Participant Needs, Service Utilization, and Costs in a Medicaid Housing Pilot Program.

Importance: Housing instability and homelessness have wide-ranging health and social effects. Health systems increasingly recognize the importance of addressing these needs to make progress toward health equity goals and reduce health care costs. State Medicaid programs are uniquely positioned to support the housing needs of their members but are relatively new to the housing space and need to understand how to most effectively partner with the housing sector to improve health outcomes. Objective: To evaluate the implementation and initial outcomes of a housing benefit pilot program, including participant characteristics, needs, and service utilization. Design, Setting, and Participants: This was a cohort study involving a pilot program that provided temporary rental assistance, housing navigation, and additional supports to Medicaid members between May 2022 and October 2024. The pilot took place in the Portland, Oregon, metropolitan area involving Medicaid members of Health Share of Oregon, a large coordinated care organization. Individuals were referred to the program primarily from foster care, substance use disorder residential programs, and corrections facilities. Data were analyzed from October 2024 to March 2025. Exposure: Enrolled participants received services, including temporary rental assistance, housing navigation, and other supports, for up to 12 months, with modifications made mid-pilot due to capacity challenges. Main Outcomes and Measures: Participant demographic characteristics, baseline needs, service utilization, and costs associated with the housing benefit program. Results: Of 716 referrals, 517 individuals (mean [SD] age, 37.8 [11.1] years; 295 [57.1%] male) enrolled; including 14 American Indian or Alaskan Native individuals (2.7%), 7 Asian individuals (1.4%), 67 Black individuals (13.0%), 22 Hispanic individuals (4.3%), 6 Native Hawaiian or Pacific Islander individuals (1.2%), and 308 White individuals (59.6%); 513 individuals (99.2%) spoke English. Participants had substantial housing needs, with rent (383 individuals [74.1%]) and utility (282 individuals [54.5%]) support being the most frequently reported needs and used services. The mean (SD) cost per member per month was $2225 ($1586). Frequently reported nonhousing needs included employment (154 individuals [42.3%]), food (152 individuals [41.8%]), mental health (94 individuals [25.8%]), and transportation (86 individuals [23.6%]). Conclusions and Relevance: The findings of this cohort study provide critical insights into the types of services needed and associated costs for supporting housing as a Medicaid benefit. Significant needs were observed, emphasizing the necessity of cross-sector collaboration and clear role definitions between health care and housing organizations. The findings offer valuable lessons for the design and implementation of housing support programs under Medicaid; these insights are crucial as Oregon and other states consider similar initiatives to address housing as a health-related social need.