Sacramento, Calif.: At the start of 2022, Thomas Marshall weighed 311 pounds. He had been hospitalized 10 times in five years, including six surgeries. He had an open wound on his left leg that refused to heal — made worse by living in a dirty, moldy house with five other people, two ball pythons, four Chihuahuas and a cage full of rats.
More than a year later, Marshall has lost nearly 100 pounds. His wound has healed. His blood pressure has returned to normal levels. His foot, which had nerve damage, has improved to the point he goes on regular walks to the park.
Lots of factors are at play in Marshall’s dramatic turnaround, but the one he credits the most is finally having stable housing, after the nonprofit Sacramento Covered helped him get a one-bedroom, 500 square-foot (46.4-square-meter) apartment in a downtown high rise. He has hardwood floors, white pine cabinets and a glass jar on the counter filled with Bit-O-Honeys.
“To me it’s the most important 500 square feet I’ve ever had,” he said. “Living here has just improved my well-being in every possible way.”
Marshall’s story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses.
But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.