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How Medicaid could help cover immigrants' housing costs

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Feb 28, 2024
Illustration of a stethoscope tube making the shape of a house.

Illustration: Gabriella Turrisi/Axios

States struggling to house recently arrived immigrants may have a new way to get financial help from the federal government: through Medicaid.

Why it matters: The Biden administration's push for Medicaid to cover housing and other social needs comes as blue cities and states overwhelmed by the number of immigrants arriving from the border have been demanding more federal support to provide them shelter and care.

  • But some experts are skeptical about whether covering housing through Medicaid — the low-income health program jointly financed by states and the federal government — is the best use of limited resources.

Driving the news: The administration is weighing a request from Massachusetts to have Medicaid temporarily cover the housing of some homeless populations, including immigrants.

  • Generally, many groups of new immigrants aren't eligible for Medicaid, but refugees and asylees are among those who can enroll immediately if they meet other state eligibility requirements.
  • Most of the immigrants in Massachusetts' shelter system are Haitian or asylum seekers from other countries.

Massachusetts is looking to cover housing under a special waiver, but experts say a handful of other states may already have this authority.

  • "The Commonwealth, like other states, has faced a recent influx of immigrants, including recent arrivals with an immigration status that entitles them to full Medicaid benefits," the state wrote in its request to the federal health department in October.
  • Massachusetts wants to provide up to six months of temporary housing assistance and related support for families and pregnant individuals, including newly arrived immigrants in Medicaid.
  • The state expects the housing plan and other changes to its Medicaid program would bring in about $2 billion in federal reimbursements, a state health services spokesperson said.
  • Massachusetts Gov. Maura Healey met with White House officials last week to discuss the waiver request and remains in talks with federal officials, a Healey spokesperson said.
  • The White House referred Axios to HHS for comment on waiver negotiations. HHS did not respond.

The big picture: The health care system increasingly recognizes how housing and health are intertwined, as part of a larger push to address social needs — like access to transportation and healthy food — that affect a person's wellbeing.

  • But it's still unclear whether some of the programs that address these so-called "social determinants of health" are making people healthier, and experts disagree whether they should be funded the same way as other health care services.
  • That's particularly true within Medicaid. States' portion of program funding is limited by the need to balance their budgets.
  • Those who support using Medicaid dollars for social needs acknowledge Medicaid alone can't solve systemic problems like the housing crisis, but they said temporary housing can provide relief and help connect people with other services.

The intrigue: A handful of states already have approved waivers that allow them to cover temporary housing needs for some populations.

  • Although these waivers don't specifically mention immigrant populations, it's possible they are already covered in some states.
  • While the pending Massachusetts request was very specific, "it could be that other states are including similar populations under their individuals at risk of experiencing homelessness umbrella," said Elizabeth Hinton, a Medicaid expert at KFF.

Stef Kight and Steph Solis contributed reporting.

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