Healthcare for the Homeless (HCH) Projects and Medicaid Expansion

Medicaid expansion was ruled optional in 2012 by the Supreme Court, which allowed some states to adopt it while others did not. This study examines the differences in the percent uninsured, healthcare utilization by service type, and clinical quality of care measures at HCH (Healthcare for the Homeless) projects between expansion and non-expansion states. An exploratory state-level retrospective analysis of annual Uniform Data System data limited to HCHs from 2012 to 2019 from 50 states plus Washington DC is presented. Using descriptive statistics and linear mixed models, we found that the percentage of uninsured HCH patients decreased across all states, but the decrease was greater in states that expanded Medicaid compared to states that did not (- 8.23, p < .0.0001). This implies HCH projects can rely less on grants and more on insurance reimbursement. When examining specific service categories, medical services in expansion states increased at a statistically significant rate post expansion as compared to non-expansion states (2.52, p = 0.0085). The percentage of substance use visits were lower in expansion states compared to non-expansion states (- 0.79, p = 0.0267). Finally, there were three preventive clinical quality of care measures at HCH projects that showed significant improvement in expansion states post expansion: colorectal cancer screening, blood pressure control, and diabetes control. Maintaining Medicaid expansion is advantageous given its association with reductions in uninsured, increased medical services utilization, and improvement in some clinical quality of care measures for homeless populations receiving services at HCH projects in expansion states.