Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness

Abstract

BackgroundA rapid increase of Medicaid expenditures has been a serious concern, and housing stability has been discussed as a means to reduce Medicaid costs. A program evaluation of a New York City supportive housing program has assessed the association between supportive housing tenancy and Medicaid savings among New York City housing program applicants with serious mental illness and chronic homelessness or dual diagnoses of mental illness and substance use disorder, stratified by distinctive Medicaid expenditure patterns.MethodsThe evaluation used matched data from administrative records for 2827 people. Sequence analysis identified 6 Medicaid expenditure patterns during 2 years prior to baseline among people placed in the program (n = 737) and people eligible but not placed (n = 2090), including very low Medicaid coverage, increasing Medicaid expenditure, low, middle, high, and very high Medicaid expenditure patterns. We assessed the impact of the program on Medicaid costs for 2 years post-baseline via propensity score matching and bootstrapping.ResultsThe housing program was associated with Medicaid savings during 2 years post-baseline (−$9526, 95% CI = −$19,038 to -$2003). Stratified by Medicaid expenditure patterns, Medicaid savings were found among those with very low Medicaid coverage (−$15,694, 95% CI = −$35,926 to -$7983), increasing Medicaid expenditures (−$9020, 95% CI = −$26,753 to -$1705), and high Medicaid expenditure patterns (−$14,450, 95% CI = −$38,232 to -$4454). Savings were largely driven by shorter psychiatric hospitalizations in the post-baseline period among those placed.ConclusionsThe supportive housing program was associated with Medicaid savings, particularly for individuals with very low Medicaid coverage, increasing Medicaid expenditures, and high Medicaid expenditures pre-baseline.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2816-9) contains supplementary material, which is available to authorized users.

Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

“… 34 , 35 Interventions designed to address homelessness such as supportive housing have shown to impact healthcare utilization and expenditures. 36 – 38 …”

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

“…We found 19 studies assessing the cost and net cost of housing interventions. 30,41,45,[130][131][132][133][134][135][136][137][138][139][140][141][142][143][144][145] In some studies, permanent supportive housing interventions were associated with increased cost to the payers, and the costs of the interventions were only partially offset by savings in medical and social services as a result of the intervention. 30,41,[131][132][133][134]142 Six studies showed that these interventions saved payers money.…”

Lignes directrices de pratique clinique pour les personnes sans-abri, logées précairement, ou ayant connu l’itinérance

“…Logements permanents combinés avec support Nous avons recensé 19 études qui ont évalué le coût et le coût net des interventions axées sur le logement 30,41,45,[130][131][132][133][134][135][136][137][138][139][140][141][142][143][144][145] . Selon certaines, les interventions de type logement permanent combiné avec support (LPCS) ont été associées à une augmentation des coûts pour les payeurs, et les coûts des interventions n'ont été que partiellement compensés par les économies sur le plan des services médicaux et sociaux par suite des interventions 30,41,[131][132][133][134]142 .…”