We examined factors associated with frequent
hospitalizations and emergency department (ED) visits among Medicaid members
who were homeless.
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.
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).
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.
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- 1Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
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