The biggest barrier to CMS paying for housing? Congress

The CMS has some big regulatory hoops to jump through to realize the agency’s vision of paying for housing and other social determinants of health.

Under current law, Medicare and Medicaid funds can’t be used to pay directly for housing. If the plan to do so moves ahead, the CMS would likely pilot the model through the Center for Medicare & Medicaid Innovation.

But if it wants to integrate the assistance as part of the Medicare or Medicaid programs, it would need Congress to change the Social Security Act.

And health policy experts said changing the law would be a tough sell on Capitol Hill.

Dr. Anthony Shih, president of New York-based not-for-profit United Hospital Fund, called the statutory limitations, the “biggest barrier” to integrating payment for housing and other social needs in CMS programs.

But others were optimistic that Congress may get on board if it’s proven that the pilot model leads to reductions in costs and improvements in outcomes. “They will change the statute based on evidence,” said Len Nichols, professor of health policy at George Mason University.

There has been growth in published literature showing that addressing social risk factors can improve patients’ outcomes as well as decrease costs for health plans and providers through lower utilization of emergency departments and reduced readmission rates.

“There’s a lot of evidence out there that some of these social determinants of health interventions can pay for themselves,” Nichols said.