Tag Archives: Healthy Adult Opportunity

Housing stability issues facing Medicaid beneficiaries

The scope of homelessness and housing insecurity as an issue is substantial. According to the U.S. Department of Housing and Urban Development 2019 point-in-time estimates, approximately 568,000 people around the country are homeless on any one night. Around two-thirds stay in emergency shelters or transitional housing programs. The remaining third reside in unsheltered settings.

Policy makers and Medicaid administrators realize the value in achieving housing security for Medicaid beneficiaries as a means of improving health outcomes and decreasing high-cost healthcare services. Housing security is a social determinant of health, playing a major role in influencing a person’s health and well-being. To that end, the federal and state governments are pursuing ways to provide Medicaid beneficiaries with a variety of housing-related services.

In this brief, Milliman’s actuaries and consultants explore the flexibilities available under Medicaid to address homelessness and housing insecurity, including Section 1115 Demonstrations Waivers and the new Healthy Adult Opportunity.

Health Adult Opportunity 1115 waiver option considerations

On January 30, the Centers for Medicare and Medicaid Services (CMS) introduced guidance describing the new Healthy Adult Opportunity (HAO) 1115 waiver option. This option outlines conditions under which a state might convert open-ended matching funding for expansion adults into a block grant or per capita program.

The HAO offers states new flexibilities for their Medicaid programs in return for assuming the financial risk of block grants. State program directors face many complex considerations as they evaluate these options. While the HAO will clearly appeal to states that have previously considered requesting a block grant, the range of policy options made available under this initiative may bear considerations for states across the country.

In this paper, Milliman’s consultants discuss 10 key considerations for states evaluating the HAO.