Sacramento, California –
At the beginning of 2022, Thomas Marshall weighed 311 pounds. He has had his 10 hospitalizations, including his 6 surgeries, in his 5 years. He had an open wound on his left leg that hadn’t healed, along with five other people, two ball pythons, four chihuahuas, and a cage full of rats, in a filthy moldy area. It was made worse by living in an old house.
After over a year, Marshall has lost nearly 100 pounds. his wounds have healed. His blood pressure returned to normal. His nerve-damaged legs have improved enough to go for walks in the park regularly.
Many factors contributed to Marshall’s dramatic turnaround, but the one he credits most is the acquisition of a one-bedroom, 500-square-foot (46.4-square-meter) apartment by the nonprofit Sacramento Covered. Finally got a stable housing after moving in. skyscrapers downtown. He has hardwood floors, white pine cabinets, and glass jars on the counter filled with Bit Oh Honey.
“For me, it’s the most important 500 square feet ever,” he said. “Living here has improved my health in every way.”
Marshall’s story is part of a fundamental rethinking of the relationship between housing and healthcare in the United States. For decades, Medicaid, a joint state-federal health insurance program for the disabled and low-income, only covered medical costs. But the Biden administration last year gave Arizona and Oregon permission to use Medicaid funds for housing.
Now California wants to join those states based on the success of programs like getting homes in Marshall. He proposed spending more than $100 million a year on the state’s Medicaid program to pay for up to six months of housing for people. Coming out of prison or foster care. or at risk of hospitalization or emergency room visit.
This will be the biggest test yet of using Medicaid money for housing.California has more than 13 million patients, roughly one-third of the state’s population, making it the country’s We have the largest Medicaid program. According to federal data, California is home to nearly one-third of the nation’s homeless population.
Anthony Wright, executive director of consumer advocacy group Health Access California, said, “This is a big step in breaking down the silos that have held us back from caring for the whole person, not limb by limb or disease by disease.
It will also be an expensive step. California is expected to run a US$22.5 billion budget deficit this year, and it could get even bigger in the years to come. Meanwhile, the state’s Medicaid spending is projected to grow by $2.5 billion over the next three years, according to the nonpartisan Office of Legislative Analysts.
Wayne Weingarden, a senior fellow at the Pacific Research Institute, a group that advocates free market policy, said, “What we’re really doing is expanding the welfare state, which is just a huge financial problem. will be
California experimented with using Medicaid funds for a portion of housing-related costs in 2016 when it launched pilot projects in 26 counties. Medicaid didn’t pay the rent, but it did pay for things like security deposits and furniture.
In Marshall’s case, he pays his rent with a portion of the US$1,153 a month that he earns from Social Security and Supplemental Security income. But Medicaid paid for his security deposit, bed, sofa, table, chair, and about 3 1/2 gallons of pine his sol. Marshall said keeping his apartment clean helped the wound on his leg eventually heal.
Over five years, the program reduced costly hospitalizations and emergency room visits for Medicaid participants, saving taxpayers an average of US$383 per patient annually, according to an analysis by UCLA researchers.
Now, California wants to go further by using Medicaid funds to pay some people’s rent directly. Democratic Rep. Joaquín Alambra, who chairs the budget subcommittee that will scrutinize Newsom’s proposal, said lawmakers support him, after spending 10 years as an emergency room doctor.
“I’ve gotten really good at getting cockroaches out of people’s ears,” said Alambra. “Living conditions in many of our communities, especially rural ones, can really affect our ability to get enough sleep, prepare for the next day, and stay healthy.”
Advocates for homeless people say they welcome such programs, but say spending more on rent isn’t enough and the state still has a significant shortage of affordable housing. doing.
Kelly Bennett, founder and CEO of Sacramento Covered, said California’s first trials of using Medicaid funds for housing services often took workers up to eight months to place patients in apartments. said. In some cases, people wait years to find a place.
“Even with a security deposit and some rental subsidy, it’s still very difficult to find a room, and a room for a landlord to lease to a client,” Bennett said.
Marshall said he grew up in Sacramento and earned a degree in diet technology and culinary arts. He used to camp at an old landfill and eat leftovers from people’s picnics in a nearby park.
He applied for an apartment in several subsidized housing projects, but never dropped out of the waiting list. It took him about a year to get his current apartment, which he pays $186 a month with the help of subsidies.
“I feel like electricity….I have the power and the ability to do things I haven’t been able to do for a very long time,” said Marshall, 64. “How many more years do I have left?” I plan to spend my time in this glass tower.”
