Housing Advocates See Major Wins in Medicaid Expansion

Starting next year, more Oregonians can enroll in an expanded state Medicaid program that will provide some recipients with health-related social costs like food, rent and home modifications.

“We often talk about the critical nature of housing and services,” Andrea Bell, executive director of Oregon Housing and Community Services, told The Skanner. “This makes pre-tenancy and tenant support services an actual Medicaid benefit. This is also about a course of action that has the ability to impact people’s lives in a really positive way, particularly our Black, Indigenous, people of color – communities that have been historically and in the current day marginalized.”

About a third of Oregonians currently receive Medicaid, according to the Oregon Health Authority. Each state operates its own Medicaid and Medicare programs in partnership with the federal government, and under the new agreement approved late last month, the Oregon Health Plan (OHP) will receive $1.1 billion in federal funding over the next five years in order to implement an ambitious offering of services, as well as expanded eligibility for children and for young adults aged 19 to 26 who have special health care needs.

Centers for Medicare & Medicaid Services administrator Chiquita Brooks-LaSure called Oregon’s new initiatives “groundbreaking.”

“For the first time ever, children with Medicaid coverage in Oregon will be able to keep their coverage until the age of 6 — ensuring they can get the care they need during their formative years,” Brooks-LaSure said. “The OHP will address many of the complex challenges facing many of Oregon’s underserved residents, including individuals experiencing major life transitions such as children aging out of foster care, youth with complex medical needs approaching adulthood, individuals experiencing homelessness, and adults transitioning to dual Medicaid-Medicare enrollment.”

Network of Needs

Expressing support for the new Medicaid initiatives, many leaders described the approach as “holistic.”

“Health care does not occur in a vacuum.

"It’s clear that we must look beyond a traditional, siloed approach to truly meet the needs of people, particularly those experiencing complex challenges,” Gov. Kate Brown said. “With the approval of our Medicaid waiver, we will be taking an innovative, holistic approach to closing equity gaps by addressing health-related social needs––such as housing, nutrition, and support for extreme climate events.”

The expansion largely operates on two principles: that minimizing re-enrollment requirements for Medicaid will lead to continuous coverage and improved health outcomes, and the importance of providing resources that are medically necessary but not traditionally considered medical in nature.

For one, the OHP will further codify that extreme weather is a serious health risk. Under the new initiative, some recipients will be eligible to receive air conditioners, heaters, humidifiers, air filtration devices, generators and refrigeration units, ventilation system repairs, mold treatment and pest control.

“These are existing resources that we are fully optimizing and leveling up on behalf of the people of Oregon,” Bell said. “So we’re talking home modifications to make the home as safe and accessible for people, particularly if they’re going through different transitions of care. We want to make sure that people will not only have access to housing, but the housing that they’re in is safe, that it meets their own individual life’s needs.”

She added, “What’s in front of us here is not only transformative on an abstract, broader level in terms of what’s proposed, but the actual contents of it. So we’re talking about over $1 billion in new federal aid, which not only expands health care coverage, particularly continuous coverage for kids under 6, but we’re also talking about a specific course of action, of which people experiencing homelessness are specifically called out and able to receive a new broad suite of services – rental assistance, temporary housing, home modifications.”

Setting an Example

Rent assistance and temporary housing will not automatically be available for all Medicaid recipients, but will prioritize those transitioning out of homelessness, transitioning out of the foster system or transitioning out of a correctional facility.

Bell explained the new Medicaid has services specifically tailored for those experiencing or at risk of experiencing homelessness.

“Can you imagine if you are discharged from a particular setting and you have limited to no housing support?

"What are the options?

"And the reality is, in order to change the health trajectory of our BIPOC community, our LGBTQIA+ community, our tribal community, our system has to work differently. Not just aspirationally, but operationally as well.”

The new OHP plan has another advantage, Bell said: It is replicable.

“I think as we chart this new pathway, we’ll certainly be in conversation with our partners across the nation to really talk about what we’re finding and learning from this, but the stakes are as high as they’ve ever been and it warrants us to do things differently (by) centering the people that are closest to some of the pain, that are close to some of the heartache, and to do some things differently in a major way in service to them.”