Oregon’s new Medicaid rental assistance aims to prevent homelessness

Beginning Nov. 1, Oregon’s Medicaid program takes on a new approach to improving overall health via housing benefits.

Qualifying Oregon Health Plan members will be eligible for six months of rent payments, including missed payments. Those receiving rental support also can apply for six months of storage and/or utilities assistance. And the Oregon Health Plan will provide tenant support like help understanding a lease or navigating transportation systems.

To qualify, an individual must be an OHP member who meets designated income requirements and does not have the resources to prevent homelessness, has a qualifying health condition and an existing lease.

In Salem, for example, an individual must make $19,200 or less to qualify, or 30% of the area’s average yearly income, which is defined by the U.S. Department of Housing and Urban Development as one of the markers someone is at risk of homelessness. For a family of four, the maximum income is $27,400.

Members also can be covered for medically necessary home improvements, such as adding wheelchair ramps or pest removal, and the costs of associated lodging during work on the project. These benefits have different requirements than the rental and tenant assistance programs. More information on how to qualify can be found on the Oregon Health Authority website.

Other states have begun implementing similar programs but, “we’re the first in the country to test out the structure of this being a benefit, meaning that eligible members are entitled to receive these benefits,” according to Steph Jarem, OHA 1115 waiver policy director.

Dave Baden, OHP’s deputy director for policy and programs, emphasized the purpose of the program is to keep people at risk of homelessness in their current housing.

“It really is focusing on trying to keep those most at risk still housed, hopefully leading to them being able to have some short-term help that would lead them to some better long-term outcomes,” Baden said during a media briefing. “Preventing people from becoming homeless really is about expanding preventive services.”

The rental assistance is just one piece of Oregon’s current 1115 waiver, which lets states ask the federal government for permission to try new things with Medicaid. The current waiver began in October 1, 2022 and will continue until September 30, 2027 when it can be changed or continued for another five-year period.

“The 1115 more broadly is meant to be a demonstration to show that new innovative things can happen in the Medicaid program. … It’s an opportunity for states to lead with new innovative ideas to address and improve health for the people that the Medicaid program serves,” said Oregon Medicaid Director Emma Sandoe.

Oregon implements different programs under its Medicaid waiver

The current waiver implemented several programs.

One aspect of the waivers is intended to address health-related social needs, which housing falls under. Also included are outreach and engagement, climate and nutrition. Benefits addressing these needs already are in place, except the nutrition assistance which will start in January.

Oregon has a maximum of $904 million in federal funding to spend on the current waivers’ health-related social needs benefits. As part of the deal, the state must contribute at least $71 million.

An additional $119 million was set aside for Community Capacity Building Funds, $38 million of which already has been distributed based on total enrollment to Coordinated Care Organizations around the state. These organizations oversee local Medicaid services and providers.

More of the funding will be given out next year. The grants “will be invested in infrastructure to be able to deliver on the waiver program and benefits,” according to PacificSource vice president of Medicaid programs Erin Fair Taylor. PacificSource is the Coordinated Care Organization for four regions in the state.

More than $3.8 million was granted to PacificSource Marion/Polk with $244,000 set aside for the Salem Housing Authority.

The housing authority plans to use the funds “to provide housing support services, including case management to address landlord/tenant conflicts, referrals to community resources, and financial support,” said spokesperson Sarah Murray.

“We also have been talking quite extensively with our local housing providers and collectively they have been sharing that preventing homelessness is more cost effective than helping families in a shelter find housing,” Jarem said.

“Helping families move from that homelessness space into housing can cost about $15,000 on average per household, and that would be compared to about $3,000 on average per household to prevent homelessness in the first place,” she said.

Applications for rental assistance through the Oregon Health Plan open Nov. 1

OHP members can apply for many of the new benefits. They will be eligible one time to receive the six months of rent assistance until the trial period ends in 2027.

Jarem said other benefits, such as tenancy supports, are more flexible.

Applications open on Nov. 1. Applicants should anticipate about two weeks to process and an additional wait to receive the benefit, if eligible.

Preparations for the 2027 to 2032 waiver application will begin next year.

“We have an external, third-party evaluation, and they’ll have a midpoint evaluation that will help inform some of that, and we’ll work with CMS (Centers for Medicare and Medicaid Services) to understand what they’re seeing in other states as well,” Jarem said.

“Ultimately, they are the deciders of whether or not benefits like this will continue,” she said. “Overall, though, we’ve built the structures into our systems with the understanding that this will, that there is an effort to create stability in the program.”

Anastasia Mason covers state government for the Statesman Journal. Reach her at acmason@statesmanjournal.com or 971-208-5615.