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.
Having a parent with a behavioral health condition increases the likelihood that a child will develop one too. In the paper “Household dynamics in the prevalence of mental health conditions and substance use disorders,” Milliman’s Stoddard Davenport and Marissa North explore the prevalence of mental health and substance use disorders within commercially insured families in the United States to understand the likelihood of a household being affected by these conditions.
The infographic below illustrates key findings and trends from the paper.
Many social determinants of health have important effects on
behavioral health and can apply to all members of a family. Some research has
found that having a family member with a mental illness decreases family
functioning and is a general stressor for families. With that in mind, payers
and providers may find that the diagnosis of a behavioral health condition in
one family member could signal that it may be worth screening for circumstances
that might affect the entire household. This could provide an opportunity for
earlier diagnosis and intervention with other household members who may be at
heightened risk for similar behavioral health concerns.
In order to shed more light on how behavioral health conditions affect families, Milliman analyzed the prevalence of several conditions among family members in a national, commercially insured population in 2017. In this paper, Milliman’s Stoddard Davenport and Marissa North expand on existing research by analyzing the prevalence of behavioral conditions in parents of children with behavioral conditions versus those without as well as children of parents with behavioral conditions versus those without.
Growing recognition that social determinants are significant drivers of health and healthcare utilization patterns has increased the desire to better understand and identify these issues as well as to develop actionable steps at both the population and member levels. There has been a growing focus on developing the ability to identify the presence of social vulnerabilities among population health entities, Medicaid state agencies, risk-taking provider organizations such as accountable care organizations, and any entity with a vested interest in the reduction of healthcare spending. It is not unusual for health actuaries to get involved in this discussion. Milliman’s Ksenia Whittal provides some perspective in this article.
This article was published in the December 2018/January 2019 issue of The Actuary.