On March 12, 2021,Governor Spencer Cox signed into law House Bill 34, Medical Respite Care Pilot Program, an important piece of legislation that ensures that people experiencing homelessness can receive the recuperative and end-of-life care they need. This is landmark legislation for Utah being the first Medicaid 1115 Waiver for medical respite in the entire country.
H.B. 34 is a win-win-win-win solution that has many positive outcomes, including:
- Giving Medicaid members who lack housing increased access to health care, which will result in better health care outcomes, improved continuity of healthcare, and more appropriate utilization of primary care over emergency room care.
- Giving clinics and hospitals a sub-acute care solution for patients who are too sick to be on the streets but not sick enough to stay in the hospital. This applies to people who need to recuperate after hospitalization, stabilize prior to hospitalization, or simply need a place to recuperate in lieu of being admitted to a hospital.
- Decreasing costs to Utah Medicaid by being able to "right-size" care - having a cost-effective option to reduce medically unnecessary hospital stays.
- Relieving stress on our homeless services system, particularly the homeless resource centers.
How does the waiver work?
H.B. 34 directs the Utah Department of Health (UDOH) to create a Medicaid 1115 waiver that will add medical respite as a covered benefit for Medicaid members who lack housing and are covered by the Medicaid Expansion program. In this sense, the term "waiver" can be thought of as a program. UDOH will draft the waiver and submit it to the Centers for Medicare and Medicaid Services (CMS) for approval, after which they will implement the program and evaluate it for a three-year pilot period to demonstrate its efficacy and cost effectiveness. As Utah's only medical respite facility, The INN Between was selected as the provider under the three-year pilot program. Over the next 6 months, we will collaborate with UDOH and other stakeholders to define the program parameters and performance measures. The entire process could take 12 to 18 months.
What is medical respite?
At its core, medical respite is about what comes next... For most of us, we see the doctor, and the next is "Go home, get some rest, take your medication, drink plenty of fluids, keep your wound clean, make it to your follow up appointment [chemo, x-ray, lab], etc. Arguably, the most important component of the next is emotional well-being - the tender loving care of family and friends - which plays such an important role in health.
However, the next is often completely out of reach for those who lack housing. Without the next, their condition often worsens and they end up back in the emergency department.
Medical Respite provides the place where the next can happen. It is temporary supportive housing for individuals who are too sick to be on the streets or in shelter but not sick enough to be in the hospital. It provides all basic needs, comprehensive social, emotional, and medical support, in a compassionate and non-judgemental environment. As a service, medical respite is a spectrum of care that can include:
- recuperative care after illness, injury, or hospitalization,
- stabilization care so that patients can become eligible for surgery, cancer treatment, and other medical interventions,
- emergency department diversion for patients who do not need to be admitted to the hospital but cannot be released back to the streets,
- end of life care for the terminally ill.
H.B. 34's history.
The INN Between opened in 2015 to address the need for end of life and medical respite care. This was groundbreaking work, and our program was one of just a few in the country. This was at a time when mental health practitioners were advocating to have residential mental health services covered by Medicaid, a goal which was later realized. However, our health care system did not provide a benefit that would house individuals through the acute portion of their medical condition. This led to people remaining hospitalized far longer than necessary, or exiting to the streets where their condition would worsen.
Kim Correa began working on this issue several years ago, advocating for Medicaid members and the benefits of medical respite. She attended many committee meetings, discussed the issues with UDOH and many other stakeholders, and refined the approach to a solution. The project caught the attention of Representative James Dunnigan who understood the necessity and value of the initiative. In the fall of 2020, he invited Kim to present to the Health Care Reform Task Force. During that meeting, he moved to open a bill file, becoming its official sponsor. The motion passed unanimously.
From there, the bill moved to the House Health and Human Services Committee (HHS), passing with all yes no votes. The next step was the Senate HHS, where it again passed with all yes votes. After that, the bill went to the full House floor, where it again passed with all yes votes. Senator Evan Vickers stepped up to sponsor the bill in the Senate, where it again passed with all yes votes. The bill returned to the House for a final vote, again all yes votes, and was then sent to Governor Cox's desk.
Today, the bill was signed into law by Governor Spencer Cox.
We are grateful to so many people who collaborated and contributed to make this happen. Representative Dunnigan for his leadership, counsel, and encouragement throughout the past several years. Former Representative Kory Holdaway who has given his time generously to assist with government relations. Emma Chacon, Nate Checketts and Tonya Hales at the UDOH for their experience and collaboration. Senator Vickers for his leadership in the Senate. All the Committee members who so thoughtfully considered the merits of the bill. The members of The INN Between's staff and board of directors who supported Kim throughout the process. There are many others, and if we have left someone off the list, it is unintentional and with no disrespect.
We at The INN Between are committed to working with our community partners to create and implement a program that improves healthcare outcomes for Medicaid members, increases the efficiency and effectiveness of our healthcare system, and reduces costs to Utah Medicaid. We look forward to demonstrating the efficacy and cost effectiveness of medical respite to the community.