Policy reforms to improve health care

August 23, 2020 2 minute read

Andy McMahon

Former Vice President, Impact Investments, UHG Office of Health Equity

In my first post, I outlined UnitedHealthcare Community & State’s multi-pronged strategy to address the social needs of our members and drive alignment between the health care, human services, and housing systems. This approach includes a focus on partnerships, data analytics, and financial investments, which I expanded on in follow-up posts (here and here). This post will focus on the fourth element of our strategy: policy reforms and system change.

Our efforts to better align and integrate health care with housing and other social determinants of health require that we pursue policy reforms and system change that can support and sustain these efforts. There are an array of statutory and regulatory (as well as administrative and cultural) issues that need to be addressed to improve the alignment and integration of these systems and programs. As a result, we are working on several specific policy initiatives in Medicaid, as well as reforms related to the housing and human services systems, to improve coordination and care for Medicaid beneficiaries. In future posts, I will elaborate on the reforms highlighted below.

Tenancy supports

Tenancy supports provide an array of services that help individuals secure and maintain housing, including housing searches, landlord relationship management, and eviction prevention support. In 2015, the Center for Medicare and Medicaid Services (CMS) provided guidance to states and outlined the parameters for using Medicaid to pay for tenancy supports. UnitedHealthcare Community & State is actively engaging with states to promote the request of waivers to allow for tenancy supports and provide input on the design of the waivers. Some states, including Washington and Hawai’i, have already applied for and received waivers. We are assisting with the planning and execution of these waivers, including identifying community-based organizations to provide tenancy supports and developing payment structures that meet their needs.

Medical respite care

As a hospital discharge option, medical respite care programs can help individuals experiencing homelessness by providing a safe place to rest and heal. Medical respite care programs provide a stable setting for those who have nowhere to go post-discharge, and who have medical needs that cannot be met at a shelter. Medical respite care provides a safe place to recuperate, access needed medical care and social supports, and establish a plan for discharge to affordable or supportive housing. We have partnered with National Healthcare for the Homeless Council on this guide to financing medical respite care that can be used by states and managed care organizations as they consider adding medical respite care as a covered, billable benefit to strengthen and expand medical respite capacity.

Community Health Workers

Community Health Workers (CHWs) are trusted, frontline public health workers that deeply understand the communities and people they serve. CHWs serve as a link between the health care and social services systems to support access to services individuals need. As part of our advocacy efforts, we work with State Medicaid agencies to recognize CHWs as authorized Medicaid providers and allow Medicaid to pay for services provided by CHWs through proposed state plan amendments and/or waivers. We have recently developed a partnership with the National Association of Community Health Workers to jointly promote and advance community health worker efforts.

As UnitedHealthcare Community & State work with states to better meet the needs of our members and all those accessing Medicaid, we are focusing on concrete policy and financing changes that will expand access to care, provide more patient-centered services, and best leverage community-based partners and CHWs. Advocating for the adoption of policies like these provide a sustainable pathway for improving health care and health outcomes.