A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 4.1. Overview of Authorities and Options


States take several different approaches to using Medicaid benefits to cover the medical and behavioral health services most frequently used by people experiencing chronic homelessness. These include the services that connect homeless people to housing opportunities and the services and supports that people receive to promote recovery and stability and address their ongoing health care needs after they move into housing.

The authorities that states may consider using to cover services for people experiencing chronic homelessness through their Medicaid program are listed below:

  • State plan benefits and services: Services delivered by FQHCs,34 and optional state plan benefits such as Rehabilitative services,35 TCM services,36 Health homes,37 and Home and community-based state plan services.38

  • HCBS Waiver Programs.39

  • Other types of Medicaid waiver programs that may be approved by CMS.40

Services provided under these authorities may be delivered by qualified staff through a variety of structures and use a variety of payment mechanisms, including fee-for-service and managed care. Payment mechanisms are described in Chapter 7. Within the framework of federal laws, regulations, and policies established by CMS, states have significant latitude to define the types and qualifications of providers that may participate in their Medicaid programs as well as where care may be delivered. State professional practice acts are state laws and regulations that define the scope of practice for a particular provider type. These requirements, as well as licensing requirements and professional standards, apply to providers regardless of whether they are paid by Medicaid or other sources of funding.

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