By: Laura Summers, Senior Health Care Analyst
During the 2019 legislative session, Utah confirmed that it will soon become one of 37 states to adopt Medicaid expansion. This means the state is expanding Medicaid eligibility to uninsured, low-income, childless adults and raising the mandatory income eligibility level for jobless and working parents.
As part of this expansion, Utah is planning to submit a waiver to the Centers for Medicare & Medicaid Services (CMS) seeking several permissions and additions to its Medicaid expansion program. The state is requesting that CMS allow it to develop behavioral and physical health integration pilot programs for the newly eligible population, require work and community engagement from select Medicaid enrollees, mandate enrollment in employer-sponsored insurance when available, and implement a per-capita cap on federal Medicaid funding, among others.
While many of these provisions are designed to restrict enrollment and benefits, the waiver will also ask CMS to allow the state to use federal Medicaid funds for housing supports. The list of qualifying housing supports is still being developed by the Utah Department of Health, and may include services such as assisting Medicaid members obtain and complete housing voucher applications, health-related home modifications (e.g., the installation of grab bars in showers), or home safety improvements (e.g., mold removal).
Utah isn’t the first state to request permission to use federal funds for non-traditional benefits such as housing.
North Carolina – In 2018, CMS approved North Carolina’s waiver request to use federal Medicaid funds to pay for housing support services, food support services, transportation, and provide resources, such as legal assistance, to support Medicaid enrollees overcome interpersonal violence and other harmful interpersonal situations.
Massachusetts – Massachusetts received approval in 2018 to develop a Flexible Services Program. Massachusetts’ Medicaid Accountable Care Organizations (ACOs) can use the flexible services program funds to pay for health-related nutrition and housing supports for qualified Medicaid members.
Oregon – Oregon’s current waiver allows its Coordinated Care Organizations, or managed care plans, to provide a certain amount of non-medical “flexible services,” or cost-effective alternatives to traditional Medicaid covered benefits. The services must improve members’ health and lower costs.
Why should Utah join the rank of these other states and seek permission to use Medicaid funds to pay for housing and potentially other non-traditional benefits?
Research increasingly shows a positive connection between addressing non-health factors and improving people’s health. For example, data show that providing supporting housing to those who are chronically homeless is more effective in decreasing emergency department use than increased access to case management or other outpatient health services. Research also shows that non-medical factors, such as a persons’ living and working conditions, social environment, economic situation, and healthy behaviors account for up to 60 percent or more of a person’s health outcomes, while genetics and the health care system comprise less than 40 percent.
In August 2018, the Kem C. Gardner Policy Symposium “The Root of the Issue: Utah’s Social Determinants of Health,” focused on strategies and innovations the health care industry can use to address these non-medical factors. Speakers noted that Utah is and can continue to be a leader in addressing social determinants of health—and submitting a waiver to use Medicaid funds to provide housing supports is one of many steps Utah is currently taking that proves it continues to be a leader in this area.
Laura Summers is the senior health care analyst at the Kem C. Gardner Policy Institute.
 Moore, D. T. and R.A. Rosenheck. 2017. Comprehensive services delivery and emergency department use among chronically homeless adults. Psychological Services, 14(2), 184–192.
 HealthyPeople.gov, Office of Disease Prevention and Health Promotion. Adapted from James Rubin, TAVHealth. Leavitt, M., DeSalvo, K. (2017 September 23). Guest Commentary: Valuebased care’s success hinges on attention to social determinants. Modern Healthcare.