Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees

By Bradley Corallo: For Complete Post, Click Here…

Executive Summary

The COVID-19 pandemic and the ensuing economic disruption have drawn more attention to longstanding issues related to housing and internet access and how these issues can impact health. As the primary source of health insurance for low-income populations, Medicaid covers a considerable share of people living in homes that are unaffordable, inadequate, or have limited access to the internet. This brief examines housing adequacy, affordability, and internet access within the homes of Medicaid enrollees using data from the 2019 American Community Survey (prior to the COVID-19 pandemic) and assesses the limited role that Medicaid can play in helping to address these challenges. Key findings include the following:

  • Prior to the pandemic, in 2019, the majority (57%) of Medicaid enrollees lived in a home that was inadequate (defined as lacking complete plumbing or kitchen facilities or being overcrowded) or unaffordable (defined as costing more than 30% of household income), representing more than one-third (36%) of all individuals in such homes nationally.
  • We estimate that 13% of Medicaid enrollees did not have internet access in their home prior to the pandemic, either through a computer or cell phone, and an additional 13% have internet but with limited computer access in their homes (i.e., a smartphone was the only computer device in the home or no computer device).
  • The likelihood of Medicaid enrollees living in inadequate or unaffordable homes were especially high for Native Hawaiian/Other Pacific Islander enrollees (70%) and Hispanic enrollees (67%), as well as enrollees ages 18 and under (63%) and enrollees in metro areas (59%). Limited internet and computer access was highest among American Indian/Alaska Native enrollees (43%), enrollees ages 65 and older (41%), and enrollees in non-metro areas (31%).
  • Housing problems can negatively impact health, but Medicaid plays a narrow role in addressing these impacts. Medicaid has traditionally been able to cover certain non-clinical services (including housing-supports) through home and community-based services (HCBS) programs that support seniors and people with disabilities. Beyond HCBS programs, states have limited ways to leverage Medicaid for supporting access to some housing supports, though Medicaid generally cannot pay the direct costs of non-medical services like rent and food.

While housing insecurity and other “social determinants” can affect health, policies and programs outside of Medicaid – and the health care sector generally – have the greatest impact on housing issues among the broader Medicaid population. Recent legislation has created or extended funding for several federal housing programs, which likely helped to stabilize housing for many people during the pandemic. Additionally. one of the key priorities in the proposed infrastructure bill, the Infrastructure Investment and Jobs Act, would address some issues related to broadband access in rural and low-income communities if signed into law. The Centers for Disease Control and Prevention also implemented a temporary eviction moratorium that likely contributed to greater housing stability for people behind on rent; however, the Supreme Court ended the moratorium in August 2021, requiring that Congress authorize the moratorium to continue.

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