{"id":5941,"date":"2017-01-31T05:47:17","date_gmt":"2017-01-31T11:47:17","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=5941"},"modified":"2017-01-31T07:02:40","modified_gmt":"2017-01-31T13:02:40","slug":"homelessness-healthcare-yes-gaming-system","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/01\/homelessness-healthcare-yes-gaming-system.html","title":{"rendered":"Homelessness, healthcare, and, yes, gaming the system"},"content":{"rendered":"\n<\/head>

In the news the other day, \u201cHawaii bill would classify homelessness as medical condition<\/a>.\u201d \u00a0Yes, you read that right:<\/p>\n

[Hawaii State Senator Josh] Green last week introduced a bill in the Hawaii Legislature to classify chronic homelessness as a medical condition and require insurance companies to cover treatment of the condition.<\/p>\n

But if a doctor wrote a prescription for six months of housing, where would the patient fill the prescription?<\/p>\n

That\u2019s where Green wants Medicaid to step in.<\/p>\n

He wants to redirect some of Hawaii\u2019s $2 billion annual Medicaid budget to pay for housing.<\/p><\/blockquote>\n

It\u2019s indeed true that homeless produces\/exacerbates health conditions, whether its chronic health problems like diabetes or high blood pressure, or mental health conditions. \u00a0The homeless have a such a high rate of emergency room visits that it costs less to simply pay for housing, and there have been various pilot programs taking the approach of simply providing for the homeless without setting out preconditions such as sobriety\/drug abuse treatment or requiring efforts to find employment. \u00a0These programs are called \u201cHousing First<\/a>,\u201d and, per Wikipedia<\/a>, have been around since 1988, and are already supported by federal grants.<\/p>\n

But if this funding isn\u2019t enough for Hawaii, why fund this through Medicaid? Why not just allocate money for such a program from somewhere else in the system, knowing that, in the end, if the state reduces the funds it pays for Medicaid, it\u2019s a win in terms of the overall budget?<\/p>\n

Consider how Medicaid is funded<\/a>: \u00a0the standard funding method had been for the federal government to match, on a dollar-for-dollar basis, all state spending. \u00a0If the state spends generously, the federal contribution is equally generous. \u00a0What\u2019s more, for any individuals who were ineligible under a state\u2019s pre-Obamacare eligibility requirements, but are eligible under Obamacare, the federal government pays 100% of the cost, sliding down to 90% in 2020 and later.<\/p>\n

Seems like a recipe for massive cost overruns, if the states design the benefits but the federal government pays, but, if I\u2019m not mistaken, what keeps the states in check is that they have to offer the same benefits to everyone. \u00a0If, previously, poor mothers and their children, plus the poor disabled and elderly, were eligible, with benefits funded 50\/50 between the state and the federal government, and now poor men, childless women, and poor empty-nester couples are also covered, at the 100% -> 90% level, the states can\u2019t increase benefits\/doctor reimbursement rates for the second group without doing so for the first group as well.<\/p>\n

But the homeless are pretty much all in the second group \u2014 while poor mothers with children might technically be homeless, they are more likely to have the stability of a stay in a mothers-and-children shelter and transitional housing support. \u00a0So if the state can find a way to deem funds for rent to be \u201cmedical care\u201d and covered under Medicaid, then they\u2019ve come up with a way to get the federal government to pay 90% of a cost which, if it were to come from housing funds, would otherwise be paid for by the state.<\/p>\n

And \u2014 it seems to me \u2014 this happens repeatedly. \u00a0There was an article not long ago about a local town deciding whether to repair or replace a bridge. \u00a0Repair cost considerably less and would have been a perfectly appropriate decision, as the bridge, if repaired, would have plenty of useful life left. \u00a0Repair would have been the least wasteful decision, both in terms of money spent and the use of resources to destroy a bridge and build a new one. \u00a0But the feds would provide matching funds for the replacement, not for a repair.<\/p>\n

And how many other similar decisions are made, day in and day out, because it\u2019s better to use someone else\u2019s money wastefully than spend your own wisely?<\/p>\n

So, to sum up: \u00a0providing housing for the homeless, good. \u00a0Trying to get \u201csomething for nothing\u201d because the feds are paying, not so much.<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

In the news the other day, \u201cHawaii bill would classify homelessness as medical condition.\u201d \u00a0Yes, you read that right: [Hawaii State Senator Josh] Green last week introduced a bill in the Hawaii Legislature to classify chronic homelessness as a medical condition and require insurance companies to cover treatment of the condition. But if a doctor […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[545,256],"class_list":["post-5941","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-medicaid","tag-obamacare"],"yoast_head":"\nHomelessness, healthcare, and, yes, gaming the system<\/title>\n<meta name=\"description\" content=\"In the news the other day, "Hawaii bill would classify homelessness as medical condition." \u00a0Yes, you read that right: Green last week introduced a bill in\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/01\/homelessness-healthcare-yes-gaming-system.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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