordination and case management services, so we can get individuals connected to care quickly when they leave that correctional environment through a variety of providers, including our justice clinic sites.”
Snyder said Arizona also wants to be able to reimburse for outreach and engagement services that it can’t currently in order to engage with homeless populations or individuals who are at risk of homelessness — just letting them know what benefits are available to them through the Medicaid program. “Finally, our big ask in the housing arena with our CMS waiver renewal is to be able to fund up to 18 months of transitional housing for individuals who are homeless or at risk of homelessness, and leaving some sort of institutional placement, whether that’s a correctional setting, a nursing facility, and extended inpatient stay,” she said. “We have a number of providers in the State of Arizona who have successfully implemented transitional housing models with blended funding from municipalities, from counties, from philanthropic sources, but we’d like to be able to provide more stable funding Medicaid funding to those entities that are committed to this work, because we know that individuals are much more likely to be successful long term, if we can stabilize them clinically in a transitional setting, before we transition on to permanent supportive housing.”
In another new development, Snyder said the state will begin providing incentives for community-based organizations to participate in its Community Cares closed-loop referral system operated by the state health information exchange. “The community-based organizations in Arizona don’t really want to become Medicaid providers,” she said. “They’re not interested in billing, like traditional providers do, but they do want to partner with us in ensuring the individuals that we serve are connected to community-based supports. So the incentives that the Department of Health Services is able to offer to CBOs — I think those are going to be really critical to ensuring that we have that partnership among those community-based organizations, in addition to the Medicaid-enrolled providers that we support in our delivery system.”
Another request in the 1115 waiver renewal that’s in front of CMS now is to reimburse for traditional healing. “We’ve been working on this for years, as have California and Nevada,” Snyder said. “We know that traditional healing is present within our Tribal Nations now, but we want the ability to be able to reimburse for those services with Medicaid dollars.”