Reflections on 10 years of health care and housing integrations

April 2025

When I first joined Homebase in November 2014, it was to work on a national project called The Housing-Healthcare (H2) Integration Initiative. I was part of a small team supporting 20 community-focused action planning sessions across the country, to bring partners from the homeless response and mainstream health care systems together. The goal was to learn about each other and develop strategies to improve the housing and health care outcomes of people experiencing homelessness.

There were already innovative and exciting cross-system partnerships and programs happening around the country, but they were rare, shining examples to aspire to. During the H2 action planning sessions, we discussed the possibility that Medicaid and health system funding could be used to support cross-system collaboration. The idea of Medicaid funding rent was an impossibility back then, but we frequently and enthusiastically discussed how Medicaid funding could support housing stability in other ways. We envisioned Medicaid health plans as partners and CoC providers billing Medicaid for some of their services. We presented these strategies as real, tangible ideas, but we knew they would require a significant investment – of financial resources, time, staff, and political will – that would be very challenging to realize.

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Early days of health care and housing integration – the H2 action planning sessions.

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Today, many of the ideas that felt aspirational in 2014 are being actively implemented in states across the country. In California that’s largely thanks to HHIP and CalAIM’s housing-related programs. After a decade of doing this work, it’s remarkable to witness and genuinely an honor to support even in a small way.

When HHIP and CalAIM first launched in 2022, we knew they had the potential to transform cross-system efforts and to infuse the resources and capacity that are critically needed to improve the housing and health outcomes of unhoused people with complex care needs. Implementation challenges persist, and there are still opportunities to make it easier for people to get housing and health care resources. But talking with CoCs, counties, managed care plans, and providers across the state about their experiences so far – and working to support their efforts – not only shows the promise of these programs but has also been one of the most inspiring and satisfying experiences of my professional life. 

As Homebase releases a new suite of reports on housing and health care integrations, I am so thrilled that we’re able to share this information about California’s health care and housing integration efforts – all the rich detail about the positive impacts, the frustrations and setbacks, and the opportunities for growth and improvement. And I’m immensely grateful to the people who continue to work at all levels across systems to turn innovative ideas into tangible actions that help improve the lives of so many of our neighbors.

By Gillian Morshedi

Gillian Morshedi is a Senior Directing Attorney at Homebase.