Pandemic raised food, housing insecurity in Oregon despite surge in spending

Despite a heavy infusion of public and private support during the COVID-19 pandemic, Medicaid and Medicare beneficiaries in Oregon reported that housing and food insecurity shot up during the onset of the pandemic in March of 2020 — and their basic needs remained in doubt through at least the end of the following year.

The survey data were reported in a study led by Oregon Health & Science University and published today in the Annals of Family Medicine.

The Oregon study provides a state-specific dimension to a nationwide survey commissioned by the Centers for Medicare & Medicaid Services, or CMS.

Earlier this month, CMS released a report involving surveys of 1.1 million beneficiaries nationwide. The nationwide survey data found that beneficiaries whose basic needs — housing, food, transportation, utilities, interpersonal safety — were addressed in a health care visit were on average healthier and spent less on health care compared with those who did not receive assistance.

CMS promotes the use of screening, referral and navigators to connect beneficiaries directly with social service agencies.

“Together, these findings drive home the point that health care organizations need to think about the social care of their patients,” said senior author Anne King, M.B.A., an OHSU adjunct faculty member who serves as Oregon state director of Comagine Health, a nonprofit health care quality improvement firm. “It actually improves their health and it reduces costs for taxpayers.”

Survey gauges health-related social needs

Beginning in 2019, researchers in OHSU’s Oregon Rural Practice-based Research Network engaged with a consortium of 50 clinical sites around the state providing health care to people insured by Medicare and Medicaid. As part of a CMS-sponsored initiative to better understand the health-related social needs of beneficiaries, researchers began regularly surveying them. Some 21,000 beneficiaries were surveyed in Oregon over three years.

The timespan just happened to coincide with the biggest health calamity in a century.

For all the death, despair and economic disruption wrought by COVID-19, the pandemic also afforded a natural experiment. In Oregon, researchers recorded an abrupt 17.7-percentage-point increase overall in health-related social needs in March of 2020 — just as the pandemic shuttered everything from NBA basketball games to restaurants to schools.

Beneficiaries received a big infusion of support in the form of eviction moratoriums, extension of unemployment benefits and direct government cash payments.

Despite the help, Oregon beneficiaries surveyed in the study reported that food, housing and interpersonal safety needs increased by 16.5%, 15.9% and 4.4%, respectively, starting in May 2020 and continuing through the end of 2021. Needs related to transportation and utilities also shot up initially but settled back over time.

“What if we hadn’t done anything?” said lead author Jean Hiebert Larson, M.S., an OHSU finance analyst. “Would this have been much worse?”

Taking action

In addition to highlighting the effectiveness of addressing basic needs in health care visits, the findings suggest the need for more research to better understand which specific interventions, investments and policies may be most useful in addressing health-related social needs.

One Oregon program is moving forward now.

Oregon Health Authority, coordinated care organizations and community organizations have just launched a program that involves CMS subsidizing short-term rent assistance and other eviction-prevention services for beneficiaries in need. King describes it as a benefit akin to paying for a pair of eyeglasses.

“Oregon is ahead of the nation,” King said. “We’re at the forefront of the nation in understanding the relationship between stable housing and effective delivery of health care.”

In addition to King and Hiebert Larson, co-authors include Zoe Major-McDowall and Bruce Goldberg, M.D., all of OHSU’s Oregon Rural Practice-based Research Network; and Anna L. Steeves-Reece, Ph.D., M.P.H., of OCHIN, a nonprofit organization previously known as Oregon Community Health Information Network.

The project described was supported by Funding Opportunity Number CMS-1P1-17-001 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.  The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.