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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.

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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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Wes Streeting denies Labour has made ‘mistakes’ with ‘unpopular’ policies despite poor local election results

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Wes Streeting denies Labour has made 'mistakes' with 'unpopular' policies despite poor local election results

Health Secretary Wes Streeting has defended “unpopular” policies such as the cut to the winter fuel allowance despite Labour’s poor performance at the local elections.

Mr Streeting denied the government had made any mistakes when asked whether the policy was partly to blame for the party losing 189 council seats less than a year since the General Election.

Since coming into government last July, Labour has enacted a number of policies that were not in its manifesto.

These include means-testing winter fuel payments for pensioners, increasing employers’ national insurance contributions and slashing £5bn from the welfare bill.

Asked what mistakes his government had made so far that had led to its drubbing at the ballot box, Mr Streeting told Sunday Morning with Trevor Phillips: “Well, we will make plenty of mistakes.”

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Pressed again on whether he believed “mistakes” had been made, the health secretary replied: “No. When we made those choices, we knew they would be unpopular. And we knew that they would be opposed.

“The reason we made those choices is because we genuinely believe they’re the right choices to get the country out of the massive hole it was left in. And right across the board. Whether it’s the NHS, whether it’s schools, whether it’s prisons, whether it’s our defence and security, whether it’s crime and policing, there were enormous challenges facing this country when we came in.

“And we’ve had to make big and sometimes unpopular decisions so that we can face those challenges and deal with them. People might thank us if we just kind of go for the easy but we want to make the right choices.”

Some Labour MPs have urged the government to change direction, with one telling Sky News the cut to winter fuel was a “catastrophic error” that must be “remedied” if the party is to see any improvement in public opinion.

Others have warned that in courting Reform voters, the party risks fracturing its coalition of voters on the left who may be tempted by the Liberal Democrats and Green Party.

However, in the aftermath of the local elections, Sir Keir Starmer suggested the poor results meant he needed to go “further and faster” in delivering his existing agenda.

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Inside Reform’s election success

The real victor to emerge from Thursday’s local elections was Reform UK, which won control of 10 councils and picked up 677 council seats largely at the expense of the Conservatives in the south.

However, Reform also won the Runcorn by-election from Labour by just six votes, as well as control of Doncaster Council from Labour – the only local authority it had control of in this set of elections – in a significant win for Nigel Farage and his party.

The Reform UK leader declared that two-party politics was now “finished” and that his party was now the official “opposition” to Labour.

Asked whether the results meant that Labour would now treat Reform as “your most serious opposition”, Mr Streeting said: ” I certainly do treat them as a serious opposition force.”

“As I say, I don’t know whether it will be Reform or the Conservatives that emerge as the main threat,” he added.

“I don’t have a horse in that race, but like alien versus predator, I don’t really want either one to win.”

Read more:
Reform’s mission to ‘remoralise’ young people
Reform has put the two traditional parties on notice

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Reform UK are ‘fighting force’

Tory Party chairman Nigel Huddleston said Reform UK was not just a protest party and that Mr Farage was “a force in British politics”.

He told Trevor Phillips: “But the one thing about Nigel Farage is, and we’re seeing this again and again and again, he is a populist.

“He is increasingly saying everything that anybody wants to hear. He’s trying to be all things to all men.”

“We are establishing ourselves as a credible alternative government based on sound conservative principles and values and our values and our principles, and therefore our policies, will define the future of our party,” he added.

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It’s back: Hyundai IONIQ 5 qualifies for $7,500 tax credit – again!

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It's back: Hyundai IONIQ 5 qualifies for ,500 tax credit – again!

The Hyundai IONIQ 5 got a raft of upgrades and sporty, rally-focused XRT trim level for 2025 – but the biggest upgrade for the Made in America Hyundai might be this: the 5 has regained eligibility for the full $7,500 federal EV tax credit!

Despite being assembled at Hyundai’s Georgia meta plant for the last four month, the 2025 Hyundai IONIQ 5 was nowhere to be found on the EPA’s list of rebate-eligible vehicles. But that was then – with a fresh updated to the list coming online May 1st, Hyundai’s new-age electric hot hatch is back in the rebate game.

It’s worth noting that lease customers had been able to access the incentive under some circumstances, but this latest update to the EPA list makes it possible for cash and payment buyers to take advantage of the full Federal incentive, too – as long as they earn less than $300,000 as a married couple filing jointly, less than $225,000 as a head of household, or less than $150,000 as an individual.

With the $7,500 federal tax credit in the equation, you can get a new 2025 IONIQ 5 for somewhere in between $36,575 and $49,475, well under the $80,000 Federal MSRP cap.

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Victory lap

As if to celebrate, Hyundai announced that it was taking on the celebrate One Lap of America road rayy and race event in a factory collaboration with the track-focused enthusiasts at Grassroots Motorsports this week with One Lap veterans Andy Hollis and Tom Suddard campaigning a stock, 601 hp 2025 Hyundai IONIQ 5 N in the Alternative Fuels class.

“After winning our class in a gutted, caged race car last year, we wanted to compete in the best-of-all worlds this year: A vehicle that’s incredibly fast, incredibly comfortable on a road trip, and incredibly capable on a racetrack,” explains Suddard. “Electrification means it’s finally possible to have huge power without huge compromises in a street car, and the IONIQ 5 N promises to pair that huge power with the durability and capability to survive a week of racing.”

One Lap is widely regarded as one of the toughest street-legal motorsports events in the world, pitting amateur and professional drivers alike compete in stock and heavily modified vehicles of every description, battling it out in a series of scored challenges, including timed events at road courses, drag strips, skid pads, and autocross courses.

In between tracks, competitors safely travel thousands of miles around the country, proving the mettle and durability of the vehicles and the teams that drive them. This year, 86 teams from all over the country will compete in 17 scored events over the course of eight days at tracks like Virginia International Raceway and NCM Motorsports Park.

The Tire Rack One Lap of America is currently underway – you can track the Hyundai’s progress here, then let us know what you think of this new tax development in the comments.

SOURCES | IMAGES: Hyundai, One Lap of America; FuelEconomy.gov.


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It is ‘feasible’ Nigel Farage could be the next prime minister, says Kemi Badenoch

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It is 'feasible' Nigel Farage could be the next prime minister, says Kemi Badenoch

Kemi Badenoch has admitted it is “feasible” that Nigel Farage could become the next prime minister.

The Tory leader told the BBC’s Sunday With Laura Kuenssberg programme Mr Farage’s party was “expressing the feeling of frustration that a lot of people around the country are feeling” – but added it was her job to “come up with answers and solutions”.

Asked if it was feasible that Mr Farage could be the next prime minister, she cited how Australian Prime Minister Anthony Albanese had won re-election this weekend.

“As I said, anything is feasible,” she said. “Anthony Albanese: people were writing him off. He has just won a landslide, but my job is to make sure that he [Farage] does not become prime minister because he does not have the answers to the problems the country is facing.”

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Could Nigel Farage be prime minister?

Asked what Mr Farage was doing right, Ms Badenoch said: “He is expressing the feeling of frustration that a lot of people around the country are feeling.

“But he also doesn’t have a record in government like the two main parties do. Now he’s going to be running some councils. We’ll see how that goes.”

Mr Farage was the undoubted winner of Thursday’s local elections, in which 23 councils were up for grabs.

His party picked up 677 council seats and took control of 10 councils.

By contrast, the Conservatives lost 677 council seats as well as control of 18 councils in what was their worst local elections performance on record.

Mr Farage said the outcome spelt the end of two-party politics and that his party was now the official “opposition” to Labour – with the Tories having been rendered a “waste of space”.

Read more:
Reform has put the two traditional parties on notice

‘I get it’: Starmer responds after losing Runcorn by-election

Ms Badenoch said she believed the vote for Mr Farage on Thursday was partly down to “protest” but added: “That doesn’t mean we sit back. We are going to come out fighting.

“We are going to come out with the policies that people want to see, but what we are not going to do is rush out and tell the public things that are not true just so we can win votes.

“This is not about winning elections; this is about fixing our country. Yes, of course, you need to win elections to do that, but you also need a credible plan.”

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‘Farage is a force in British politics’

Conservative co-chairman Nigel Huddleston sought to play down the threat from Reform UK, telling Sky News: “When they’re in a position of delivering things, that’s when the shine comes off.”

He told Sunday Morning with Trevor Phillips: “The one thing about Nigel Farage is, and we’re seeing this again and again and again, he is a populist.

“He is increasingly saying everything that anybody wants to hear. He’s trying to be all things to all men.”

“We are establishing ourselves as a credible alternative government based on sound conservative principles and values and our values and our principles, and therefore our policies, will define the future of our party,” he added.

Asked whether the results meant that Labour would now treat Reform as “your most serious opposition”, Health Secretary Wes Streeting told Trevor Phillips: ” I certainly do treat them as a serious opposition force.”

“As I say, I don’t know whether it will be Reform or the Conservatives that emerge as the main threat,” he added.

“I don’t have a horse in that race, but like alien versus predator, I don’t really want either one to win.”

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