Healing After the Hospital: Medical Respite Care

7/18/2022

Bar chart of the Growth in Medical Respite Care Over Time

Patients discharged from the hospital often require continued recuperative care to ensure they heal and recover. Patients experiencing homelessness, however, may not have a safe location to go to where they can rest and manage their conditions and medications after a hospital stay.  

Medical respite presents a safe, transitional housing option for people experiencing homelessness to use during recovery. Medical respite programs are growing rapidly as an opportunity to support the health needs of people experiencing homelessness and to address high health care costs associated with hospital readmissions. The number of medical respite programs nearly tripled in the past decade, from 38 in 2011 to 133 in 2021.

What Is Medical Respite?

Medical respite care, often also referred to as recuperative care, offers acute and post-acute medical care for people experiencing homelessness. Medical respite provides people experiencing homelessness a safe place to manage a chronic condition and get help finding permanent housing.

Based on the Standards for Medical Respite Programs developed by the National Health Care for the Homeless Council, medical respite programs include:

  • Safe and quality accommodations.
  • Quality environmental services (e.g., hazardous waste handling, disease prevention and safety).
  • Timely and safe care transitions to medical respite care.
  • High-quality post-acute clinical care.
  • Care coordination and wraparound services.
  • Safe and appropriate care transitions from medical respite to the community.
  • Quality improvement.

Medical respite care differs from caregiver respite, skilled nursing facilities, nursing homes, assisted living facilities, hospice care and supportive housing programs. Instead, medical respite is meant to provide a safe healing environment for people experiencing homelessness, equivalent to recovering at home.

Outcomes

While research on health outcomes and cost effectiveness for medical respite care is sparse, data from medical respite providers indicates:

In addition, current research suggests medical respite care may reduce unplanned inpatient hospitalizations and stays and emergency room admissions and stays, while increasing the likelihood of housing security for participants through structured partnerships and pathways.

A 2018 study found that hospitals, particularly those in non-Medicaid expansion states, could save money by funding medical respite programs that avoid preventable hospital readmissions due to wounds not healing or medication not being taken or stored properly.

Funding

Medical respite programs are financed through a variety of mechanisms, including funding from hospitals, private donations, state and local governments, Medicaid or managed care organizations, federal agencies (the Health Resources and Services Administration, for example) and others.

Three primary funding sources—hospital, Medicaid and state/local government—are outlined below.

Hospital

While most medical respite programs are not run by hospitals, nearly two-thirds of programs across the country receive funding from them. There are a variety of sources for medical respite funding within hospitals, including community benefit resources, operations funding and contributions from a hospital’s foundation or charitable arm.

Medicaid

The outcomes of medical respite care—including decreased hospital stays, medically appropriate care and safe hospital discharge planning—present an opportunity for state Medicaid programs as vested stakeholders in the cost and quality of health care services for enrollees. Even so, medical respite programs face many barriers when securing Medicaid funding for services. Stand-alone facilities operated by nonprofits that do not directly provide clinical care are not usually licensed by the state or recognized as Medicaid providers. Medicaid is prohibited from paying for rent or room and board, except in certain medical institutions, which limits the services that may be reimbursed within medical respite programs.

States have navigated these challenges in various ways, including implementing Medicaid waivers to provide medical respite care to individuals experiencing homelessness and operating through managed care organizations to address housing and other social determinants of health.  

Medicaid Waivers: While federal law sets minimum standards related to Medicaid-eligible groups and required benefits, states may apply to the Centers for Medicare & Medicaid Services for formal waivers that provide additional flexibility to design and improve their Medicaid programs.

Under federal rules, medical respite cannot be counted in medical loss ratios (or the percentage of revenue a health plan spends on medical care), which disincentivizes health care organizations from paying for medical respite care. To address this issue, some states have implemented Medicaid waivers to allow plans to pay for medical respite care and other housing supports for homeless beneficiaries as medical expenses in their medical loss ratio.

  • Utah implemented a Section 1115 Medicaid waiver for medical respite in 2021, after the Legislature enacted HB 34. The bill created a three-year pilot program to add medical respite as a covered benefit for Medicaid beneficiaries who lack housing.
  • Kentucky enacted SJR 72 in 2022, directing the department of health and human services to apply for a Medicaid waiver to provide supportive housing, medical respite care and supported employment for individuals with severe mental illness.

Managed Care Organizations: As of July 2019, MCOs provided care for 7 in 10 Medicaid beneficiaries across the U.S., and MCO coverage has continued to grow during the COVID-19 pandemic. States are increasingly contracting with MCOs to serve more medically complex beneficiaries, including providing services to address social factors that drive health outcomes.

State Appropriations

Approximately 43% of medical respite programs receive funding from local and state government appropriations. Public health, social services and behavioral health agencies looking to improve the health of chronically ill people experiencing homelessness may offer annual grants to support medical respite care.

  • Washington appropriated (SB 5693) over $1.5 million in 2022 for medical respite care for individuals with behavioral health needs who do not require hospitalization but are unable to provide adequate self-care for their medical conditions.

 

Additional Resource