OHSU study sheds light on the role housing and other needs play in health care

by Ben Botkin, Oregon Capital Chronicle
November 27, 2024

Housing and food insecurity sharply increased in Oregon among Medicaid and Medicare recipients during the COVID-19 pandemic, even amid a moratorium on evictions and increased government support for nutrition. 

The basic needs of Oregonians remained in peril from the start of the pandemic in March 2020 until at least the end of 2021, according to the findings of a study led by Oregon Health & Science University researchers published Monday in the Annals of Family Medicine. 

The study sheds light on the role that social determinants of health like adequate housing and food can play in a person’s overall well-being. This month, the Oregon Health Authority launched a new program to help people on Medicaid with their rent costs when a medical crisis hurts their ability to pay. 

The Oregon study surveyed and followed about 21,000 people who received Medicare or Medicaid benefits for their health care coverage, starting in 2019 and continuing through the end of 2021.  Researchers found a 17.7-percentage point increase overall in health-related social challenges such as housing instability and adequate food in March 2020, which coincided with the nation’s shutdown during the pandemic. That increase did not significantly decline through the end of 2021.

In Oregon, more than 1.4 million residents rely upon the Oregon Health Plan, the state’s Medicaid program that provides health care, dental and behavioral health services to low-income people. More than 930,000 Oregonians are on Medicare, which is available for people who are at least 65 years old or receive Social Security disability benefits. 

The study was part of a broader national effort that surveyed 1.1 million people in the U.S. in a similar situation. The nationwide survey, overseen by the federal Centers for Medicare & Medicaid Services, found that people who had their basic needs like housing, food, transportation and utilities addressed during a health care visit enjoyed better overall health compared to people who did not receive assistance. 

“Together, these findings drive home the point that health care organizations need to think about the social care of their patients,” said senior author Anne King, an OHSU adjunct faculty member and Oregon state director of Comagine Health, a nonprofit health care quality improvement firm. “It actually improves their health and it reduces costs for taxpayers.”

Work started before the pandemic 

In 2019, researchers in OHSU’s Oregon Rural Practice-based Research Network enlisted the help of 50 clinics across Oregon to connect them to people. The participants spanned a swath of Oregon from the Portland metro area to rural communities in 15 counties.

With that timing, the study started just before the COVID-19 pandemic hit. The rise in housing and food needs continued, even as government benefits like unemployment payments and eviction moratoriums increased. 

Oregon’s new rental assistance program comes through its Medicaid waiver, which is a five-year plan that the federal Centers for Medicare & Medicaid Services approved. States can receive waivers as a tool to try new Medicaid programs and spend money in ways it otherwise could not. 

During this period, Oregon has nearly $1 billion available for the rental assistance programs and other new programs within the Medicaid plan for air conditioners, air filters and food benefits. Most of the money — $904 million — is federal funding, with a state match of $71 million. 

“This study lends credence to the importance of having this activity happen in conjunction with health care,” King said in an interview. “In allowing a waiver, CMS is recognizing that meeting people’s social needs and addressing them in the clinical setting, is actually beneficial, both to the patient and also to just the healthcare system nationally, at large.”

Oregon’s current Medicaid waiver is in effect from Oct. 1, 2022, through Sept. 30, 2027. 

The rise in needs also raises questions about how much bleaker the picture would have been without increased benefits. 

“What if we hadn’t done anything?” said lead author Jean Hiebert Larson, an OHSU finance analyst. “Would this have been much worse?”

The study recommends more research into what potential policies and changes can best address health-related social needs. 

But Oregon researchers also say the state’s new program to provide short-term rental assistance to people on Medicaid is a step in the right direction. The rental assistance program can cover rental and utility costs for up to six months, including past-due amounts. People also can receive medically necessary home improvements, including wheelchair ramps, pest control and heavy-duty cleaning. 

“Oregon is ahead of the nation,” King said. “We’re at the forefront of the nation in understanding the relationship between stable housing and effective delivery of health care.”

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