For people who cannot afford safe housing or nutritious food, doctor visits and hospitalizations can only do so much to solve their health problems.
That’s the premise of a plan to allow Colorado’s Medicaid system, which provides government-funded health insurance to low-income people, to cover the cost of housing and nutrition services.
This novel idea, which is spreading across the country, is based on the recognition that health care happens outside of a doctor’s office, and that if people have the tools to stay healthy, taxpayers might save money in the long run.
A new law recently signed by Gov. Jared Polis directs the Colorado Department of Health Policy and Financing, which includes the Medicaid program, to consider asking the federal government for permission to cover the costs of food and housing. The department has already begun that process, soliciting public comment this month on a proposal to cover the social needs of three groups: people who are homeless or at risk of homelessness, people with disabilities leaving institutions, and young people leaving the foster care system.
One group keeping a close eye is Project Angel Heart, a nonprofit that delivers about 2,000 meals a week to seriously ill patients in Colorado, customizing each meal an average of 80 times.
Kidney patients shouldn’t eat tomatoes, so they’re offered a roasted red pepper blend instead, for example, while other patients are offered gluten-free, vegetarian or heart-healthy options.
According to data from Project Angel Heart, the medically customized meals delivered frozen across the Front Range are helping people avoid hospitalization: Hospitalizations among people who received the meals fell by 13 percent in a 2018 study. Overall medical costs for people with congestive heart failure, pulmonary disease and diabetes fell by 24 percent.
The meals are provided free of charge, and the costs are covered primarily through donations and grants to the Angel Heart Project. This year, the Angel Heart Project aims to provide 750,000 meals to about 5,000 people. Currently, only one or two people per month meet the requirements for Medicaid benefits for the meals. Certain people who are discharged from the hospital can receive meal services for up to 30 days.
Project Angel Heart clients in the southeastern corner of Colorado have their meals sent by FedEx: The nearest food pantry is an hour’s drive away and is only open two hours a month, said Nick Soucy, the organization’s government relations manager.
“This just highlights the need,” she says. “Firstly, it’s important to recognise how big an issue food and nutrition is, and in particular the role it plays in reducing diet-related disease.”
The nonprofit provides services in the midstate, from Greeley to Pueblo, but could expand into rural and mountain areas to help more people if it were covered through Medicaid, Soucy said. How far the Angel Heart Plan expands will depend on what’s included in Colorado’s final Medicaid proposal and what the federal Centers for Medicare and Medicaid approve, a process that could take months.
The proposal does not include children.
At present, the categories of people who can benefit are very limited.
Project Angel Heart hopes that “everyone living with a chronic illness” will be able to get medically tailored meals through Medicaid coverage, but for now, that’s not part of the plan.
The HHS proposal also makes no mention of children, which is bad news for programs like Children’s Hospital Colorado, whose on-site food pantries provide fresh fruits, vegetables, meat and milk.
With record numbers of children losing Medicaid coverage after the COVID-19 national emergency ends, it’s even more concerning that Colorado’s Medicaid department is implementing the new law “in a way that specifically excludes children,” said Zach Zaslow, vice president of community health and advocacy at Children’s Hospital.
“We look forward to future Medicaid program changes to include children’s health, and look forward to working with Congress and the Polis administration to make these important investments a reality,” he said in an email.
Food and housing insecurity leads to higher rates of emergency room visits, school absenteeism and missed pediatric checkups, Zaslow said. This year’s legislation and a companion law passed last year could allow Medicaid to reimburse community health navigators, who connect people with food, housing and utility assistance, helping to “nudge” the Medicaid system in the right direction, he said.
For now, Zaslow said, the children’s program, called Resource Connect, relies mainly on charitable support because health insurance companies don’t typically cover services.
Parents who bring their children to medical appointments can fill out a screening form and, if they indicate they need help with food, housing, mental health or even paying their utility bills, they can speak with a Resource Connect navigator. From there, they can shop at food pantries, apply for Medicaid or food stamps, or get in touch with nonprofits that provide diapers and school supplies.
Colorado is one of at least 20 states moving forward with such proposals.
Any proposals states make to the federal government must be neutral to the federal budget: At least 20 states have been approved for or are considering similar proposals, and within federal exemptions they could use federal funding to test new ideas for five years to see if they work.
A 2022 White House conference on hunger, nutrition and health linked stable housing and nutrition to overall health and well-being, and since then, innovative proposals from states have begun to pour in.
Healthy Colorado, which pushed for Colorado’s new law, said stable housing reduced detoxification services by 65 percent and nutritional support reduced inpatient medical costs by 62 percent.
Colorado’s current proposal estimates that Medicaid would provide varying levels of housing and nutrition assistance annually to about 11,000 people who are homeless or on the verge of homelessness. About 300 people with disabilities transitioning from nursing homes to their own homes and 100 young people ages 18 to 25 transitioning out of the foster care system would receive services.
Some recipients would receive up to six months’ rent. Other benefits, according to the proposal, would include medically sensitive food delivery, food pantry deliveries and nutrition counseling.
The State Department is accepting public comment on the proposal through July 10.
The bill was introduced by Sen. Robert Rodriguez, a Denver Democrat, Sen. Barbara Kirkmeyer, a Brighton Republican, Rep. Kyle Brown, a Louisville Democrat, and Rep. Shannon Byrd, a Westminster Democrat.
