Health
Health care or housing? More states are using Medicaid funds to help the homeless
In some states, the line between housing and health care is becoming increasingly blurred.
The Medicaid program is intended to offer government assistance with medical expenses for those with low incomes. Yet in at least 20 states, some of those funds are being allocated to social services — including housing support for the homeless.
While some tout the move as a means of alleviating the health conditions that can arise from poor living conditions, others say the funding will not solve the underlying problems.
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The federal government oversees the Medicaid program, yet each state can set its own benefits and eligibility requirements.
“States have broad flexibility in their Medicaid programs to create a program that is unique,” said Dr. Marc Samuels, founder and CEO of ADVI Health, a health care and life sciences advisory and consulting services firm headquartered in Washington, D.C.
In some states, Medicaid funds are being directed toward housing support for the homeless. (iStock)
“In general, states look to aid in housing on a temporary basis in an effort to focus on social determinants of health/population-based issues around serious mental illness or substance abuse disorders, and those with disabilities or receiving long-term care, high-risk pregnancy, or with a history of chronic homelessness,” he told Fox News Digital.
Which states offer Medicaid-funded housing?
At least 20 states today cover housing support services under their Medicaid program, according to the National Academy of State Health Policy (NASHP).
“There are five states — Arizona, California, New York, Oregon and Washington — that have received the approval from the federal government to cover short-term housing assistance through their Medicaid program using a specific type of waiver from the federal government (section 1115 demonstration waiver),” NASHP said in a statement provided to Fox News Digital.
“States have broad flexibility in their Medicaid programs to create a program that is unique.”
States can also offer this type of coverage through a program called Money Follows the Person.
This program “facilitates rebalancing states’ long-term care services and supports from institutional to community-based care,” the agency said.
A homeless woman begs for money along a city sidewalk. Her sign reads, “Homeless & Hungry – Please help. Thank you.” (Getty Images)
California has unveiled the most ambitious plan so far for state-funded housing support.
In 2022, Gov. Gavin Newsom announced a $12 billion, five-year plan to revamp its Medicaid program — called Medi-Cal — to include a range of social services outside the scope of medical care.
Those non-traditional services, officially called “in lieu of services,” include housing deposits, moving costs and rent, according to the state’s Health and Human Services Agency website.
California’s non-traditional medical services are officially called “in lieu of services.”
Nearly all the state’s public and private managed care health insurers participating in Medi-Cal will cover housing-related expenses.
In Sept. 2023, the Oregon Health Authority submitted a proposal for expanded Medicaid benefits that would include six months of rent assistance. If approved, the housing support would be available starting in Nov. 2024.
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Arizona’s Medicaid program — the Arizona Health Care Cost Containment System (AHCCCS) — also offers funds for a “limited number of housing units” for members, according to the state’s health services website.
Non-traditional services — officially called “in lieu of services” in California — include housing deposits, moving costs and rent. (iStock)
Arkansas, Massachusetts, Hawaii, New Jersey and Washington are among the other states that have launched Medicaid initiatives targeting homelessness, according to the National Academy of State Health Policy (NASHP).
Last month, New York was approved for a Medicaid expansion that will include housing support — and additional states are expected to follow suit.
Link between housing and health
Proponents of this funding believe there is a direct connection between housing and health.
The Medicaid and CHIP Payment and Access Commission (MACPAC), a non-partisan federal agency that makes recommendations to Congress about Medicaid programs, stated in a 2018 brief that “poor housing conditions can worsen health outcomes related to infectious and chronic disease, injury and mental health, and may also affect childhood development through exposure to harmful toxins such as lead.”
The agency added that people experiencing homelessness or housing instability may struggle to get health care for routine visits as well as necessary medical treatments.
“Data suggest that among those who are chronically homeless, the provision of supportive housing … led to a decrease in emergency department use,” MACPAC wrote in the brief.
While some tout the move to use Medicaid funds for housing as a way to alleviate the health conditions that can arise from poor living conditions, others say the funding will not solve the underlying problems. (iStock)
Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said he does not think that providing housing is the answer to homelessness.
“It is a huge money drain on the state and it doesn’t solve the underlying problems of chronic mental health issues, excess drug use and the spread of infectious disease — not to mention the unemployment that drives all of it,” he told Fox News Digital.
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Siegel pointed out that housing in California is not currently affordable — an issue that affects everyone, not just the homeless.
“Using Medicaid to finance housing for the homeless bypasses the blue-collar workers who can’t really afford housing either,” he said.
The doctor does believe that shelter is a health issue, however.
“The vast majority of health variations are driven by factors completely unrelated to health care.”
“Without shelter, you are prone to many more medical issues, including dehydration, exposure to the elements, contagious diseases, malnutrition, drug use and the impact of mental illness,” he said.
“I like the New York City shelter system, which has worked well over the last three decades,” Siegel added. “It is starting to struggle now because of the influx of migrants with nowhere to go — which also represents part of the public health crisis.”
“Using Medicaid to finance housing for the homeless bypasses the blue-collar workers who can’t really afford housing either,” said Dr. Marc Siegel. (iStock)
Other doctors, however, said they are supportive of Medicaid funding going to housing costs.
“Many people think of health care as what happens in a doctor’s office, hospital or pharmacy — but what I can do for my patients as a doctor can quickly be undone if they don’t have food to eat or a roof over their heads,” said Colin Banas, M.D., chief medical officer for DrFirst, a health care technology company in Maryland.
“It’s refreshing to see that states such as California, Arizona, Oregon and Arkansas are allocating Medicaid funding in innovative and practical ways, especially as people experiencing homelessness are nearly twice as likely to have diabetes or experience heart attacks, according to the CDC,” he told Fox News Digital.
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Rather than using “scarce resources” for housing instead of traditional health care, Banas said he believes that an “additive approach” is ideal.
“Programs addressing homelessness should help us learn where interventions can have the greatest impact,” he said.
Homeless people stand with their belongings in front of an outpatient mental health clinic in Los Angeles, California, on Dec. 6, 2022. (FREDERIC J. BROWN/AFP via Getty Images)
Scott Shipman, M.D., executive director of the Institute for Population Health at Creighton University in Omaha, Nebraska, said the association of secure housing with better health is “widely understood.”
In an email to Fox News Digital, Shipman referred to Medicaid-funded housing as “a means of achieving better, and more stable, health while curtailing a vicious, often multigenerational cycle of costly recurring physical and mental health services that are exacerbated by prolonged housing insecurity.”
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When state governments pursue housing coverage through Medicaid waivers, they get a match of federal funding, Shipman noted.
“These programs do not shift funding away from medical services in favor of housing, but rather attract additional resources to meet housing needs, typically for those whose health is most directly at risk due to inadequate housing,” he said.
Shipman called for investments in addressing community-level social needs rather than simply pouring more money into “shiny new medical care technology,” which he said will lead to “overspending and disappointing results.”
“It doesn’t solve the underlying problems of chronic mental health issues, excess drug use and the spread of infectious disease.”
“The vast majority of health variations are driven by factors completely unrelated to health care,” he added.
To qualify for housing assistance, people must meet certain needs-based health criteria, including serious mental illness, disability, pregnancy or homelessness, according to NASHP.
Fox News Digital reached out to the Centers for Medicare & Medicaid Services as well as several state health agencies for additional comment.
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Feeling lonely may take a toll on older adults’ memory — but it may not speed up cognitive decline, according to a new study.
Researchers from Colombia, Spain and Sweden analyzed data from more than 10,000 adults ages 65 to 94 across 12 European countries and found those who reported higher levels of loneliness did worse on memory tests at the start of the study, according to research published this month in the journal Aging & Mental Health.
Over a seven-year period, however, memory decline occurred at a similar rate regardless of how lonely participants felt.
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“The finding that loneliness significantly impacted memory, but not the speed of decline in memory over time was a surprising outcome,” lead author Dr. Luis Carlos Venegas-Sanabria of the School of Medicine and Health Sciences at the Universidad del Rosario said in a statement.
Loneliness may be linked to memory performance in older adults, a new study suggests. (iStock)
“It suggests that loneliness may play a more prominent role in the initial state of memory than in its progressive decline,” Venegas-Sanabria said, adding that the findings highlight the importance of addressing loneliness as a factor in cognitive performance.
The findings add to debate about whether loneliness contributes to dementia risk. While loneliness and social isolation are often considered risk factors for cognitive decline, research results have been mixed.
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The study looked at data from the long-running Survey of Health, Ageing and Retirement in Europe (SHARE), which tracked 10,217 older adults between 2012 and 2019. Participants were asked to recall words immediately and after a delay to measure memory performance.
Social isolation and loneliness could play a surprising role in cognitive health among seniors. (iStock)
Loneliness was assessed using three questions about how often participants felt isolated, left out or lacking companionship.
About 8% of participants reported high levels of loneliness at the outset. That group tended to be older, more likely to be female and more likely to have conditions such as depression.
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Researchers found that those with higher loneliness had lower scores on both immediate and delayed memory tests at baseline. Still, all groups — regardless of loneliness level — experienced similar declines in memory over time.
The results suggest loneliness may not directly accelerate the progression of memory loss, though it remains linked to poorer cognitive performance overall.
Researchers look at a brain scan at the National Institutes of Health in Bethesda, Maryland. (Saul Loeb/AFP/Getty Images)
Experts warn, however, that the findings should not be interpreted to mean loneliness is harmless.
“The finding that lonely older adults start with worse memory but don’t decline faster is actually the most interesting part of the paper, and I think it’s easy to misread,” said Jordan Weiss, Ph.D., a scientific advisor and aging expert at Assisted Living Magazine and a professor at NYU Grossman School of Medicine.
“It likely means loneliness does its damage earlier in life, well before people show up in a study like this at 65-plus,” Weiss told Fox News Digital.
By older age, long-term social patterns may already be established, making it harder to detect when the effects of loneliness first took hold, an aging expert says. (iStock)
He suggested that by older age, long-term social patterns may already be established, making it harder to detect when the effects of loneliness first took hold.
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“By the time you’re measuring someone in their late 60s, decades of social connection patterns are already baked in,” he said.
Weiss, who was not involved in the research, added that loneliness may coincide with other health conditions, and noted that participants who felt more isolated also had higher rates of depression, high-blood pressure and diabetes. The link, he said, may reflect a cluster of health risks rather than a direct cause.
“While they can go hand-in-hand, it’s not clear that loneliness contributes to dementia,” a psychotherapist says. (iStock)
Amy Morin, a Florida-based psychotherapist and author, said the findings reflect a broader pattern in research on loneliness and brain health, and that the relationship may be more complex than it appears.
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“The evidence shows there’s a link between loneliness and cognitive decline but there’s no direct evidence of a cause and effect relationship,” she said. “So while they can go hand-in-hand, it’s not clear that loneliness contributes to dementia.”
Morin added that loneliness, which can fluctuate, may not be the root of the problem, but rather a symptom of other underlying mental or physical health issues.
Researchers suggested screening for loneliness be incorporated into routine cognitive assessments as one way to support healthy aging. (iStock)
She said staying socially and mentally engaged is crucial for overall brain health.
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“It’s important to be proactive about social activities,” Morin said. “Joining a book club, having coffee with a friend, or attending faith-based services can be a powerful way to maintain connections in older age.”
The researchers also suggested screening for loneliness be incorporated into routine cognitive assessments as one way to support healthy aging.
Fox News Digital reached out to the researchers for comment.
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Research continues to uncover new details on how fasting may help extend life.
A new study published in the journal Nature Communications investigated how intermittent fasting can boost longevity in small worms often used in aging research.
Researchers from the University of Texas Southwestern Medical Center in Dallas compared worms that were fed normally to those that underwent a 24-hour fast in early adulthood and were then fed again, according to a press release.
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The scientists measured a variety of factors, including stored fat, gene activity related to fat metabolism and lifespan.
The results showed that the life-boosting benefit did not depend on the fasting itself but on the body’s behavior after eating again.
Experts say sustainability is key when choosing a long-term weight-loss strategy. (iStock)
Study lead Peter Douglas, associate professor of molecular biology and a member of the Hamon Center for Regenerative Science and Medicine at UT Southwestern, suggested that these discoveries “shift the focus toward a neglected side of the metabolic coin – the re-feeding phase.”
“Our data suggest that the health-promoting effects of intermittent fasting are not merely a product of the fast itself, but are dependent on how the metabolic machinery recalibrates during the subsequent transition back to a fed state,” he said.
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“Our findings bridge a gap between lipid metabolism and aging research,” he added. “By targeting aging, the single greatest risk factor for human disease, we move beyond treating isolated conditions toward a preventive model of medicine that enhances quality of life for all individuals.”
Lauri Wright, director of nutrition programs at the University of South Florida’s College of Public Health, called this a “high-quality” study that adds an “important nuance to how we think about fasting and longevity.”
Intermittent fasting typically involves limiting meals to an eight-hour daily window or fasting every other day. (iStock)
The benefits of the refeeding phase after fasting were “especially interesting,” Wright, who was not involved in the study, told Fox News Digital.
“The researchers showed that longevity was linked to the body’s ability to turn off fat breakdown after fasting, allowing cells to restore energy balance,” she reiterated.
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“From a scientific standpoint, that’s a meaningful shift because it suggests fasting is not just about burning fat, but about metabolic flexibility.”
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Fasting may support longevity through triggering metabolic switching, enhancing cellular repair and stress resistance and improving markers like insulin sensitivity, research shows.
Limitations and cautions
Although this study provides “important insight” on the power of refeeding, Wright noted that the findings should be approached with caution, as the study was done on worms and cannot always be translated to humans.
“Additionally, it explains how a process might work in a controlled lab condition rather than real-world eating behaviors,” she added as a limitation. “Finally, the study is short-term and doesn’t give us the long-term translation on lifespan outcomes.”
The review found intermittent fasting was barely more effective than doing nothing, according to the study authors. (iStock)
Wright cautioned that fasting is “not a magic solution for longevity, and how you eat overall matters more than when you eat.”
“I advise, first and foremost, to focus on diet quality, including a variety of fruits and vegetables, healthy fats and minimally processed foods,” she said.
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For those who are considering fasting, it’s better to stick with a moderate plan — like a 12- to 14-hour overnight fast — rather than going to extremes, Wright said. After fasting, she recommends focusing on well-balanced meals.
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Several groups of people should be cautioned against fasting, according to Wright, including those with diabetes who are on insulin or hypoglycemic medications, those who are pregnant or breastfeeding, anyone with a history of eating disorders and older adults at risk of malnutrition.
Anyone considering intermittent fasting should consult with a doctor before starting.
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