In 2022, the Centers for Medicare & Medicaid Services (CMS) announced the Section 1115 demonstration waiver opportunity to expand the tools available to states to address enrollee health-related social needs (HRSN).¹ The HRSN framework developed by CMS suggests that housing and home environments are key factors in improving enrollees’ health outcomes and that states can further improve patient health outcomes by addressing housing instability and other housing needs. In 2024, CMS approved an amendment to New York’s Medicaid section 1115 demonstration that bundles a series of actions to advance health equity and strengthen access to primary and behavioral health care across the state. States are currently implementing Section 1115 demonstration projects to explore various strategies to address housing needs for Medicaid and Medicare enrollees. In addition, CMS has begun promoting opportunities to directly assess housing needs. At present, wide-scale screening of social determinant factors such as housing status has not become standard practice. Moreover, the optimal setting for deployment of services remains uncertain. Learn more about a Section 1115 demonstration that addresses housing and substance use disorder here.

Homelessness is associated with a higher prevalence of mental illness and substance use disorders when compared to stably housed individuals,² and it is critically important for psychiatrists to understand the emerging needs of populations experiencing homelessness.