At the crossroads: Initial findings and lessons learned from a Medicaid housing benefit pilot
Presentations from 2025 SIREN National Research Meeting: Advancing the Science of Social Care
Background
Housing insecurity has profound impacts on health outcomes, and effective coordinated approaches between healthcare and housing systems are still evolving. From 2022-2024, an Oregon Medicaid Coordinated Care Organization funded a housing benefit pilot to improve health outcomes among members at risk of or experiencing homelessness.
Objective
The evaluation of the pilot has 3 key objectives: 1) understand implementation and inform quality improvement for Medicaid entities in the housing space, 2) assess the reach and fit of the benefit package, and 3) identify the costs and health and social outcomes associated with the pilot. Findings have major implications for Oregon’s statewide Medicaid 1115 Waiver implementation and understanding how Medicaid benefits may better meet member needs.
Methods
Using a mixed methods approach, program data (collected during referral, enrollment, ongoing check-ins, and through invoices), participant surveys and interviews, and healthcare claims were leveraged to understand utilization, experiences, and impact, and qualitative interviews were conducted with staff from participating community-based organizations to understand program implementation and lessons learned.
Results
Over 700 members were referred, and the majority of enrollees (n=516) entered from a substance use residential programs, corrections, or foster care. The most frequent services received were housing navigation, monthly rent support, move-in support, and utility assistance. Average rent support totaled $10,245. The population with the highest total benefit utilization was individuals transitioning out of corrections. Staff interviews highlighted the importance of shared visions and expectations among stakeholders, program infrastructure, and staff training and support for successful implementation. Participant surveys and interviews revealed challenges and successes with program experiences and impacts on housing stability.
Conclusion
Across the nation, Medicaid is stepping into the housing space to improve adverse health outcomes associated with housing insecurity. This pilot informs ongoing efforts to implement housing supports and build stronger cross-sector collaboration as part of Medicaid-covered benefits.
Livingston C, Craigie A, Gill M, Holtorf M, Gronowski B. At the crossroads: Initial findings and lessons learned from a Medicaid housing benefit pilot. Health Serv Res. 2025;60(S1):e14484. doi:10.1111/1475-6773.14484