March 1, 2023

A pilot program showed that housing support for at-risk moms leads to better birth outcomes. Now, we’re expanding it.

Amy Riegel, Executive Director, Coalition on Homelessness and Housing in Ohio (COHHIO)

Those of us who work in housing have known instinctively for a long time that there’s a strong link between stable housing and better health outcomes. How could there not be? Without stable housing, it’s very hard for people to plan for anything else in their lives — including managing diabetes or hypertension, keeping medical appointments, eating well and countless other things we have to do to stay healthy. It’s certainly no different for people who are pregnant.

Our state’s health plans understand this, but rent and other housing supports — helping find a unit and secure a lease, arranging for utilities and furnishings, for example — aren’t covered by Medicaid, making them difficult to fund.

There’s good news: Gov. Mike DeWine has committed to seeking a federal waiver from Medicaid rules to allow funds to cover housing needs. No waiver allowing Medicaid to go toward rent payments ever was granted before 2022 but late last year, the federal Centers for Medicaid and Medicare Services (CMS) approved the first two, for Arizona and Arkansas.

That precedent is extremely encouraging and we look forward to being able to provide housing support via Medicaid, but there is work do be done beyond obtaining the waiver. Organizations that help with housing will have to become credentialed to be a part of the Medicaid system and health plans will have to develop procedures for processing this new form of care.

Despite these challenges, I’m confident the end goal will more than justify the effort. Here in Ohio, we have a success story that demonstrates the potential power of housing assistance to boost health outcomes.

When I was senior director of housing for CareSource, a Medicaid managed care organization, the company participated in Healthy Beginnings at Home (HBAH) — a study beginning in 2018 that compared birth outcomes between a group of 50 single moms who received typical Medicaid services and a similar group who also received rental assistance and housing supports. All were poor; all had insecure housing situations when HBAH began.

Just as we expected, stable housing didn’t just provide a roof over these families’ heads; it was associated with healthier newborns — fewer born prematurely or with low birth weight. That translated into fewer and shorter NICU stays and Medicaid claims that were one-quarter the size of those for the families that didn’t receive housing help. Overall, the average claim paid for members in the control group at the time of delivery was $21,521, compared with $4,175 for those who received rental and housing assistance.

Last year I became executive director of the Coalition on Homelessness and Housing in Ohio (COHHIO) and I am very excited to report that we are launching HBAH 2.0, expanding the cohort to 300 at-risk women in order to provide statistically significant data. There won’t be a live “control group” this time because we don’t feel it would be ethical to exclude some women in our project from housing assistance, given what we learned from the pilot project. Instead, we’ll look at after-the-fact Medicaid data to compare the outcomes of our group to those of demographically similar women who were pregnant at the same time.

Our great hope is that the results of HBAH 2.0 will make the case for housing support even stronger. The pilot program attracted notice at the state and federal levels; a U.S. Department of Housing and Urban Development case study called the program “a novel approach to reducing infant mortality” with “promising results.”

We already are recruiting women for HBAH 2.0 in Columbus and Akron and Gov. DeWine’s budget proposal includes $17 million for the study, which would allow it to expand to Dayton, Cincinnati and Cleveland. I’m excited about what I see as a new era in addressing health and social conditions together. Ohio has tremendous resources in terms of hospitals and health plans, yet when you look at health outcomes, especially infant mortality, we’re at the wrong end of too many lists. I hope HBAH 2.0 can help us change that.