Online Program

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

Monday, November 2, 2015 : 3:30 p.m. - 3:50 p.m.

Wen-Chieh Lin, PhD, Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Robin Clark, PhD, Dept. of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Jianying Zhang, MD, MPH, Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Elizabeth O'Connell, MS, Center for Health Policy & Research, University of Massachusetts Medical School, Shrewsbury, MA
Jessie Gaeta, MD, Boston Health Care for the Homeless Program, Boston, MA
Monica Bharel, MD, MPH, Boston Health Care for the Homeless Program, Boston, MA
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.

Learning Areas:

Program planning
Provision of health care to the public
Public health administration or related administration
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Compare health care expenditures between homeless Medicaid members and matched housed Medicaid members

Keyword(s): Homelessness, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator or co-investigator of multiple federally and state funded grant to study health care delivery and financing for vulnerable populations. My research focus is using large administrative databases for health services research to improve public health, health care delivery, and outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.