Homeless veterans who are likely eligible for the Medicaid expansion under the Affordable Care Act

The Affordable Care Act (ACA) introduces the state option to expand Medicaid coverage to millions of low-income and homeless adults in the U.S., including veterans. While the ACA is being implemented, the U.S. Department of Veterans Affairs (VA) has had an ongoing federal campaign to end homelessness among veterans. Thus, it may be important to consider how Medicaid expansion and VA services may be coordinated to best provide for homeless veterans. VA administrative data on the population of VA service users in 2010 (n= 3,841,225) were analyzed to compare the number and characteristics of homeless and non-homeless VA service users who are likely to be eligible for the ACA’s Medicaid expansion. Further, data from the VA’s Homeless Operations Management and Evaluation System (n= 114,497) were analyzed to compare homeless and at-risk veterans who are likely and not likely eligible for Medicaid under the ACA on their health needs. The results showed that homeless VA service users were twice as likely to be eligible for the Medicaid expansion as non-homeless service users. Homeless veterans who are likely eligible had various serious medical and psychiatric conditions, which could benefit from dual access to VA and Medicaid-funded services. However, potential care coordination issues may arise with dual eligibility for different systems of care so careful planning and education for homeless providers may be needed.