Housing Instability, Its Impact on Health, and Innovative New Solutions

We know that when it comes to our health, social drivers can be just as important as physical and behavioral drivers. Do we have access to nutritious food? Do we have reliable transportation? Are we able to see a doctor when we need to? And do we have a stable place to call home? Multiple studies show that people who experience housing instability or homelessness are more likely to have untreated health conditions.

People who experience homelessness are much more likely to visit the emergency room and have higher rates of chronic conditions such as diabetes, hypertension, heart disease, depression, and substance use disorders. Even frequent moves can carry health costs: Children who move three or more times in a year are more likely to have chronic conditions and poor physical health — at the same time they are less likely to have consistent health insurance coverage.

Unfortunately, there are many people who experience housing instability or homelessness all over the country, in rural and urban areas. According to 2023 data from the United States Department of Housing and Urban Development (HUD), more than 650,000 people experienced homelessness in the U.S., and 28 percent were families with children.
 

Nevada Housing Interventions

To help people who are experiencing housing instability, Medicaid programs and managed care plans are increasingly implementing new approaches. In Nevada, where homelessness has been on the rise since the COVID-19 pandemic, a study found Elevance Health’s affiliated Medicaid plan improved housing stability for families with housing-specific programs. 

Two of these were the Housing Flex Fund and the Family Stabilization Program. The Housing Flex Fund provides one-time or short-term flexible financial assistance to members experiencing housing instability or homelessness. The fund, for example, can provide financial assistance for utility bills and payments for security deposits. The Family Stabilization Program partners with a community-based housing assistance organization to offer housing support services and flexible financial assistance to households with children and at least one plan member to quickly resolve housing instability and homelessness.

Six months after participating in one of these programs, more than 90 percent of members maintained stable housing. The programs also improved housing stability equitably; nearly 60 percent of those who participated in the program and maintained housing were Black people.
 

Helping People Stay In Their Homes

As noted in the Nevada study, Elevance Health’s Housing Flex Fund addresses housing concerns for people who are experiencing — or at risk of — homelessness. The fund can assist with rent, utilities, moving expenses, and other housing-related costs. Community engagement navigators help members by connecting them to community resources and finding creative ways to address additional factors that negatively affect health overall, such as employment and food insecurity.

Rebecca Boyd, an Elevance Health community engagement navigator in Kentucky, works with individuals enrolled in Medicaid and Medicare plans to learn about the barriers to their health, as well as any health-related social needs they may be experiencing. Over the course of several months, she helped a 61-year-old member obtain food and pay their utility bills, and when they were about to lose their home because of an overdue tax bill, they turned to Elevance Health for help.

With Boyd’s help, the member gathered and submitted the documents needed so the tax bill could be paid with assistance from the Housing Flex Fund. “I’ve been a social worker for 20 years, and I’m still brought to tears when I hear about the challenges our members are going through,” Boyd said. “I’m incredibly proud of the resources we offer to truly help support our members.”
 

Giving People Who Experience Homelessness A Place of Their Own

Around the country, there are other examples of innovative solutions to housing insecurity and homelessness. For example, one Seattle-based company is working to address homelessness by constructing 8-foot-by-8-foot tiny cabins that can be built in just an hour, loaded onto pallets, and combined to create “villages” of transitional housing for people who need it. Pallet is a public benefit corporation that was founded in May 2016 and has built more than 4,000 shelters nationwide, and more than 121 villages in 24 states. In addition, more than half of Pallet’s workforce has experienced homelessness, substance use disorder, or have been involved with the justice system.

Pallet shelters include heat or air conditioning, plus a desk and a bed, and there are community bathrooms, laundry facilities, and common areas. Pallet partners with its clients — usually community-based organizations — to provide food and social services for the people who are staying there.

“When we talk about the homelessness crisis, it's very clear that it is an ecosystem of problems, and Pallet helps solve one of the pieces of that puzzle: shelter,” said Katya Hill, director of marketing and communications for Pallet. “Our aim is to get people off the street and into a shelter, but that's not the end destination. Their end destination is to use that space to heal, to use that space to deal with things that living on the street you’re not able to deal with, and hopefully move into a permanent housing situation. We don't want people to be in the shelters for long periods of time,” she said. “An ideal timeframe of somebody being in the shelter is probably around six months.”

Just having a safe space and a door of your own to open and close, Hill said, can mean a world of difference to someone experiencing homelessness. “So now they can start doing the other things. They can work on their mental health, they can get support for drug use. They can look at, ‘OK, what is my Social Security number? How do I find a job?’ All of those things. Because their basic needs are being met so they can start to focus on their more complex needs.”
 

Developing Lower-Cost, Faster Affordable Housing

While Pallet and other companies and organizations are focused on transitional housing for people experiencing homelessness, there are also efforts to build more affordable permanent housing, which has been on the decline in the U.S. The lack of affordable and accessible housing has become even more pressing given the volatility in the housing market and inflation pressure.

Some innovations to address the lack of affordable and accessible housing include:

• 3D-printed homes: One company, Icon, uses a 10-foot-by-35-foot printer to squeeze out layers of concrete to construct homes in 24 hours, using cheaper materials and lower labor costs. The company says overall costs are 10% to 30% lower than typical construction costs. The company worked with the nonprofit, New Story, to build a 50-unit neighborhood of 500-square-foot 3D-printed homes in Southern Mexico. Even Habitat for Humanity has started working to create homes using 3D-printer technology for the families it helps.    
  
• Advocacy Efforts: Government officials and nonprofit organizations are working to ensure that communities can move more quickly to develop and build affordable, accessible, and attainable housing for their residents. 
  
• Modular and prefabricated homes: These homes and buildings can be built faster and at lower cost than traditional building methods. FullStack Modular, for example, is building a 176-unit apartment building in Cypress Hills, Brooklyn, that is designed to provide affordable housing.