A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 7. Medicaid Payment Mechanisms and Innovative Service Delivery Structures


This chapter begins with a review of the basic fee-for-service payment mechanisms and payments for FQHCs that have been used most frequently to provide Medicaid reimbursement for services to people living in PSH. Next, the chapter focuses on Medicaid managed care. While new payment mechanisms are being developed, these three mechanisms will likely be the ones used for years to come to pay for the most services for the greatest number of PSH tenants and people currently experiencing chronic homelessness. Thus it is important to understand how these payment mechanisms work for the PSH-eligible population and how states can use them to respond to this population's needs.

The last half of this chapter focuses on emerging models of payment reform that are tied to changes in health and behavioral health care delivery systems and approaches to care coordination. These include health homes, "super-utilizer" programs, ACOs, and other mechanisms to pay for care coordination. Some of these innovative approaches offer potential for achieving better health outcomes as well as cost savings associated with PSH residents with long histories of homelessness who have complex health care needs. The Federal Government considers several of these alternatives so important for saving Medicaid dollars that the Affordable Care Act includes incentives to states that adopt them.

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