Bridging Recovery and Housing

Imagine being discharged from the hospital, IV bandage still fresh, only to recover on a sidewalk with no shelter, no food, and no doctor to check on you. In the turbulent landscape of American healthcare, medical respite (MR) services have emerged as one of the most promising interventions for people experiencing homelessness. Medical respite programs provide lower-acuity medical services to people who need hospital care beyond the streets but aren’t ill enough to require hospital readmission. More than just a stopgap, medical respite acts as a critical conduit between hospital discharge and long-term recovery. By providing medical support, case management, and warm meals, MR creates a space that enables individuals to rebuild their lives. The future of MR remains promising, albeit deeply entangled with the political determinants of health. Health and Housing Outcomes Medical respite care consistently demonstrates its effectiveness in enhancing both housing stability and clinical health results for homeless individuals. Patients in the MR program in Boston who received respite care after discharge accessed follow-up appointments more easily and had fewer hospital readmissions during the first 90 days than those discharged without formal care. Respite care programs in Florida and Connecticut yielded comparable outcomes. Benefits included reduced hospital durations and decreased emergency room usage, and better follow-up care. These findings shed light on the benefits of MR and bolster the idea that these programs have the foundations to be an essential component for the health and well-being of these individuals. Cost Savings and Financial Sustainability In addition to better health indicators, respite programs are also financially viable. When you ease the burden on hospitals, you achieve results. Medical respite care demonstrates a strong return on investment, yielding $1.81 in savings for every dollar invested in MR. The savings result from decreased uncompensated care and preventable readmissions. These savings optimize hospital resource allocation and enhance the system’s efficiency. In states that expanded Medicaid, these savings ripple across the entire system, relieving pressure on jam-packed ERs and freeing up hospital beds that are too often in short supply. Recent Policy Shifts and State-Level Expansion While the benefits of medical respite care are well established, its long-term viability has historically been dependent on patchwork funding from hospitals, non-profits, and government subsidies. That is now beginning to change. In January 2024, the Centers for Medicare & Medicaid Services (CMS) granted New York clearance to cover medical respite under a Section 1115 waiver, making it the last state to do so. California had already included recuperative care as a “Community Support” service under the CalAIM waiver since 2022. Other states rapidly followed suit. Massachusetts will introduce its Short-Term Post-Hospitalization Housing benefit in 2025. Nevada’s Senate Bill 54 would mandate the state to expand Medicaid to cover respite houses. North Carolina has included medical respite in its Healthy Opportunities Pilots. Medicaid Recognition: Catalyst for Change The state-level policy changes [pdf] both provide funding for beds and establish a care model that promotes equity and recovery. The official recognition of Medicaid’s role serves as a catalyst to enable wider adoption and standardization of the program. The current momentum suggests that respite programs will achieve transformative scaling, something previously considered quixotic. However, there is an increasing paradox emerging within the government. While some states are now boosting their Medicaid respite funding, federal policy directions show signs of future cuts. The Medicaid continuous enrollment provision that started during the COVID era ended in mid-2025. This led to the loss of Medicaid coverage for more than 22 million people. More cuts are likely on the way. The combination of administrative challenges, eligibility redetermination processes, and job requirements leads to widespread disenrollment among people who have unstable housing or sporadic employment. What happens to medical respite care when the communities it serves, namely low-income, uninsured, and people experiencing homelessness, are cut off from Medicaid? States that use Medicaid waivers to fund respite care may experience a broken safety net. This is inevitable when the financial gap between eligible and ineligible populations grows wider. States that have not expanded Medicaid or received waiver approvals, including Texas, face specific challenges when building sustainable respite care systems. Local initiatives in these areas face funding instability. They depend on hospital donations and intermittent grants instead of receiving steady public support. In turn, this creates a precarious environment for an indispensable service. The core elements of the political determinants of health are quite evident here. The decision to let someone recover with dignity or force them onto the streets depends more on budget lines and governor policies than medical evaluations. A Call for Standardization The National Institute for Medical Respite Care (NIMRC) has developed standards across four service models for characterizing and evaluating respite care. They also provide technical assistance in the design and development of new programs [pdf]. The intended approach provides some degree of consistency across Medicaid plans [pdf]. The current fragmented system creates both geographic disparities and administrative challenges. Standardization needs political support, which changes according to election cycles and federal mandate requirements. Health systems are in a standstill, because they are aware of the financial and moral benefits of respite care. Yet, many are hesitant to invest until reimbursement structures are clearly defined. The federal government can help instate initiatives by providing CMS with specific guidance and financial incentives. States should adopt the same approach as pioneering states to develop waivers that establish respite care as an essential element in the progression of public health. Health systems need to maintain their testing of new programs while assessing financial returns and working to establish payment systems. Filling A Systemic Gap in Post-Hospital Care Medical respite care is not a silver bullet, and it was never intended to be. It cannot eliminate homelessness single-handedly, nor can it address the need for affordable housing and strong mental health services. But it provides something unique in our splintered system, a moment of grace for these unsheltered individuals. In an era of legislative impasse and overburdened hospitals, respite care demonstrates what humane policy looks like in practice. It affirms the ideology that society must uphold the principle that no one falls through the cracks and that everyone, regardless of their situation, deserves a chance to flourish.