Do Medicaid Expenditures Increase After Adults Exit Permanent Supportive Housing?

Abstract

The effects of homelessness and permanent supportive housing (PSH) on healthcare utilization have been well documented. Prior research on the association between PSH entry and Medicaid expenditures indicates that such housing support could result in savings to Medicaid programs; however, whether changes occur in healthcare use and expenditures after individuals exit PSH is unknown. If efficiency gains from PSH persist after the individual leaves, the savings to payers such as Medicaid may continue even after the costs to provide housing for a PSH recipient have ended. We used linked Medicaid and housing data from Pennsylvania to examine changes in the level and composition of Medicaid expenditures for 580 adult enrollees during the 12 months before and after exit from PSH, adjusting for relevant covariates. In adjusted analyses, we estimated that monthly spending declined by $255.96 (95% CI: $358.70, $154.40) in the first quarter post exit and by $271.50 (95% CI: $394.30, $146.50) in the fourth quarter. Our findings suggest that PSH may have sustained budgetary benefits to state Medicaid agencies even for beneficiaries exiting the program. However, more research is needed to understand whether these reductions in expenditures last beyond 12 months and do not reflect underuse of care that may be important for managing health over the long term.

Keywords:

• Medicaid
• permanent supportive housing
• expenditures

Disclosure Statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by an intergovernmental agreement between the University of Pittsburgh and the Pennsylvania Department of Human Services. Dr. Hollander was supported by a T32 grant [T32MH109436].

Notes on contributors

Evan S. Cole

Evan S. Cole is a research associate professor in the Department of Health Policy and Management in the School of Public Health at the University of Pittsburgh. He also serves as the Research Director of the Medicaid Research Center within the University of Pittsburgh's Health Policy Institute.

Mara A. G. Hollander

Mara A. G. Hollander is a postdoctoral fellow in the Department of Health Policy and Management in the Bloomberg School of Public Health at Johns Hopkins University.

Molly Ennis

Molly Ennis is a student in the University of Pittsburgh’s School of Law. She was formerly a policy analyst at the University of Pittsburgh’s Health Policy Institute.

Julie M. Donohue

Julie M. Donohue is a professor and Chair in the Department of Health Policy and Management in the School of Public Health at the University of Pittsburgh. She is also the Director of the Medicaid Research Center within the University of Pittsburgh's Health Policy Institute.

A. Everette James

A. Everette James is the M. Allen Pond Professor of Health Policy and Management at the School of Public Health as well as Associate Vice Chancellor for Health Policy and Planning for the University of Pittsburgh’s Schools of the Health Sciences. He also serves as director of the University of Pittsburgh’s Health Policy Institute.

Eric T. Roberts

Eric T. Roberts is an assistant professor in the Department of Health Policy and Management in the School of Public Health at the University of Pittsburgh.