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Huber K, Nohria R, Nandagiri V, Whitaker R, Tchuisseu YP, Pylypiw N, Dennison M, Van Stekelenburg B, Van Vleet A, Perez MR, Morreale MC, Thoumi A, Lyn M, Saunders RS, Bleser WK. Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina's Healthy Opportunities Pilots Program. Health Aff (Millwood) 2024; 43:190-199. [PMID: 38315916 DOI: 10.1377/hlthaff.2023.01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
North Carolina Medicaid's Healthy Opportunities Pilots program is the country's first comprehensive program to evaluate the impact of paying community-based organizations to provide eligible Medicaid enrollees with an array of evidence-based services to address four domains of health-related social needs, one of which is housing. Using a mixed-methods approach, we mapped the distribution of severe housing problems and then examined the design and implementation of Healthy Opportunities Pilots housing services in the three program regions. Four cross-cutting implementation and policy themes emerged: accounting for variation in housing resources and needs to address housing insecurity, defining and pricing housing services in Medicaid, engaging diverse stakeholders across sectors to facilitate successful implementation, and developing sustainable financial models for delivery. The lessons learned and actionable insights can help inform the efforts of stakeholders elsewhere, particularly other state Medicaid programs, to design and implement cross-sectoral programs that address housing-related social needs by leveraging multiple policy-based resources. These lessons can also be useful for federal policy makers developing guidance on addressing housing-related needs in Medicaid.
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Affiliation(s)
- Katie Huber
- Katie Huber, Duke University, Durham, North Carolina
| | - Raman Nohria
- Raman Nohria, Duke University, Durham, North Carolina
| | | | | | | | | | - Meaghan Dennison
- Meaghan Dennison, Cape Fear Collective, Wilmington, North Carolina
| | | | - Amanda Van Vleet
- Amanda Van Vleet, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Madlyn C Morreale
- Madlyn C. Morreale, Legal Aid of North Carolina, Inc., Raleigh, North Carolina
| | | | - Michelle Lyn
- Michelle Lyn, Duke University, Durham, North Carolina
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Bien MB, Whitton A, Meehan A, Thornhill L, Ellis K, Leopold J, Borne D, Vickery KD, Imbert E, Twohey-Jacobs L, Perez KA, Mosites E. Strengthening Public Health Capacity to Address Infectious Diseases: Lessons From 3 Centers of Excellence in Public Health and Homelessness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:775-779. [PMID: 37738595 PMCID: PMC10552800 DOI: 10.1097/phh.0000000000001830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
People experiencing homelessness are disproportionately affected by infectious diseases and often face barriers to receiving appropriate medical treatment. Responding to the needs of people experiencing homelessness requires state and local health departments to integrate information sources and coordinate multisector efforts. From 2021 to 2023, the CDC Foundation, in cooperation with the Centers for Disease Control and Prevention, established pilot Centers of Excellence in Public Health and Homelessness in Seattle, Washington; San Francisco, California; and the state of Minnesota. These centers strengthened their capacity to address the needs of people experiencing homelessness by supporting cross-sector partnerships, assessing the interoperability of data systems, prioritizing infectious disease needs, and identifying health disparities. These programs demonstrated that health departments are heterogeneous entities with differing resources and priorities. They also showed the importance of employing dedicated public health staff focused on homelessness, establishing diverse partnerships and the need for support from local leaders to address homelessness.
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Affiliation(s)
- Michael B. Bien
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Alaina Whitton
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Ashley Meehan
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Lee Thornhill
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Karin Ellis
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Josh Leopold
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Deborah Borne
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Katherine Diaz Vickery
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Elizabeth Imbert
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Lorraine Twohey-Jacobs
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Kenneth A. Perez
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
| | - Emily Mosites
- CDC Foundation, Atlanta, Georgia (Mr Bien and Ms Whitton); Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Meehan); Public Health Seattle and King County, Seattle, Washington (Mr Thornhill and Mss Ellis and Twohey-Jacobs); Minnesota Department of Health, St Paul, Minnesota (Mr Leopold); San Francisco Department of Public Health, San Francisco, California (Dr Borne); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota (Dr Vickery); Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, San Francisco, California (Dr Imbert); University of California San Francisco Benioff Homelessness and Housing Initiative, San Francisco, California (Dr Imbert and Mr Perez); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Mosites)
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