Missouri should make medical respite part of its health care infrastructure

Missouri’s healthcare system routinely pays for a hospital stay, a surgery or a course of treatment, then reaches the edge of its own plan when the patient has no home in which to recover.

For a person experiencing homelessness, “discharge” can mean returning to a shelter, vehicle or street while managing a wound, infection, cancer treatment, new dialysis schedule or medication regimen. The predictable result is not only suffering. It is fragmented care, missed follow-up and avoidable use of emergency departments and inpatient beds.

Medical respite care offers a practical alternative. The National Institute for Medical Respite Care defines it as short-term residential care that allows people experiencing homelessness to rest, recover and access medical care and supportive services when they are too ill to recover on the street but no longer require hospitalization. National guidance describes medical respite as a bridge between acute care and housing, with hospital collaboration essential to referrals, data collection and sustainable funding.

Missouri should recognize this bridge as healthcare infrastructure rather than an optional charitable add-on.

At Haven Recovery in St. Louis, recuperative care serves people with serious wounds, infections, cancer, heart disease, trauma and other medical conditions. Staff provide a safe place to heal, three meals a day, transportation to follow-up care, medication support, nursing coordination, case management and connections to housing and benefits.

The financial signal is notable. Data provided to our program on 27 Missouri Medicaid members served in 2024 compared spending in the 12 months before recuperative care with spending afterward. Average inpatient and outpatient spending declined from $3,091 per member per month to $956. Pharmacy spending declined from $515 to $457. The combined observed reduction was $2,193 per member per month, equal to approximately $710,532 when annualized across the 27-member cohort.

This is a small before-and-after analysis, not a controlled evaluation. It cannot prove that every dollar of the observed change resulted from recuperative care. That limitation is precisely why Missouri should invest in both capacity and rigorous statewide evaluation. The appropriate response to promising early data is not to ignore it; it is to test it at scale.

Evidence from other communities also supports the model’s potential. The Center for Health Care Strategies has highlighted medical respite as a pathway to better health and housing outcomes and noted that Medicaid policy can help finance it. A Commonwealth Fund case study similarly describes medical respite as short-term residential care for people who need a safe place to recover after hospitalization.

Missouri can act in four ways.

First, the state and its Medicaid managed care organizations should establish consistent reimbursement pathways for qualified medical respite services. Programs cannot responsibly add beds or retain specialized staff when payment depends on temporary grants or one-time agreements.

Second, Missouri should define quality standards. Medical respite must be more than a bed. Programs should demonstrate safe operations, care coordination, transportation, medication support, connections to primary and specialty care, and pathways to housing.

Third, the state should require shared outcome measurement. At a minimum, programs and payers should track hospital readmissions, emergency department use, total cost of care, connections to primary care and housing status after discharge.

Fourth, public and private capital partners should support facility development. Demand cannot be met without appropriate physical space. Haven currently operates 11 recuperative care beds and is planning an expansion to approximately 35 at its Davis Street location, but our referral demand already far exceeds available capacity.

Medical respite will not solve homelessness by itself, nor should it replace permanent housing. It solves a specific and urgent problem: where a medically vulnerable person can safely recover today while longer-term supports are arranged.

Missouri already pays when that gap goes unfilled — through extended hospital stays, repeated crises and human suffering. A structured medical respite system would allow the state to spend more intelligently while treating people with dignity.

The question is not whether Missouri can afford to build this part of the continuum. The current pattern shows that we are already paying for its absence.