Abstract
Context: There is growing interest in developing Medicaid-funded tenancy support services (TSS) for homeless populations due to greater enrollment of homeless persons following the Affordable Care Act (ACA) Medicaid expansion and an emerging body of evidence that such services can reduce avoidable healthcare spending. Methods: Drawing on linked Homeless Management Information System and Medicaid claims and encounter data, this study describes the characteristics of adults who could be eligible for Medicaid TSS in New Jersey and compares their utilization and Medicaid spending patterns to matched non-homeless beneficiaries. Findings: More than 8,400 adults are estimated to be eligible for Medicaid TSS benefits in 2016 including approximately 4,000 living in permanent supportive housing, 800 formally designated as "chronically homeless" according to federal guidelines, 1,300 who are likely to be eligible for chronically homeless designation, and over 2,000 who are at risk of becoming chronically homeless. The groups of homeless adults are disproportionately ages 30-64, male, and African American and suffer very high burdens of mental health and substance use disorders, including opioid-related conditions. Medicaid spending for beneficiaries who are potentially eligible for TSS is 10% ($1,362) to 27% ($5,727) more than non-homeless Medicaid beneficiaries matched on demographic and clinical characteristics. Hospital inpatient and emergency department utilization accounts for three fourths or more of "excess" Medicaid spending among the homeless groups. Conclusions: The analysis identifies a large group of high-need Medicaid beneficiaries who could benefit from TSS and specific areas where Medicaid funding for TSS could potentially reduce avoidable Medicaid utilization and spending.