MedStar Investigator Evaluates Medicaid-funded Tenancy Support Services for Homeless Adults

Under the Affordable Care Act, large numbers of homeless adults gained Medicaid coverage and policymakers began to identify strategies to improve care and reduce avoidable hospital costs for homeless populations. “Medicaid Utilization and Spending among Homeless Adults in New Jersey: Implications for Medicaid‐Funded Tenancy Support Services” was published in The Milbank Quarterly by MedStar investigator Dr. Derek Delia, Director of Health Economics Research at MHRI. The study sought to examine data that would suggest tenancy support services (TSS) can reduce avoidable health care spending.

The study utilized linked data from the Homeless Management Information System and Medicaid claims to identify homeless adults who could be eligible for Medicaid TSS in New Jersey.  The data compares their Medicaid utilization and spending patterns to matched non-homeless beneficiaries. Homeless adult beneficiaries have higher levels of health care needs compared to non-homeless adult Medicaid beneficiaries. 

In 2016, more than 8,400 adults in New Jersey were estimated to be eligible for Medicaid TSS. Approximately 4,000 adults were living in permanent supportive housing, 800 formally designated as chronically homeless and 1,300 who were likely eligible for the chronically homeless designation, and over 2,000 who were at risk of becoming chronically homeless. In this study, the homeless adults tended to have substantial difficulties with mental health and substance abuse disorders and are more inclined to visit the emergency department or require inpatient admission. The results showed that Medicaid spending for a homeless beneficiary eligible for TSS ranged from 10% to 27% ($1,362 - $5,727) over what was spent on a non-homeless Medicaid beneficiary.

The study found emergency care and inpatient admissions can possibly be avoided when individuals have access to high-quality, community-based care.  Providing tenancy support services to homeless adults may help the population achieve stable housing and other healthy living conditions.  In conclusion, Medicaid funding for TSS could reduce avoidable Medicaid utilization and spending.

The research team included Derek DeLia, PhD, from MedStar Health Research Institute in collaboration with researchers from the Rutgers Center for State Health Policy, Monarch Housing Associates, and Rutgers School of Social Work.

The Milibank Quarterly, DOI: 10.1111/1468-0009.12446