Social Determinants of Health (SDOH) – defined by the World Health Organization as “the non-medical factors that influence health outcomes” – have received considerable attention over the past several years by public health practitioners and policymakers. In fact, both sets of stakeholders increasingly have sought to address the health care needs of their patients and the general population not only by improving direct health care services, but also by addressing socioeconomic, behavioral, and environmental factors that affect health risks.
In November 2023, in keeping with that trend, the Biden Administration’s Domestic Policy Council released “The U.S. Playbook to Address Social Determinants of Health.” Not surprisingly, the playbook highlighted housing as an SDOH that is a “key driver of health outcomes.” It cites the risks posed by both homelessness and inadequate housing, such as “exposure to unsanitary conditions, poor indoor air quality, and climate-related hazards,” and notes that “all manifestations of inadequate housing can negatively impact health, and a variety of health conditions can negatively impact housing status.” Earlier in 2023, the federal Department of Health and Human Services also acknowledged the connection between housing and health by announcing an initiative to allow states to expand their access to Medicaid funding to address housing and other health-related social needs for their Medicaid enrollees.
Similarly recognizing that housing is one of the foremost determinants of health and well-being – particularly for low-income populations – Milwaukee County has devoted considerable resources through its Housing Division to support individuals experiencing homelessness, homeowners and renters facing foreclosure and eviction, and individuals with mental health and substance use disorder needs who may benefit from on-site supportive services within their housing units.
Private sector health care stakeholders – including health systems, community health centers, and insurers – also have increasingly invested in housing supports and programming to address the shelter-related issues facing their patients and clients. Examples include investments in screening practices, “housing navigators” to assist clients in obtaining or retaining safe and affordable housing, and direct financial support toward rent and security deposits.
Still, despite this growing public and private sector emphasis on addressing housing as a key SDOH, there has been little analysis of the efforts by health care stakeholders to invest in their clients’ housing needs and the benefits such investments are generating in reduced health care utilization and improved health care outcomes.
This report seeks to provide such analysis. Authored jointly by the Wisconsin Policy Forum (WPF) and IMPACT Planning and Evaluation, it describes the landscape of health care-related housing initiatives and supports that are offered to low-income individuals in Milwaukee County, with a particular emphasis on those offered to Medicaid recipients and uninsured residents as part of the health care delivery system.
We assess the state of housing and health care in the county by providing both a detailed analysis of a single initiative created by the Milwaukee Heath Care Partnership (MHCP) called Housing is Health, as well as a broader assessment of the full landscape of health care-sponsored housing support initiatives for low-income individuals in Milwaukee County. We also offer a brief scan of how health care providers and insurers are investing in housing supports in other communities across the country.
Among the key research questions we seek to answer are the following:
- What are the primary types of housing support programs offered to Medicaid recipients and other low-income individuals in Milwaukee County as part of their health care-related services, and who are the primary players offering such supports?
- What do we know about the volumes, outputs, and outcomes associated with such housing support program in terms of both improved health for recipients and reduced health care utilization and associated costs?
- Are there examples of successful health care-related housing strategies in other cities and counties nationally that should be considered in Milwaukee County?
- To the extent that these types of housing supports are achieving positive outcomes or showing significant promise, what is the potential to maintain, expand, and bring them to scale and what would be needed for that to occur?
Overall, our goal is to enhance the knowledge of health care providers and insurers, other health care stakeholders, and policymakers at the state and local level about the various efforts that are currently underway to address the housing needs of low-income individuals who present in health care settings. We also seek to assist them in determining how to better coordinate and enhance those efforts to produce better health care outcomes for Milwaukee County residents.