Many of us have heard the stark statistics about U.S. health care from a global perspective: when compared to other high-income countries, the U.S. spends a significantly higher percentage of our Gross Domestic Product (GDP, which measures the total output of a country’s goods and services during a given time) on health care, yet we have the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates. This discordance—spending more for worse outcomes—has persisted for decades.
There are myriad forces and factors that drive and perpetuate this troubling reality; among them is the outsized impact of poverty, and how it prevents people, particularly those in historically underrepresented and marginalized communities, from accessing critical services that could dramatically improve and save lives.
Having a safe, stable home and consistent access to nutritious food is fundamental to a person’s well-being and ability to maintain good health. Yet many individuals across the country and in Colorado lack these basic necessities, and the entities they rely on to help – including Medicaid health plans and community-based organizations – often lack sustainable funding to provide these services. The State of Colorado has an opportunity now to include food and housing in health care, leading to better health outcomes, reduced health care costs, and the prevention of homelessness.
Bipartisan legislation this session (House Bill 24-1322) would enable the Department of Health Care Policy and Financing to study how to provide certain housing and nutrition services within Medicaid and to pursue federal approval to do so through a Section 1115 waiver. These waivers allow states to test new approaches in Medicaid, and several states – Arizona, North Carolina, Oregon, and more – have already taken advantage of this transformative opportunity to receive federal approval for covering housing and nutrition services such as rental assistance and meal delivery for populations with the greatest need. Traditionally, we don’t think about food and housing as a part of health care, but mounting evidence shows they are key factors in our overall health.
As the state’s largest Medicaid health plan, Colorado Access serves approximately half a million members across Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+). Addressing social determinants of health such as housing and nutrition offers a moment of great change and opportunity for Medicaid.
From the Colorado Health Access Survey, we know that: in Denver County, 35% of Medicaid members reported that they or their dependents ate less than they thought they should in the past year because they could not afford food. In Douglas, Adams, and Arapahoe counties, 36% of Medicaid members worried that they may not have stable housing in the next two months and/or reported problems paying their rent or mortgage in the past year.
A robust body of research, including analysis of programs in Colorado, shows the benefits of addressing social needs, including less time in emergency rooms, lower health care costs, and a reduction of criminal justice involvement. Our experience serving Medicaid members here in Colorado for nearly 30 years affirms this.
Not only does Medicaid support for housing and food for target populations, such as members experiencing homelessness and individuals who are pregnant or postpartum, reduce future costs and save taxpayer dollars, but it also brings in more federal dollars to our state – dollars that other states are already accessing.
Notably, Medicaid could potentially pay for six months of rental assistance or temporary housing at a time when the number of individuals experiencing homelessness in Colorado continues to grow. Medicaid could also cover a range of other services, such as pre-tenancy and tenancy support services, home modifications, and supplies to maintain healthy temperatures and clean air in extreme climate events.
In addition to housing support, Medicaid could pay to address food insecurity through nutrition counseling and education, meal delivery, medically tailored food prescriptions, and links to community-based food resources.
We need to embrace the opportunity that this legislation offers for Medicaid, and we appreciate legislators’, advocates, and the administration’s support. By addressing the social determinants of health such as housing and nutrition, we have a new, meaningful opportunity to improve overall health and well-being of our communities and to redefine health care to support the whole person.
Annie Lee is president and CEO of Colorado Access. Before joining Colorado Access in 2022, she held leadership positions at Children’s Hospital Colorado and Kaiser Permanente Colorado. Prior to that, Annie worked at the Colorado Department of Health Care Policy and Financing in both CHP+ and Medicaid benefits policy.