Thomas Marshall shows off the kitchen in his one bedroom apartment, in Sacramento, Calif., on February 24, 2023. Marshall, who had been homeless, got the apartment through a program championed by Gov. Gavin Newsom, to use some of the state's Medicaid money to pay for up to six months of housing for some people, including those who are homeless or at risk of becoming homeless. SACRAMENTO, Calif. — — At the start of 2022, Thomas Marshall weighed 311 pounds.
Marshall's story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses. But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.
It would also be an expensive step. California is expected to have a $22.5 billion budget deficit this year, and it could get bigger in years to come. Meanwhile the state's Medicaid spending is projected to increase by $2.5 billion over the next three years, according to the nonpartisan Legislative Analyst's Office.
Over five years the program has reduced expensive hospital stays and emergency room visits for people on Medicaid, saving taxpayers an average of $383 per patient per year, according toNow California wants to go further by using Medicaid money to directly pay some people's rent. Democratic Assemblymember Joaquin Arambula, who chairs the budget subcommittee that will vet Newsom's proposal, said lawmakers are supportive. Arambula spent a decade as an emergency room doctor.