Homelessness is rapidly increasing across the country, which poses a serious challenge for both the housing and health care sectors. People experiencing homelessness are more likely to experience serious health challenges and less likely to access needed health care services. This not only affects their well-being, but also comes at an enormous cost to government programs like Medicaid.

In 2022, Denver launched the Housing to Health Pay for Success project to provide supportive housing to people facing homelessness who frequently interact with emergency health care services and the criminal legal system. Pay-for-success financing means the project received up-front funding from private investors to pay for intensive, wraparound services for participants. If the project achieves its performance targets for housing stability and reduction in jail days, the City of Denver will then repay the private investors. The project is also financed through a mix of federal and state housing vouchers and Medicaid reimbursements for covered services.

Housing to Health is one of the first projects supported by the federal Social Impact Partnerships to Pay for Results Act (SIPPRA) program. Under the SIPPRA program, the US Department of the Treasury will pay the City of Denver the equivalent value of the net reduction in Medicaid expenditures for supportive housing participants as compared with a control group.

The Urban Institute is conducting a seven-year randomized controlled trial evaluation and implementation study to measure how supportive housing affects health care utilization and net Medicaid costs. We will calculate outcomes-based payments from the City of Denver and Department of the Treasury and provide rigorous, long-term evidence on scaling supportive housing as a health care solution.