Medicaid Utilization and Spending among Homeless Adults in New Jersey: Implications for Medicaid-Funded Tenancy Support Services

Joel C. Cantor
Sujoy Chakravarty
Jose Nova
Taiisa Kelly
Derek Delia
Emmy Tiderington
Richard W Brown
Peer-Reviewed Article
January 2020

Adults experiencing homelessness have high levels of health care needs, including those related to mental health and substance use disorders, and are more likely to visit the emergency department (ED). Many policymakers are interested in improving the health of this population and in reducing avoidable ED and inpatient utilization, and some state Medicaid agencies are exploring funding tenancy support services (TSS) for Medicaid enrollees experiencing homelessness. Tenancy support services may include service planning, tenant orientation and move-in assistance, and landlord dispute resolution, to help individuals achieve stable housing.

An analysis of linked Medicaid and homeless services data in New Jersey found that offering TSS to adult Medicaid beneficiaries experiencing homelessness could reduce avoidable Medicaid spending. The study found that a significant number of very high-need Medicaid enrollees experiencing homelessness could benefit from TSS. Additionally, Medicaid spending for individuals experiencing homelessness who are potentially eligible for TSS was 10 – 27 percent higher than for the non-homeless population, with most of that increased spending on hospital inpatient and ED utilization. Enrollees with disabling health conditions and longer histories of homelessness may have the greatest opportunity to offset the cost of TSS, as these groups experience more potentially avoidable health care interventions.

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