A Comparison of Health Care Expenditures between Homeless Individuals and Matched Housed Individuals Under Medicaid

Objective: Homeless individuals are likely to be eligible to enroll in Medicaid as many states expand Medicaid coverage under the ACA. We compared health care expenditures between Medicaid members experiencing homelessness and a matched comparison group of housed Medicaid members. Findings can be useful to states in developing care management strategies as homeless individuals become insured through Medicaid expansion.

Methods: We included 6,494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. Geographic areas, insurance coverage, demographics, and clinical profiles were considered in the propensity score matching for housed Medicaid members (N=6,494). Healthcare utilization and expenditures were analyzed.

Results: A higher proportion of homeless Medicaid members had more than five ED visits or two hospitalizations than their matched counterparts. Total adjusted annual health care expenditures for the homeless group were $1,630 higher than for the latter group. The difference in expenditures was higher for behavioral health services ($942) than for general medical care ($688).

Conclusions: Compared to matched housed Medicaid members, homeless people experienced more frequent hospitalizations and ED visits, and incurred significantly higher health care expenditures. Underlying factors associated with these differences are likely to be multifaceted, including poor housing, social stigma and other social determinants of health that require assistance beyond that typically provided in healthcare settings. Medicaid programs may need to work with other public entities to address social determinants of health, e.g., stable housing, in order to effectively manage health expenditures for homeless members.