Alternative Financing Mechanisms: Exploring Options for Healthy Homes Services
by Lillian Agbeyegbe
The National Center for Healthy Housing (NCHH) is a “go-to” resource for practitioners in the housing as healthcare industry. We get inquiries regularly: “Where is this being done? By whom and how?” We also look at the industry landscape ourselves and ask the same questions.
As we looked at the landscape in 2015, we closely reviewed the robust evidence base about the potential for transforming health outcomes and reducing healthcare costs by incorporating home-based interventions into patient care. Such interventions target social determinants of health, and investing in them has the potential to reduce the burden of preventable housing-related illness dramatically. The investing bit caught our attention, because we heard two conflicting scenarios.
On the one hand were states or individual managed care organizations providing Medicaid coverage for services delivered in the home environment related to asthma and lead exposure. On the other hand were states that indicated an interest in delivering home environment services but had not yet achieved Medicaid coverage. It seemed like their only option was to wait for Medicaid expansion coverage. But was it? As these conversations continued, we were aware of some states utilizing other financing mechanisms as either a complement or alternative to healthcare financing. The inevitable a-ha moment happened, and a series of questions followed: “What if more people know about these alternative financing mechanisms being used by certain states?” “Can someone, somewhere, adopt an existing model as-is or with some modification?” “Is there a chance to increase the number of people receiving home environment services around the country?” We liked all the positive answers to these questions, and what followed was the alternative financing mechanism information project – after we secured funding from the W.K. Kellogg Foundation, of course. (Yes, our ideas depend on funding to be actualized.)
In 2016, NCHH interviewed several states providing one or more home-based asthma services, childhood lead services, or healthy home services using funding other than Medicaid or grants. The interviews provided information on the funding mechanism and how it operates, the program being funded and how it operates, outcome and evaluation information (where available), and lessons learned. We are pleased to share our findings of 12 different financing mechanisms.
This project does several things, but I would like to highlight one major feature—the “behind-the-scenes” information that the interviews provide.
The Montana Asthma Home Visiting Program (MAP) website tells us about the program. It is the interview that lets us know that not only does the program receive funding from the Master Settlement Agreement (MSA), it began to receive funding in 2007, nine years after the MSA accord was reached! This implies that even if MSA funds have not been a source for home-based asthma services or lead-based follow-up services, it is a potential source. Who else can begin to receive funding from their state’s MSA for home environment services?
One of the Massachusetts program interviews tells us how a trade-off was instrumental to raising funds for the program. The state amended the lead law to remove liability from organizations, and as a trade-off they accepted “surcharge on fees assessed by certain boards of registration, or state agencies for the licensure or certification of certain professionals, and on fees assessed for the renewal of such licensure or certification.” These surcharges raise about $2.5 million annually for Massachusetts Lead Education Trust Fund, income that would otherwise have been unavailable to support lead education services in the state!
The Maine interviewee spoke about the need to make the distinction between primary and secondary prevention. Just like several other states, Maine had a secondary prevention program. But secondary prevention only reacts after the fact. With the Lead Poisoning Prevention Fund, Maine now tests homes not just after a child has been poisoned in it, but before poisoning can happen to prevent poisoning.
Here are two things that stand out from the New Jersey’s project ReHEET interview: One, you can start where you are: Although they have received funding as high as $480,000, they have also worked with funding as low as $80,707! They began work with a few units. Two, the interviewee also pointed out how addressing more than one issue when intervening in a home lowers cost. They are committed to promoting energy and weatherization services to be incorporated with healthy homes services as a total package. Was someone thinking this might be a good idea? It is. They are working with it in New Jersey.
The page includes many more insights from our interviewees. For practitioners, we hope you are thinking “If them, why not us?” That’s what we are thinking too. Unhealthy homes are costing our nation too much in lost school and work days, medical expenses, and reduced quality of life. We encourage states and nonprofits to continue exploring alternate financing mechanisms that can support implementing evidence-based interventions for healthy homes.
Dr. Lillian Agbeyegbe is a public health practitioner with over a decade of experience in program development, implementation, and evaluation. As a project manager, she leds and supported NCHH’s Housing as Healthcare portfolio by developing resources, training, and providing technical assistance to support states in providing healthy home services.