Medicaid’s Housing Problem Isn’t Placement — It’s What Happens Next

In Medicaid, a small group of members accounts for a disproportionate share of spending — and exposes the limits of how care is delivered today.

Roughly 5% of the population drives nearly half of all Medicaid spending. These are the members most likely to cycle through emergency departments, experience repeated hospitalizations, and struggle with unmanaged chronic and behavioral health conditions. They are also disproportionately likely to experience housing instability, with nearly half living in housing that is unaffordable  — and to lose housing even after it has been secured.

Some states have elevated housing as a core component of whole-person care. Health plans are investing in navigation services, building partnerships with community organizations, and expanding funding to help members move into stable living environments.

But the reality is, placement is only the beginning.

Housing stability remains fragile even after placement. Supportive housing programs consistently show that the majority of residents remain housed after one year, but a meaningful share still cycles back into instability. For the highest-risk Medicaid members, that challenge is often even more pronounced.

This is where traditional approaches begin to fall short.

Most housing interventions are designed around access: identifying available units, completing applications, coordinating placements. These are necessary steps, but they assume a level of stability that often doesn’t exist for the small group of members driving the majority of cost.

These members are not simply unhoused. They are navigating overlapping challenges — chronic illness, untreated behavioral health conditions, financial instability, and years of disconnection from healthcare and social services. A lease does not resolve those issues. In many cases, it simply relocates them.

What happens after placement is what determines whether housing — and health — stabilize.

Members who are newly housed face immediate pressures: managing rent, maintaining appointments, securing medications, and rebuilding routines that support daily life. Without sustained support, small disruptions can quickly escalate. Missed appointments become unmanaged conditions. Financial strain becomes eviction risk. Isolation becomes disengagement.

And when housing is lost, the consequences extend far beyond shelter.

Members experiencing housing instability use emergency departments at rates up to four times higher than the general population and are significantly more likely to require inpatient care. Care continuity breaks down. Costs rise. And the system is forced to start over — often with fewer options and higher stakes.

This cycle is not inevitable. But it requires a shift in how housing is approached in Medicaid.

• First, engagement must be continuous, not episodic. The highest-risk members are often the hardest to reach, and they require consistent, in-person, relationship-based support to stay connected to care and services. Engagement is not a single intervention — it is an ongoing process of building trust and responding quickly when challenges emerge.

• Second, housing support must be integrated with care delivery. Housing does not exist separately from health. Members need coordinated support that connects primary care, behavioral health, and social services in a way that reflects how they actually live. Fragmentation — between housing providers, healthcare systems, and community organizations — creates gaps that undermine stability.

• Third, success must be measured over time. It is not enough to count how many members are housed. We need to understand how many remain housed, how their health outcomes evolve, and how utilization patterns change as stability improves. Without that longitudinal view, short-term placement can be mistaken for long-term success.

Housing interventions are often evaluated at the point of placement — but the cost curve is shaped by what happens in the months that follow.

Some organizations are beginning to operationalize this more comprehensive approach. They support high-risk members through the full lifecycle of housing — combining navigation, move-in assistance, and ongoing stabilization support. When housing is paired with sustained engagement, members are more likely to remain housed and less likely to return to high-cost settings.

But the broader lesson is not about any single model. It is about recognizing that housing is not a one-time intervention — it is a condition that requires ongoing support. If we focus only on placement, we will continue to see cycles of progress and regression. If we focus on stability — on what happens after the keys are handed over — we have an opportunity to change those trajectories more permanently.

Housing is essential. But for Medicaid’s highest-need members, it is not the solution on its own. It is the starting point — and what happens next is what determines whether the system actually works.

Photo credit: Lolon, Getty Images

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