Healthcare for the Homeless (HCH) Projects and Medicaid Expansion

Area of Science:

• Public Health
• Health Policy
• Healthcare Access

Background:

• The Supreme Court made Medicaid expansion optional in 2012, leading to varied state adoption.
• Healthcare for the Homeless (HCH) projects serve vulnerable populations, including those experiencing homelessness.
• Understanding the impact of Medicaid expansion on HCH patients is crucial for health policy and service delivery.

Purpose of the Study:

• To compare uninsured rates, healthcare utilization, and clinical quality at HCH projects in Medicaid expansion versus non-expansion states.
• To assess the impact of state-level Medicaid policy on healthcare access and outcomes for homeless populations.
• To provide evidence for the benefits of maintaining Medicaid expansion for vulnerable groups.

Main Methods:

• Retrospective analysis of state-level Uniform Data System data from HCH projects (2012-2019).
• Inclusion of data from all 50 states plus Washington D.C.
• Utilized descriptive statistics and linear mixed models to compare expansion and non-expansion states.

Main Results:

• States expanding Medicaid saw a significantly greater decrease in uninsured HCH patients (-8.23%, p < 0.0001).
• Medical service utilization increased significantly more in expansion states (2.52%, p = 0.0085), while substance use visits decreased (-0.79%, p = 0.0267).
• Significant improvements were observed in colorectal cancer screening, blood pressure control, and diabetes control in expansion states.

Conclusions:

• Medicaid expansion is associated with reduced uninsurance and increased healthcare utilization for homeless populations served by HCHs.
• Expansion states demonstrated improvements in key preventive care measures, indicating enhanced quality of care.
• Maintaining Medicaid expansion offers significant advantages for the health and well-being of homeless individuals.