Maps Illustrate “Hotspots” where Poor Housing Quality, Childhood Asthma, and High Medicaid Enrollment Converge in New York City

Neighborhoods in the Bronx, Northern Manhattan, and Central and Eastern Brooklyn demonstrate where substandard housing may exacerbate pediatric asthma
 

NEW YORK, NY—October 22, 2019—A series of maps released today by United Hospital Fund (UHF) displays “hotspots” in New York City where poor housing quality, pediatric asthma, and Medicaid enrollment overlap and suggests where Medicaid-supported housing interventions might address factors contributing to uncontrolled asthma.

The maps, contained in the report Healthier Homes, Healthier Childhoods: How Medicaid Can Address the Housing Conditions Contributing to Pediatric Asthma, reveal that Hunts Point and Longwood in the Bronx, and East Harlem South in Manhattan, have some of the highest rates of asthma diagnoses among children on Medicaid and also have higher rates of home maintenance defects, cockroach exposure, and health care use related to pediatric asthma.

Other neighborhoods where poor housing quality and children’s asthma-related health care use coincide include the Lower East Side of Manhattan and the Rockaways in Queens.

“It has been well-demonstrated that the lack of stable housing can have a powerful impact on health, but the quality of housing also has considerable health effects,” said Misha Sharp, UHF senior research analyst and a co-author of the report. “Medicaid interventions directed at improving housing could be well worth it, by reducing costly emergency room visits and hospitalizations for children with asthma.”

In addition to the maps, the report describes several New York initiatives that provide promising strategies for tackling housing conditions that contribute to asthma among Medicaid-enrolled children. For example, under New York Medicaid’s reform initiative, the Delivery System Reform Incentive Payment (DSRIP) program, the Bronx Partners for Healthy Communities Performing Provider System partnered with the Northwest Bronx Community and Clergy Coalition in deploying community organizers to buildings with high asthma-related health care use. These organizers provide group education and support for improving building infrastructure and refer patients with severe asthma to in-home services provided by AIRnyc, another partner.

Another initiative, undertaken by the State’s Department of Health and its Energy Research Development Authority, is the Healthy Homes value-based payment (VBP) pilot. In this pilot, the State will work with Medicaid managed care plans and providers to target and refer children with asthma for residential healthy homes interventions. These include asthma management education, reducing asthma triggers, and other home improvements, such as enhancing home energy efficiency. Through this initiative, the State aims to provide a validated model for Medicaid payment reforms that address substandard housing as a social determinant of health.

The report also describes numerous potential challenges for Medicaid providers and plans seeking to mitigate poor housing quality and its impact on children with asthma, such as legal restrictions, financial constraints, and a range of operational concerns.

“Nevertheless, New York Medicaid’s ongoing reforms may provide new opportunities to address the housing issues that contribute to childhood asthma,” said Nathan Myers, director of UHF’s Medicaid Institute and a co-author of the report. “Such efforts could help Medicaid advance its goal of reducing avoidable hospitalizations while improving housing, and health, for children in New York City and across the state.”

The maps in the report are based on data contained in the 2018 NYC Community Health Profiles and the NYC Neighborhood Health Atlas, both produced by the New York City Department of Health and Mental Hygiene. Ian Ramdeen, a UHF intern, was also a co-author on the report.

The full report can be downloaded from UHF’s website here.

About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.