Waiver seeks fed funding for Massachusetts emergency shelter costs

Sam Drysdale

STATE HOUSE, BOSTON, OCT. 25, 2023…..Gov. Maura Healey’s administration is making a new play to deliver federal dollars to the state’s emergency assistance system, as an influx of immigrants has strained the system to the point that shelters may need to begin turning people away next week.

MassHealth, which is partially funded by federal Medicaid dollars, filed an amendment to its Medicaid waiver which would allow the insurance program to fund up to six months of temporary housing for those who are enrolled in state health coverage.

If approved, the federal government would shoulder half the cost to put up MassHealth families in the state shelter system through reimbursement, according to the Executive Office of Health and Human Services.

Over the past year, Massachusetts has faced an influx of immigrants that has strained the state’s emergency assistance housing system. Healey announced last week that shelters would reach capacity by the end of October, with about 7,500 families, or about 24,000 people, living in publicly-funded shelters, motels and hotels around the state.

Among those living in the emergency assistance system, about half are new arrivals into the country, Healey said.

Many of these new immigrants’ legal status entitles them to full Medicaid benefits, including those who are recognized as refugees, asylum seekers, Cuban and Haitian entrants, and individuals granted parole into the United States for at least one year.

In August, MassHealth announced it would submit an amendment to its Section 1115 demonstration Medicaid waiver, which allows states to tailor their public health insurance programs to more closely align with their specific preferences and needs. The Biden administration approved a new waiver for Massachusetts last year, which runs through 2027 and invests $67 billion into the state’s health plan program.

MassHealth posted the amendment for public comment in early August, and received feedback that people wanted more to be done on housing.

The amendment now includes a section where the state “seeks expenditure authority… for up to six months of temporary housing assistance and related support for families and pregnant individuals, including newly arrived immigrants, who are enrolled as MassHealth members.”

“Through this authority, the Commonwealth would provide temporary housing assistance to eligible members. Eligible members include homeless pregnant individuals and homeless families who are determined eligible for temporary housing assistance under the Massachusetts Emergency Assistance family shelter program and who are eligible for full MassHealth benefits, including those with lawful immigration statuses, such as Cuban/Haitian entrants, refugees, asylum seekers, and individuals granted parole into the United States for at least one year,” it says.

If the amendment is approved, members would also be eligible to receive support services such as case management and referrals to medical and educational services.

The proposal is directly in response to the significant growth in Massachusetts’ shelter population, and the lack of available accommodations that has prevented families from connecting to necessary health care services, according to the Executive Office of Health and Human Services.

The amendment request includes background information on the health status of those in the state’s emergency shelter system.

“A prior analysis of healthcare cost and utilization of families enrolled in MassHealth demonstrated the significant healthcare needs of the family shelter population. For example, adult MassHealth members in family shelter had significantly higher rates of alcohol, opioid, and nonopioid drug use disorders; adjustment, anxiety, and depressive disorders; injuries due to external causes; and complications during pregnancy and birth than a comparison group,” it says.

It adds that the analysis found that homeless families enrolled in MassHealth had more visits to the emergency room than other MassHealth families.

Data from “a major Massachusetts hospital” in 2022 showed that 80 percent of families experiencing homelessness in the hospital’s pediatric emergency department were Haitian asylum-seekers, the MassHealth amendment says.

Asked how many newly-arrived immigrants in the emergency shelter system qualified for and were enrolled in MassHealth, EOHHS did not immediately provide that information.

The amendment request was filed on Oct. 16, and the office said it expects a few months before they hear back.