Reframing Homelessness in Washington: Why Respite Care Works

Washington stands at an inflection point in its approach to homelessness. With federal approval of the state’s Section 1115 Medicaid Transformation Project 2.0 waiver, Apple Health (Medicaid) beneficiaries in the state will soon be eligible for medical respite care as an HRSN service. This waiver recognizes that health and housing are inseparable, and it embeds short-term post-hospital recuperative care into a broader health system commitment to housing stability.

For the first time, providers can be reimbursed through Medicaid to deliver medical respite and recuperative care services that keep people experiencing homelessness out of emergency rooms and on a path toward recovery. Implementation is scheduled to begin July 1, 2025, which aligns with changes in how the state delivers care for complex, high-need populations. 

This is not academic. It is real, practical, and measurable.

At its core, medical respite care bridges a gap that every community with a significant homeless population knows too well: the hospital discharge back to the streets or a shelter that cannot accommodate ongoing care. That gap drives unnecessary readmissions, repeated ER visits, and escalating costs. Programs that provide post-acute care in a safe, structured environment reduce that cycle and cut costs while restoring agency to people who are too often treated as passive recipients of crisis care.

Evergreen Medical Respite Care has been launched with that mission front and center. With just a hundred beds in the first year, Evergreen’s work will not be small. A cohort of 100 individuals receiving structured respite care, coordinated case management, and connection to supportive services can:

• Lower hospital readmission rates by giving patients a place to complete their recovery and attend follow-up appointments.

• Reduce emergency room utilization because people have a safe place to recuperate and access scheduled care.

• Increase successful transitions into housing and employment by pairing medical stabilization with job supports, benefits navigation, and housing placement services.

The cost savings here are tangible. National research on medical respite models demonstrates consistent reductions in total health system cost when individuals receive targeted supports that prevent avoidable acute care. When a patient who would otherwise cycle through emergency and inpatient care spends time in a purposeful recovery space, hospitals spend less and outcomes improve. Washington’s inclusion of medical respite care in Medicaid reimbursement is a recognition of that evidence.

But the impact goes beyond the health care ledger. When someone completes a period of recuperation in a program like Evergreen, they are not just medically stabilized. They are connected to the ecosystem needed for long-term success: benefits, employment services, behavioral health supports, housing navigation, and community partners that do not treat homelessness as an intractable condition but as a transitional state.

This broader ecosystem is the only way we break persistent patterns of readmission and crisis care. Apple Health’s expansion of HRSN services is a structural commitment to that ecosystem. The challenge now is execution.

Here is where private and nonprofit leadership matters. Evergreen, supported by Soul Housing’s operational expertise, is positioned to be among the first to test what a medically integrated homeless support system looks like under this waiver. One hundred beds in year one means a controlled, measurable cohort whose outcomes can inform best practices and scale. It means demonstrating reduced hospital utilization and accelerated pathways into housing, work, and community.

Washington’s waiver and Evergreen’s model will not solve homelessness alone. But they will give us a data-driven proof point: that strategic investment in medical respite, aligned with whole-person services, yields outcomes that are better for people and for taxpayers.

This is where policy meets practice. This is where compassion meets strategy. And this is where leaders who care about impact can turn innovation into replication. Washington’s commitment under the 1115 waiver is an invitation. Evergreen Medical Respite Care is a response. The work ahead is proving what is possible.