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In 2019, pursuant to a Section 1115 waiver, Florida launched a Statewide Medicaid Managed Care housing assistance pilot to foster housing stability and reduce preventable health care use in adults with serious mental illness (SMI) or substance use disorder (SUD). We conducted a retrospective cohort study to examine the relationship between four housing support services provided in the pilot (transitional housing support, tenancy support, peer support, and crisis management) and health care use and health outcomes among 1,300 pilot enrollees during the period December 2017-June 2024. Transitional housing support services were associated with a 15 percent increase in emergency department (ED) visits. Tenancy support services were associated with 51 percent lower odds of all-cause mortality, and peer support was associated with a 20 percent reduction in ED use. Crisis management was associated with a 45 percent increase in ED visits, a 41 percent increase in outpatient visits, and a 90 percent increase in psychiatric hospitalizations. Findings highlight the value of tailored Medicaid housing interventions for people with SMI or SUD. Medicaid policy should prioritize high-value, data-driven housing interventions and protect them from budget cuts. Embedding such services within managed care contracts and aligning them with broader care coordination strategies offer a viable path for sustainability.