Climate Devices and Strategies
There is sufficient evidence that the provision of climate devices is associated with improved health and social outcomes.
Impact Assessment
The findings below synthesize the results of the studies on the provision of climate devices across three domains of measurement:
- Healthcare Cost, Utilization & Value: More evidence is needed to determine the effectiveness of climate devices and strategies in reducing healthcare costs and utilization. No cost-effectiveness or return-on-investment (ROI) data were identified for any evaluated device. Two modestly sized randomized controlled trials (RCTs) of home high-efficiency particulate air (HEPA) filtration found significant reductions in acute care utilization, one among adults with chronic obstructive pulmonary disease (COPD) and another among children with asthma. Additional RCTs across a wider diversity of device types, along with formal cost and ROI analyses, are required to establish sufficient cross-cutting evidence.
- Health: There is sufficient evidence for the effectiveness of climate devices, particularly access to home air conditioning, in reducing heat-related mortality and morbidity. Observational studies found that increased air conditioning prevalence was consistently associated with reduced heat-related morbidity and mortality risk. A broader review of heat intervention studies found consistent reductions in heat-related mortality across a range of non-randomized study designs. However, evidence for other devices was more mixed: a systematic review focused on cooling centers highlighted a scarcity of real-world epidemiological trials outside of immediate laboratory settings, and RCTs of portable air filtration devices for asthma and COPD found benefits on specific environmental exposures and health metrics but not across all secondary clinical endpoints. Further research is needed to examine and compare direct clinical health benefits across different devices and strategies.
- Social: There is sufficient evidence that the provision of climate devices like air filters and purifiers improves indoor environmental quality in homes and classrooms in the context of environmental events such as wildfires as well as ambient pollution. More research is needed to examine how the provision of climate devices relate to broader social outcomes such as overall wellbeing, social participation, mood and heat-protective behaviors.
Background of the Need / Need Impact on Health
Climate-related threats to health are a major source of injury, illness and death in the United States (U.S.). One such threats is extreme heat, which kills more people annually than hurricanes, tornadoes, and floods combined[1]. Syndromic surveillance data from the Centers for Disease Control and Prevention (CDC) demonstrates that emergency department (ED) visits for heat-related illness rose substantially across multiple U.S. regions during the summer of 2023 compared with prior years[2]. A national study of mortality trends from 2000 to 2020 found that deaths linked to high temperatures climbed 53%, from an annual average of roughly 2,670 to more than 4,000, while cold-related deaths also rose over the same period[3].
Wildfire smoke events are also becoming more frequent. Nationally, wildfire smoke exposure is estimated to contribute to thousands of respiratory- and cardiovascular-related ED visits, hospital admissions, and deaths each year[4]. A Southern California study found respiratory hospitalizations rose between 1.3% and 10% for every 10 μg/m³ increase in wildfire-specific fine particulate matter (PM2.5), a substantially larger effect than equivalent increases in PM2.5 from other sources[4].
Certain populations bear a disproportionate share of climate threats. Adults aged 65 and older are at elevated risk of heat- and smoke-related illness because they are more likely to already have chronic heart or lung diseases[5]. Children are especially vulnerable to smoke exposure, while people with asthma may experience worsened symptoms or asthma attacks[4]. Additionally, people with fewer financial resources often have a reduced ability to manage their exposure to extreme temperatures and poor air quality, including less access to air conditioning or air cleaners, and a greater likelihood of living in lower-quality housing that traps heat and pollutants[5].
Background on the Intervention
Climate devices and strategies include both individual interventions where a person or a household is provided with an air filter or an air conditioner and community-level strategies to ensure community members have access to adequate cool spaces. Healthcare coverage is solely focused on the devices; however, healthcare institutions are often core partners in ensuring adequate access to temperature controlled and healthy air quality spaces.
Medicaid coverage for climate devices is generally accessed through Section 1115 demonstration waivers that let states cover health-related social needs (HRSN), non-medical services for high-need enrollees who have both a qualifying health condition and a social risk factor[6]. Under this waiver authority, Oregon's Medicaid program (the Oregon Health Plan) became one of the first in the country to cover "climate supports" for eligible members, including air conditioners, heaters, and air filters for individuals whose health condition is worsened by heat, cold, or poor air quality, along with mini refrigerators and portable power supplies for medication and medical-device needs during power outages[7]. As of 2024, Oregon had distributed climate-control devices to hundreds of Medicaid members through this benefit[8]. New York's Medicaid 1115 waiver similarly funds home environmental remediation and air-quality improvements for members with asthma, allergies, or other conditions worsened by unhealthy housing conditions[9]. As of early 2024, at least eight states had approved HRSN-framework waivers covering this type of benefit, with additional states holding earlier, related social-needs waiver approvals[10]. As of 2025, HRSN-related waivers were being considered on a case-by-case basis and were subject to change[11]. Medicaid Agencies and Medicaid Managed Care Organizations may also provide climate related devices as value added benefits, community reinvestment services and In Lieu of Services (ILOS).
Outside of Medicaid, the federal Low Income Home Energy Assistance Program (LIHEAP) is the primary existing funding source for climate devices and serves millions of households nationally, providing help with heating and cooling bills, utility shutoff prevention, and, in some states, direct assistance purchasing or repairing window air conditioners or heating/cooling systems[12]. Several states require documentation from a licensed healthcare provider that a household member's condition is aggravated by extreme heat or cold in order to access LIHEAP's crisis or device-purchase benefits, tying eligibility explicitly to a clinical need rather than income alone.
Additional Research and Tools