Frequent emergency department visits and hospitalizations among homeless people with medicaid: Implications for medicaid expansion

W.-C. Lin, M. Bharel, J. Zhang, E. O'Connell and R.E. Clark

American Journal of Public Health, 2015, vol. 105, S716-S722

Abstract: Objectives: We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless. Methods: We included 6494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. We used negative binomial regression to examine variables associated with frequent utilization. Results: Approximately one third of the study population had at least 1 hospitalization and two thirds had 1 or more ED visits. More than 70% of hospitalizations and ED visits were incurred by only 12% and 21% of these members, respectively. Homeless individuals with co-occurring mental illness and substance use disorders were at greatest risk for frequent hospitalizations and ED visits (e.g., incidence rate ratios [IRRs] = 2.9-13.8 for hospitalizations). Individuals living on the streets also had significantly higher utilization (IRR = 1.5). Conclusions: Despite having insurance coverage, homeless Medicaid members experienced frequent hospitalizations and ED visits. States could consider provisions under the Patient Protection and Affordable Care Act (e.g., Medicaid expansion and Health Homes) jointly with housing programs to meet the needs of homeless individuals, which may improve the quality and cost effectiveness of care.

Keywords: adult; female; health care policy; health insurance; homeless person; hospital emergency service; hospitalization; human; insurance; male; Massachusetts; medicaid; Mental Disorders; middle aged; statistics and numerical data; United States, Adult; Emergency Service, Hospital; Female; Homeless Persons; Hospitalization; Humans; Insurance Coverage; Insurance, Health; Male; Massachusetts; Medicaid; Mental Disorders; Middle Aged; Patient Protection and Affordable Care Act; United States (search for similar items in EconPapers)
Date: 2015
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2015.302693_1

DOI: 10.2105/AJPH.2015.302693

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