This research has sought to identify the many ways that our case study states and communities are moving forward, using and modifying their Medicaid programs and health care delivery systems to better serve people with histories of chronic homelessness. Our findings indicate that Medicaid's configurations up through 2013 offered opportunities for covering a considerable array of the services needed by PSH tenants before and after they move into housing, with more possibilities becoming available through the implementation of the Affordable Care Act in 2014 and beyond.
Previous chapters described ways that our case study sites have worked with Medicaid since 2010, when this study began, to pursue innovative strategies for working with people who experience chronic homelessness and those who have moved from homelessness into PSH. They also reveal the challenges encountered during efforts to carefully articulate an integrated approach to physical health care, behavioral health care, and support services in the context of existing structures of state Medicaid programs, benefits, and provider networks. These structures have evolved over many years following priorities that also changed over time, usually within their own organizational silos. From the perspective of patients with multiple health care needs and the providers who try to treat them in a holistic manner, existing structures can be fragmented, governed by inconsistent rules and procedures, and difficult to bring together to support integrated care. The system as a whole and each patient with multiple interacting health conditions would greatly benefit from a concentrated effort by state Medicaid officials and their health care partners to bring some greater coherence to the rules and regulations, to facilitate greater continuity of care and more rational and effective delivery of health services.
While the innovations described in this chapter were all in different stages of implementation at our study's end, with none having reached a final or even a steady state, they nevertheless show promise of successfully addressing one or more pieces of the Medicaid puzzle for people with disabilities who are now or have been homeless for a long time.