Green House Project Looks to Get More States to Incentivize its Small Home Model

The Green House Project hopes to keep the small home model in the national spotlight in 2022, however, its focus may shift more to expanding in individual states.

Though the model received some attention on the federal level last year with proposals for better funding in the Nursing Home Improvement and Accountability Act followed by the Build Back Better plan, before being cut in the final version, neither initiative made it to law.

While it remains to be seen how the model will be addressed on Capitol Hill, if at all, in 2022, the Green House Project is focused on incentivizing it at both the federal and state level.


One such incentive would be getting providers who convert to Green Homes better Medicaid reimbursement rates.

“We’re really thinking about incentives right now,” Susan Ryan, senior director of the Green House Project, told Skilled Nursing News. “It’s important to me that we incentivize what we want to see incentivized and figure out how we increase quality at a lower cost and create something that meets consumer demand.”

One example of this occurred to an Arkansas provider that received an increase to their Medicaid reimbursement rate for developing Green House Homes as a way to incentivize other providers to embrace the model.


“We’re using that as a prototype to figure out what that would look like in other states to be able to try to have some of those same conversations,” Ryan said. “These are state-by-state conversations.”

She said Green House is doing its due diligence to identify which states may work with that model.

Earlier this month, New York Gov. Kathy Hochul referenced the Green House model during her state of the state address and said she’d be willing to support nursing home conversions to the Green Houses as a way to provide New Yorkers with better access to “cutting-edge care.”

Now in 371 homes across 32 states, Green House homes create non-institutional eldercare environments that are designed with private rooms and large communal spaces that better match current patient preferences.

“We will open homes in Nevada, Wyoming and Washington this year,” Ryan said. “We’re working in a few additional states. Nevada is a new state and Louisiana is a new state.”

She’s heard from provider groups, developers and state and government officials nationwide who are looking at what it might take to add Green Homes in their state.

Ryan has also looked to the Department of Housing and Urban Development (HUD) to see what type of incentives it might offer for small house construction.

“I think if we could have the convergence of funding incentives, financing incentives, Medicaid reimbursement incentives, where we really come together and say, this is the time that we’re not kicking the can down the road [to] address the the failures of a long term care system that did not fit the job during the pandemic,” she said.

The Green House Project is also seeing momentum internationally as well.

“We are having more global interest than we’ve ever had, particularly with our Canadian neighbors,” Ryan said. “They’re getting serious about what they want to do to make sure that this tragedy in long-term care doesn’t happen again.”

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