Medicaid Could Someday Fund Your Repairs!

Here in North Carolina, Medicaid has launched a pilot program that will pay for home repairs and other non-clinical services including nutrition counseling, support for victims of domestic violence, respite and permanent housing for the homeless, and transportation. 

This is part of a movement in the health care sector to identify and address Social Determinants of Health (SDOH) or “conditions in the places where people live, learn, work, and play that affect health risks and outcomes.” 

For example, a person without reliable transportation may miss a chemotherapy appointment or a family that lives in a food desert may not have access to fresh fruits and vegetables. Thanks to provisions in the Affordable Care Act and a great deal of research, the health care sector is finally recognizing what we in human services have observed for ages: conditions outside the hospital significantly impact patient health. In fact, research has found that up to 80% of a person’s health may be determined by SDOH.

Medicaid’s Healthy Opportunities Pilot Program was designed to “test and evaluate the impact of providing select evidence-based, non-medical interventions” related to:

• Housing
• Food 
• Transportation
• Interpersonal safety (toxic stress, domestic violence) 

Medicaid will spend $650 million to address SDOH in three pilot communities in North Carolina. Ideally, spending money on these interventions will improve patient health and save Medicaid more money than they spend on the interventions.

This month, regional hospitals are taking leadership roles to assemble partners and compete for one of the three awards. WARM has been working with New Hanover Regional Medical Center and other nonprofits in the four categories above.

If our community is selected, an initial round of funding will help build capacity we all need to accept the Medicaid patients. Then, Medicaid social workers will determine which patients need which non-medical service, refer to the appropriate human service organization, and pay the bill.

I’m so excited about this. I’ve preached on the connection between health and housing for over a decade to be told by many in health care, “that’s a stretch.”

But recent research is clear. Health is so greatly impacted by the condition of a patient’s home that every $1.00 spent on home repairs saves $19.00 in Medicare/Medicaid costs, according to studies compiled by the North Carolina Housing Finance Agency. 

WARM’s work addresses health risks in the two main categories below: 

Respiratory Ailments

Indoor air pollution, excessive mold, and contaminants in old carpet may create or worsen respiratory conditions such as COPD and asthma. Research by the Robert Wood Johnson Foundation found that 40% of asthma diagnosed in childhood is caused by conditions in their homes such as poor indoor air quality caused by mold, mildew, and inadequate ventilation. 

WARM’s mission improves indoor air quality, and thereby respiratory health, by repairing leaky roofs, replacing water damaged sheetrock, removing old carpet, and repairing heating and air conditioning systems.
In many cases, homeowners on oxygen have reported they need it less often (or not at all!) after WARM’s work is complete.

Risk of Falls

Dilapidated floors, inadequate or broken railings and stairs, and high tub walls may cause falls, especially as homeowners age-in-place. Falls are the leading cause of injury related deaths among senior citizens. Approximately one in four US residents aged 65 and older report falling each year. 

In one case, when WARM managers arrived at the home of Ms. Dorothy for our initial assessment, an ambulance was leaving. We stopped them to ask if Ms. Dorothy was in the ambulance. The driver told us, “No, she falls every week or so, and we come out to pick her up and check her vitals.” After WARM installed railings and grab bars and cut a safety step in her tub, her home was no longer a danger zone and she didn’t call 911 on a regular basis.

I hope you utilize the links and talking points. I invite you to write to me about your own health-related initiatives. I look forward to updating you about Healthy Opportunities data in the coming years. Many blessings on your work!

JC Lyle is the Executive Director of Wilmington Area Rebuilding Ministry in North Carolina. JC loves to travel; she's walked on glaciers, volcanoes, beaches, waterfalls, a pro football field, the London Bridge, an FBI training facility, inside the White House, on stage at Cats, and the tops of the Empire State Building and Space Needle.