In recent years, innovative practitioners and state Medicaid offices have developed strategies for incorporating Medicaid benefits into the structures of services and supports that help keep formerly homeless people healthy and stably housed.1 Implementation of the Affordable Care Act provides opportunities for states to expand Medicaid eligibility and enrollment for people who are or were experiencing chronic homelessness. The Act also expands the mechanisms that states can use to provide a package of benefits that is effective in meeting this population's needs, improving health outcomes while contributing to the goals of controlling health costs and ending chronic homelessness.
Building on the experiences of innovators and the opportunities available through the Affordable Care Act, this Primer describes opportunities for states to use Medicaid to support the health and behavioral health services needed by people experiencing chronic homelessness or living in permanent supportive housing (PSH). It offers practical building blocks for change, including Medicaid's legislative authorities, specific provisions in state Medicaid plans, benefit design, payment mechanisms, contract provisions, and implementation strategies that states could replicate or adapt. Where available, it provides links to web-based resources such as plan documents and Centers for Medicare and Medicaid Services (CMS) informational bulletins.