Nevada gets federal approval to test out Medicaid funds for housing

Nevada Medicaid recently received federal approval to use funds to cover housing and supportive services through Medicaid's managed care providers. The pilot program will help an estimated 20,300 Nevadans who had identified themselves as homeless when applying for Medicaid.

As the state implements the program, it is also seeking approval from the federal government to cover housing and other support services for a broader range of Nevadans on Medicaid, via a new Centers for Medicaid and Medicare Services (CMS) waiver opportunity called Section 1115.

Nearly 1 in 3 Nevadans – 882,000 people – are covered by Medicaid, a joint state and federal program that provides health insurance for low-income individuals or those with disabilities.

"Housing and healthcare go hand-in-hand," said Nevada Medicaid Administrator Stacie Weeks. "It's a fact that a person's overall health and wellness are impacted by where they live."

Benefits under the pilot program "are a small piece of the puzzle to improve health outcomes and lower the risk of high health care costs that can come from being unhoused," Weeks said.

Every state bordering Nevada except Idaho is experimenting with using Medicaid to fund housing.

Arizona, California, and Oregon have been approved for the new Section 1115 Waivers. Utah was approved to provide housing and nutrition services before the Health-Related Social Needs framework implementation under the Biden administration, according to KFF.

Nationwide, half the states have either begun programs to include housing within Medicaid coverage or, like Nevada, have begun moving in that direction.

Under the Section 1115 waiver Medicaid will cover the cost of rent, temporary housing, and utilities for up to six months, and up to three meals per day for six months. Both contrast with the longstanding prohibitions on Medicaid paying for "room and board."

Nevada has attempted to fund housing and supportive services through Medicaid before, but the scope of the legislation was narrower. In 2019, legislators passed a bill that would have allowed Medicaid to provide housing services for behavioral health needs. But the state "ran into some state and county administrative challenges" implementing the bill because of "federal constraints and requirements for that benefit," Ky Plaskon, the public information officer for Nevada Medicaid, said via email.

Instead, the Division of Health Care Financing and Policy, which oversees Nevada Medicaid, shifted its focus to join the other eight states moving forward in getting the Section 1115 waiver.

The bulk (78%) of Nevada Medicaid recipients are covered by managed care plans, which are private insurance companies Nevada Medicaid contracts with. The remaining are covered through a fee-for-service model in which the state pays Medicaid providers directly for each covered service.

In addition to help with rent and food, the services covered under the new pilot program will include specialized case management, housing transition services, and housing-related deposits.

Before the pilot program can begin operating, the four Medicaid managed care plans – Anthem Blue Cross and Blue Shield Healthcare Solution, Molina Healthcare of Nevada, SilverSummit Healthplan, and UnitedHealthcare Health Plan of Nevada Medicaid – will have to submit plans to cover the services to CMS for approval. The companies are expected to submit their plans to cover the services by the end of March.

The four managed care providers for Nevada Medicaid did not respond to inquiries about whether they already provide housing and other wraparound services by the deadline.

"Nevada Medicaid is still exploring how best to implement these services for the state's fee-for-service population in Medicaid under federal law," Plaskon said via email.

The state's Division of Health Care Financing and Policy anticipates completing the Section 1115 waiver to provide housing and other services to a broader portion of Medicaid recipients by the end of the year.

"Seeking federal approval through the waiver authority should allow Nevada Medicaid to accomplish the same benefit structure for housing supports and services along with meal services for those experiencing homelessness or at risk of homelessness due to a behavioral health condition across both fee-for-service and managed care," Plaskon said via email.

Those covered by the managed care plans can contact the plans directly to learn about the types of housing support and meal services available.