Housing and the Homeless in the Proposed Federal Waiver 2020-25
The Newsom Administration proposes “in lieu of services” for high risk, high users of expensive institutional medical services enrolled in MediCal managed care plans. The concept is that the program’s high users account for the bulk of medical spending, that through targeted case management their services could be treated in alternative lower cost settings (in lieu of services). For example respite care for the elderly patient being cared for at home is a far better expenditure than a stay in a nursing home. As applied to the homeless individual enrolled in MediCal managed care, this means finding an individual supportive housing as opposed to repeated emergency room visits and hospital stays.
The waiver mentions: sobering centers, housing transitions/navigation services, short-term post hospitalization housing, supportive housing services, housing deposits, recuperative care for inpatient transitions and day habilitation programs. In other words how do you as the targeted case manager in a MediCal managed care plan help a homeless person on MediCal with a range of supportive services instead of a costly hospital stay?
The Medicaid statute pays for medical care, not housing; that is an entirely different and poorly funded federal program. The waiver therefore must tie reimbursements for these sorts of “in lieu services” very tightly to individual patients otherwise needing and therefore avoiding costly medical care through the MediCal managed care program.
Prepared by: Lucien Wulsin
Dated: 1/25/20