We worked with AmeriHealth Caritas DC (AmeriHealth), the largest Medicaid Managed Care organization in the District of Columbia (DC), to finance a significant expansion of medical respite capacity in the nation’s capital. The goal of this project is to more effectively and appropriately serve the holistic health needs of individuals experiencing homelessness or housing insecurity.

The Hope Has a Home program—a partnership among AmeriHealth, Volunteers of America-Chesapeake, Unity Healthcare, Pathways to Housing, and Quantified Ventures—will address immediate medical services and provide members with the support and connections needed to address underlying chronic conditions, including behavioral health needs. By bringing members out of expensive, acute care settings and advancing their continued recovery in safe and supported environments, this program expects to improve care for AmeriHealth members and significantly reduce costs.

A combination of factors, including poor nutrition, inadequate hygiene, exposure to violence, and the constant stress of housing instability, all have profound negative effects on the health of homeless individuals and families. Individuals already disproportionately burdened with chronic illness are four times more likely to present in the emergency department and five times more likely to be hospitalized—typically involving a longer than average length of stay at a cost of roughly $3,000/day. Once discharged from the hospital, roughly two-thirds of homeless patients spend their first night after discharge at a shelter, and 11% percent spend their first night after discharge on the streets. Neither setting is a safe and supportive environment for healing, but very few other options exist.

Medical respite is a temporary care strategy that is critical to supporting the health of individuals experiencing homelessness. Recognizing the lack of respite care capacity in DC, AmeriHealth Caritas DC engaged with us to assemble a capable and experienced set of respite program partners to support the design of a customized respite care model and to develop an outcomes-based financing transaction to bring sufficient capital to sustainably support the envisioned program. Now called “Hope Has a Home,” the new program aims to double respite capacity in DC overall (even more for women), and introduce a missing—and sorely needed—approach to care for those with substance use disorder.

The expansion of new respite care facilities in DC—Hope Has a Home opened two new 8-bed medical respite facilities in 2019—dramatically improves respite care access. Hope Has a Home has now supported 70 clients referred to the program by Medicaid Health plans serving Washington, DC. In doing so, the program delivers more appropriate and high-quality care to individuals experiencing homelessness, reduces the overall cost of care, and connects more people to appropriate long-term housing.