A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 7.4. Summary


This chapter has reviewed traditional Medicaid payment mechanisms along with some of the new approaches being developed to accommodate new models of care. These newer models are of particular interest because it has often been difficult for agencies serving PSH tenants and people experiencing homelessness to cover the range of services needed by these populations through traditional fee-for-service payment structures. Some of the challenge of doing so stems from the variety of services included or left out of Medicaid state plans that are important for people experiencing homelessness or living in PSH, but some of the difficulty arises due to the fee-for-service mechanism itself. Other approaches include daily or monthly rates under fee-for-service, payment by episode, and payment through FQHCs and managed care organizations. The most recent approaches involve paying for care coordination and integration as an overlay on direct services, through health homes, care coordination entities, and some programs for super-utilizers. Another emerging approach for financing and delivering care for Medicaid beneficiaries is through ACOs. These latter approaches are particularly promising for populations with complex and interacting health and behavioral health conditions, for whom integrated care can make the difference in stabilizing living situations and improving health outcomes.


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