(92) Reducing Hospital Costs and Improving Access to Care With Hotel Vouchers

Background & Introduction: There is a substantial unmet need for effective treatment of substance use disorders (SUD) among individuals experiencing homelessness.1,2 Residential treatment is an evidence-based intervention that can help initiate recovery.3 At University of Iowa (UI) Health Care, many patients with co-occurring SUD and homelessness experience repeated hospitalizations because they are unable to access residential treatment. During hospitalization, the Addiction Medicine Consult Service (AMCS) refers eligible patients to residential treatment programs; however, this process often takes days or weeks and requires patients—after discharge—to answer phone calls and independently arrange transportation to treatment. These requirements present insurmountable barriers for many patients and routinely lead to a cycle of readmission. To break this cycle, one strategy has been to keep patients hospitalized after they are medically and psychiatrically stable until direct discharge to a residential treatment program is possible. However, keeping these patients in the hospital increases costs and contributes to bed shortages. As a lower-cost alternative to this approach, we established the Supportive Accommodation for Facilitating Enrollment in Treatment (SAFE-T) program, which provides free hotel vouchers to patients seeking residential treatment for SUD who require short-term, safe shelter to initiate recovery.

Methods: The SAFE-T quality improvement pilot program was developed in 2024 and ran from March through November 2025 with financial support from UI Health Care. The program served Iowa Medicaid beneficiaries hospitalized at UI who had a severe substance use disorder, housing insecurity, and met criteria for American Society of Addiction Medicine (ASAM) Level 3.5 (residential treatment).
The program funded lodging at the Heartland Inn in Coralville, Iowa, and, when needed, provided food vouchers redeemable at the UI cafeteria and transportation to residential treatment. Implementation leveraged existing UI resources, including AMCS staffed by a social worker and physician, a free shuttle service to and from the Heartland Inn, and Peer Recovery Coaches (PRC).
During hospitalization, AMCS evaluated patients for eligibility. If criteria were met, the AMCS social worker enrolled the patient, submitted referrals, engaged PRC, and coordinated funding. Patients traveled to the hotel via shuttle. During the hotel stay, the social worker and PRC maintained regular contact to provide support. The Heartland Inn provided complimentary meals and 12-Step programming. Patients also had access to outpatient services. Patients were discharged from the program on their residential treatment start date, with transportation arranged as needed. Program data were recorded using REDCap.

Results: During the 2025 pilot year, total program costs were $3,329, covering 50 nights of lodging at the Heartland Inn, food vouchers, and transportation. Seven patients were enrolled. All were accepted into a residential treatment program, and five were discharged directly from the hotel to residential treatment. One patient was readmitted to the hospital during the hotel stay, and one was lost to follow-up. During participation, three patients presented to the emergency department, and two attended scheduled outpatient Addiction Medicine visits.

Conclusion & Discussion: The SAFE-T pilot program demonstrates a feasible, humanistic approach to increasing access to residential treatment for hospitalized patients with substance use disorders and housing insecurity while potentially reducing hospital costs. Although a randomized controlled trial would be needed to quantify effects on access and cost, several findings suggest the program was beneficial.
Participants received short-term housing, food, transportation, safety, and social support while awaiting residential treatment. All patients were accepted into a residential program, and most were discharged directly from the hotel to treatment. Patients in the program would likely have faced significant barriers if discharged to a shelter or they would have required extended hospitalization beyond insurance coverage to access residential care.
Hospitalization at the UI Health Care costs range from $2,000–3,500 per night, compared with $65 per night for hotel lodging. Even modest reductions in hospital length of stay would offset program costs, with potential savings estimated at approximately $100,000 during the pilot year.
Future efforts will focus on expanding the program, hiring a dedicated program coordinator, and systematically collecting data on patient feedback and residential treatment completion. This model may be adaptable to other medical systems seeking to improve access to care while managing costs.

References: 1. Hossain MM, Sultana A, Tasnim S, Fan Q, Ma P, McKyer ELJ, Purohit N. Prevalence of mental disorders among people who are homeless: An umbrella review. Int J Soc Psychiatry. 2020 Sep;66(6):528-541. doi: 10.1177/0020764020924689. Epub 2020 May 28. PMID: 32460590.
2. Assaf RD, Morris MD, Straus ER, Martinez P, Philbin MM, Kushel M. Illicit Substance Use and Treatment Access Among Adults Experiencing Homelessness. JAMA. 2025;333(14):1222–1231. doi:10.1001/jama.2024.27922
3. de Andrade D, Elphinston RA, Quinn C, Allan J, Hides L. The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug Alcohol Depend. 2019 Aug 1;201:227-235. doi: 10.1016/j.drugalcdep.2019.03.031. Epub 2019 Jun 20. PMID: 31254749.