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States are plowing billions of dollars into a high-stakes health care experiment thats exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans.

This story also ran on CNN. It can be republished for free.

California is going the biggest, pumping $12 billion into an ambitious Medicaid initiative largely to help homeless patients find housing, pay for it, and avoid eviction. Arizona is allocating $550 million in Medicaid funding primarily to cover six months of rent for homeless people. Oregon is spending more than $1 billion on services such as emergency rental assistance for patients facing homelessness. Even ruby-red Arkansas will dedicate nearly $100 million partly to house its neediest.

At least 19 states are directing money from Medicaid the state-federal health insurance program for low-income people into housing aid and addressing the nations growing homelessness epidemic, according to the Centers for Medicare & Medicaid Services. Even though theres little agreement that this will provide a long-term fix for vulnerable patients health or housing, the Biden administration is encouraging other states to jump in. Several are in the pipeline, including Tennessee, West Virginia, and Montana and New York got the green light from the federal government in January.

Using health care funding to house people is a big philosophical debate, said Alex Demyan, assistant director of Arizonas Medicaid agency. We know health care cant solve all the problems, but we also know that housing agencies are maxed out and we have enormous need to help stabilize people.

Homelessness jumped 12% in the U.S. last year, to an estimated 653,104 Americans, the highest level on record, even as the nation dramatically increased its inventory of permanent housing and temporary shelter beds.

As people languish on the streets, often struggling with addiction, severe mental illness, and untreated chronic diseases, health care officials and political leaders are turning to health insurance money for relief. They argue that housing aid will improve health and save taxpayer money by keeping people out of institutions such as nursing homes, hospitals, and jails.

But evidence supporting this argument is mixed.

For instance, in a trial by researchers at the University of California-San Francisco, homeless people in Santa Clara County, California, who were randomly assigned to receive long-term housing and services used the psychiatric emergency department 38% less than a control group over four years while increasing their use of routine mental health care. But participants were still hospitalized at high rates and continued to rely on the emergency room for routine medical care or rest.

State Medicaid programs have long dabbled in housing, but with the blessing and encouragement of the Biden administration, they are launching more services for more people with heaps of new state and federal money. The trend is part of a broader White House strategy that encourages Medicaid directors to offer social services alongside traditional medical care, with the goal of making their residents healthier.

A health care dollar can do more than just pay for a doctor visit or hospital stay, Xavier Becerra, secretary of the U.S. Department of Health and Human Services, told KFF Health News. We should be using the federal health care dollar for wellness care: Get them before they get ill, and keep them healthy. Is there anyone who would deny that someone who is homeless is going to have a harder time also keeping their health up than someone who is housed with running water and heat?

Becerra acknowledged these initiatives as experiments. But he said the federal government can no longer ignore the rampant death and disease that is plaguing homeless populations around the U.S.

Were simply saying, State, if you can prove to us that with this Medicaid dollar you will improve someones health or health outcome, then you have essentially served the purpose of the Medicaid program and youre saving taxpayers more money, he said.

But not all health care leaders or even homelessness experts believe this is the best use of Medicaid money, especially by a safety-net program that faces routine criticism for failing to provide basic health care to many enrollees.

If youre on Medicaid, you often have to wait months and months for a specialty visit, even if its a life-threatening concern, so I worry about what people wont be able to get because of this, said Margot Kushel, a leading homelessness researcher and primary care doctor at Zuckerberg San Francisco General Hospital and Trauma Center who primarily treats low-income patients.

Its not that I dont want the money to be spent, but is it best spent in health care? she asked. It’s much better than nothing, but it’s far from providing the long-term housing and stability that people really need.

Kushel said the danger is that most Medicaid housing assistance can be used only once or is time-limited, such as rental payments, which typically end after six months.

By the time folks get into housing, theyre already really, really sick, she said. What happens at the end of six months when rental assistance like free rent runs out? Email Sign-Up

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Housing as Health Care

Across the country, state Medicaid programs are stretching the definition of health care and getting into the business of social services, delivering a range of nontraditional benefits such as healthy home-delivered meals for patients with diabetes and air filters for patients with asthma.

While the federal government historically has banned the use of Medicaid money for direct rent payments, that has changed.

In 2022, Arizona received federal approval for an initiative called H2O, which will prioritize homeless people and those at risk of losing housing who also have a mental health condition and chronic illness. When it launches in October, it will primarily provide two services: rent payments for up to six months; and transitional housing, which can include shelters with intensive services.

Arizona saw a 5% jump in homelessness in 2023 from the previous year. Its program will supplement a separate state-funded Medicaid initiative that provides 3,000 rent vouchers for people in southern Arizona who have a severe mental illness and are homeless or at risk of becoming homeless. About 5,000 people are on the waiting list for a voucher.

Weve seen such positive health outcomes and cost reductions as a result, so it made total sense to us to expand our work in that space, Demyan said. That program slashed ER visits 45% and reduced hospital inpatient admissions 53% at the six-month mark after patients started receiving services, while increasing less costly preventive care 56% and saving $4,300 per member, per month, according to state data.

California, home to nearly 30% of the nations homeless population, saw a nearly 6% jump in homelessness in 2023, to about 181,000 people.

The state launched its massive CalAIM initiative in 2022 to offer a wide variety of social services to a small sliver of the states roughly 15 million Medicaid enrollees. A large share of the resources are going to housing services for homeless people or those facing eviction, such as covering security deposits and enlisting case managers to hunt for available apartments. State leaders are also asking the Biden administration for permission to provide six months of rent.

If youre saddled with a great deal of either physical or behavioral health conditions, whether its diabetes or HIV, high blood pressure or schizophrenia, without housing, its really hard to stabilize those conditions, said Mark Ghaly, secretary of the California Health and Human Services Agency.

But he cautioned that Medicaids core focus must remain getting people healthy, even if theyre living outside, which is a monumental and expesive challenge because conditions like diabetes, heart disease, and HIV require continuous treatment and often multiple medications.

I do not think that health care is responsible for solving homelessness in California or anywhere else, Ghaly said. But if housing instability or lack of housing is one of the key drivers getting in the way of being healthy, then absolutely we need to pay attention to it.

Health insurers that provide Medicaid coverage in California can choose whether to provide housing services, but Oregon is requiring Medicaid insurers to do so.

Homelessness grew 12% in Oregon from 2022 to 2023, but the state is targeting patients at risk of becoming homeless. Participants will be eligible for six months of rent and other services when the program launches in November, said Dave Baden, deputy director of the Oregon Health Authority.

Were really trying to focus on people teetering on the brink, Baden said. If youre already homeless, you really need longer, sustainable housing dollars to keep that person housed.

Its not just states experimenting with this approach. Kaiser Permanente is one of the health systems that has invested its own funds into housing. In recent years, the health care giant has committed hundreds of millions of dollars to help maintain or build thousands of affordable housing units, in addition to providing housing-related Medicaid benefits for its members.

We have to do something. The crisis is out of control, said Bechara Choucair, its chief health officer. Are you covered by Medi-Cal?

We want to hear about your experiences and, with your permission, may incorporate your story into our coverage. Please tell us what it has been like for you as you have sought and received care, including the good and the bad, the obstacles and the successes.Share Your Story

Mission Creep

Sherry Glied, a professor at New York University and former Obama administration official who is an expert in health care economics, warned in a recent health policy analysis of mission creep in health care. She cautioned that health care institutions getting into the business of social services could be a dangerous distraction.

Glied pointed to at least 57 health systems and 917 hospitals around the country that have launched social service initiatives, with most focusing on housing. Because many institutions struggle to meet patient safety and quality care standards, Glied argued that they should instead improve basic care and leave housing to social service organizations that specialize in this work.

Providing people with food or housing is pretty far removed from the core mission of health care, she told KFF Health News.

Peter Lee, another former Obama administration official and the founding executive director of Californias Obamacare exchange, said health care providers should consider offering some housing and social services, but he fears such initiatives may divert money from traditional medicine and prevent patients from getting adequate care.

In the past five to 10 years, there has been a lot of recognition that health is about much more than actual health care. Very true, Lee said. The question is how do you address those issues while health care itself is not doing too great. The brass tacks of this is making sure people with diabetes have great diabetes care, that people get checkups in time, that people can get the regular health care they need.

State Medicaid programs, which provide care to at least 80 million Americans, often struggle to deliver basic medical services, such as childhood dental visits and breast cancer screenings. In California, the state spending the most on housing services, children on Medicaid did not have timely access to care for mental health or substance use in 2022, according to an audit published in November.

Despite these shortfalls, most of the states that have been given the federal go-ahead to experiment with housing services have secured funding for five years. California is among the states that hope to make the benefits permanent.

Though a Republican presidency could interrupt this trend, states say theyre committed even if their initiatives dont pass a traditional cost-benefit analysis.

The singular focus on a financial return on investment is not as clear as it was previously, said Cindy Mann, a federal Medicaid director under Obama.

States are just seeing how little sense it makes to treat people and then release them back to the streets without the support they need.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Angela Hart: ahart@kff.org, @ahartreports Related Topics California Health Industry Insurance Medi-Cal Medicaid Public Health Arizona Arkansas California Legislature Homeless Legislation Montana Oregon Tennessee West Virginia Contact Us Submit a Story Tip

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Edmonton takes control over Stars: Game 3 grades, takeaways

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Edmonton takes control over Stars: Game 3 grades, takeaways

While fans in Edmonton and Dallas are always singing about how they have friends in low places, only one of them has the high ground in the Western Conference finals. And that’s the Oilers after their 6-1 win Sunday in Game 3 to take a 2-1 series lead.

With the series tied heading into Sunday, the objective for Game 3 was to gain a firm grasp of the conference finals, and the Oilers did just that by having five players with multipoint performances. As for the Stars, losing Game 3 left them trailing a series for the second time this postseason, with the only other such occurrence coming after Game 1 against the Colorado Avalanche in the first round.

Now that the Oilers are in control of the series, what does it mean for them going forward? What must the Stars do differently ahead of Game 4 for them to return home tied rather than a game away from elimination? Ryan S. Clark and Greg Wyshynski examine those questions while delving into what lies ahead for two teams that not only faced each other in the conference finals last season but between them have been involved in every conference final since 2020.

Edmonton Oilers
Grade: A

Much could change between now and whenever the playoffs end. But for now, the argument could be made that this was the most important playoff game the Oilers have had this postseason.

The Oilers have had numerous strong performances, such as Game 3 against the Los Angeles Kings in the first round or their final two games against the Vegas Golden Knights in the conference semifinals. But what made the Oilers’ performance in Game 3 against Dallas arguably their most important was that they found a balance between being difficult in the defensive zone while not relying on a shutout to accomplish that objective.

The Stars finished with 37 shots, 13 high-danger chances in 5-on-5 play and scored only once. Connor McDavid has repeatedly stressed that the Oilers can play defense, and that has been made clear over their past five games. But Sunday proved they didn’t need Stuart Skinner or their defensive structure to blank an opponent to win. — Ryan S. Clark

Dallas Stars
Grade: C+

The final score doesn’t reflect the majority of this game, which Dallas coach Pete DeBoer can mine for positives among the many (many) negatives and some mitigating circumstances. Having Roope Hintz warm up but not be able to go because of the foot injury he suffered from a Darnell Nurse slash in Game 2? That’s deflating. Having the on-ice officials miss a delay of game call on Brett Kulak in the first period only to have Evan Bouchard open the scoring 10 seconds later? Also deflating.

So it’s to the Stars’ credit that they got to their game at 5-on-5 in Game 3 better than they have in any game of the series, at least before Edmonton ran up the score in the third. The results weren’t there and a loss is a loss — and a loss by this margin is difficult to stomach — but their second period and the performances from some of their slumbering depth players give the Stars at least a glimmer.

However, there’s no question Edmonton has this thing in well in-hand and the Stars have to find a way to solve Skinner, which is not something I thought I’d be writing at this stage of the postseason. — Greg Wyshynski


Three Stars of Game 3

Two goals and an assist for his seventh career multigoal playoff game. Hyman’s second goal was the Oilers’ fourth off the rush, the most in one game by any team this postseason. Hyman also was plus-5 Sunday.

Bouchard scored his sixth goal of the postseason and these two were on the ice for the first two Edmonton goals. At 5-on-5 this postseason, the Oilers are outscoring their opponents 7-1, and 5-0 in this series, when Bouchard and Kulak are on the ice.

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Connor McDavid restores Oilers’ 2-goal lead

Connor McDavid finds the back of the net to restore the Oilers’ two-goal lead vs. the Stars.

3. Connor McDavid
C, Oilers

For all the talk about the lack of goals from the best hockey player in the world (which was odd because he had 20 points in 13 games and was a plus-7 entering Game 3 despite having only three goals), McDavid punched out a pair of tucks for his sixth career multigoal playoff game. Also, seeing McDavid with the puck barreling toward the net on a 3-on-1 is nightmare fuel for opponents. — Arda Öcal


Players to watch in Game 4

Zach Hyman
LW, Oilers

To go from 16 goals last postseason to just three goals entering Game 3 of the conference finals is one way to assess Hyman. Another is to realize that he’s been the most physical player on a team that is among the tallest and heaviest in the NHL.

Hyman came into Game 3 leading the NHL with 99 hits. He remained physical Sunday by leading the way with six hits in a game that saw the Oilers continue their punishing style with 47. But to then see Hyman score two goals and finish with three points in addition to that physicality? It once again adds to the narrative that the Oilers might not only have more dimensions than last year’s team, they could be better than the team that finished Stanley Cup runner-up in 2024. — Clark

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Zach Hyman’s 2nd goal puts Oilers up 4

Zach Hyman taps home his second goal of the game to put the Oilers up 5-1 vs. the Stars.

This is the first two-game losing streak for the Dallas goaltender in the playoffs. A lot of what happened in Game 3 wasn’t necessarily on him — a Connor McDavid beauty and a Zach Hyman breakaway were among the Edmonton tallies — but outside of the third period of Game 1, he’s not been a difference-maker in this series. Oettinger came into the game leading the playoffs with 5.58 goals saved above expected, according to Stathletes. The Stars have been able to depend on him as a slump-breaker. But this is his third game with a save percentage south of .900 in the series. As the Stars try to build on some positives from this game, they need Otter to provide the foundation for it — and in the process, silence those “U.S. backup!” chants from the Oilers fans. — Wyshynski


Big questions for Game 4

Are the Oilers about to do to the Stars what they did to the Golden Knights?

Simply put, the Oilers are where hope goes to die. Teams in a championship window that have yet to win a title are always being judged on their evolution. What the Oilers did to the Stars a year ago in the conference finals by winning the last three games showed that they could close out a series after trailing. This postseason Edmonton has shown a calculated and methodical coldness when it comes to putting away opponents.

The Golden Knights won Game 3 on a last-second goal to create the belief they may have found an opening. They didn’t score again for the rest of the playoffs after being in the top five of goals per game throughout the regular season. Breaking out for six goals to open the series seemed to be a sign the Stars may have found an opening. Since then? They’ve scored only once in the last six periods while facing questions about what’s happened to another team that went from being in the top five in goals per game in the regular season. — Clark

Can Dallas make Edmonton uncomfortable at all?

Our colleague Mark Messier made this point between periods of Game 3: The Stars have yet to do anything to get McDavid or Leon Draisaitl off their games. That extends to the rest of the Oilers. Outside of an anomalous run of three power-play goals in the third period of Game 1, there have been precious few instances of the Stars carrying play for long stretches or putting a scare into Edmonton at 5-on-5.

They had that for a bit in Game 3 with a dominant second period: plus-14 in shot attempts, plus-11 in scoring chances and a 10-1 advantage in high-danger shot attempts. But they were digging out of a 2-0 hole, only managed to get one goal of their own on the board and then McDavid stuck a dagger in them with 19 seconds left in the second.

The Stars need a lead. They need zone time. They need to get their rush game going: Skinner had a .897 save percentage on shots off the rush entering the game. Edmonton is playing with a champion’s confidence. Dallas has to find a way to inject a little doubt into its opponent or this series is going to end quickly. — Wyshynski

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U.S. wins 1st worlds in 92 years, honors Gaudreau

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U.S. wins 1st worlds in 92 years, honors Gaudreau

STOCKHOLM — Buffalo Sabres star forward Tage Thompson scored the winner 2:02 into overtime, and Team USA outlasted Switzerland 1-0 in the final of the ice hockey world championship at Avicii Arena on Sunday.

It is the first on-ice trophy for USA Hockey in this tournament in 92 years, after the Americans brought it home back in 1933. And it was an emotional one. As Team USA posed for its championship photo at center ice, players held up a No. 13 jersey of Johnny Gaudreau, the former NHL and USA Hockey star forward who died tragically last August when he and his brother, Matthew, were hit by an allegedly drunken and enraged driver as they cycled at night in New Jersey.

Thompson, who had 44 goals and 72 points with the Sabres this season, is hoping to polish off his resume for a spot on the U.S. roster for the 2026 Olympics, and he’s off to a great start. A Team USA reserve for the 4 Nations Face-Off in February who did not suit up, Thompson made the most of his time playing with a host of young NHL forwards who either did not make, or have been eliminated from, the Stanley Cup playoffs.

Thompson’s shot, off passes from Utah Hockey Club forward Logan Cooley and Nashville Predators defenseman Brady Skjei, flew past the blocker of Swiss goaltender Leonardo Genoni, ending a dramatic but tight title game. Team USA outshot Switzerland 40-25.

Boston Bruins goaltender Jeremy Swayman capped off the shutout in the final, finishing with 25 saves a year after his NHL teammate, David Pastrnak led the Czech Republic to this same title.

“We did it, the wait is over,” Swayman said in a post to USA Hockey fans on the organization’s social media platforms. “Thanks for sticking along with us. It’s going to be a great summer.”

The Americans were also formally awarded the title in 1960 when they won the Olympic tournament and the worlds did not take place. But they hadn’t won it on the ice in more than nine decades.

The Swiss played without injured star center Nico Hischier, the captain of the New Jersey Devils. After the loss, Genoni was named the tournament’s MVP.

Earlier Sunday, Sweden defeated Denmark 6-2 in the bronze medal game. Calgary Flames center Mikael Backlund and Minnesota Wild forward Marcus Johansson scored two goals each for the hosts, marking the second-straight third-place finish for Sweden. The fourth-place result was the best-ever finish for Denmark.

The Associated Press contributed to this report.

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Oilers ‘reset,’ handle Stars for 2-1 series lead

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Oilers 'reset,' handle Stars for 2-1 series lead

EDMONTON, Alberta — Zach Hyman had two goals and an assist, Connor McDavid also had a two-goal outing and the Edmonton Oilers took a 2-1 lead in their Western Conference final series with a 6-1 victory over the Dallas Stars on Sunday.

Evan Bouchard, with a goal and an assist, and John Klingberg also scored for the Oilers. Ryan Nugent-Hopkins added three assists.

Stuart Skinner made 33 saves in the Edmonton net to improve to 4-4 in the postseason this year, his first victory in the playoffs that wasn’t a shutout.

“We had a bit of a dip, they had a bit of push,” Nugent-Hopkins said of the Stars’ play in the second period, lauding Skinner for keeping the team in it. “He stepped up big time for us, and made some big saves. You need your goalies to do that.”

The Oilers have won two straight since their third-period collapse in Game 1 in Dallas, and improved to 10-3 in the postseason since dropping the first two games of their first-round series vs. the Los Angeles Kings.

Jason Robertson scored for the Stars, who are hoping to avoid being knocked out in the third round by the Oilers for a second consecutive season.

“They were definitely the better team in the second period,” Skinner said of the Stars. “And we kind of knew that going into the third. So, we just had to reset.”

Jake Oettinger stopped 18 shots in Dallas’ net, falling to 5-10 in his career in West final contests.

Game 4 will be in Edmonton on Tuesday.

The Associated Press contributed to this report.

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