The Preventive Effect of Housing First on Health Care Utilization and Costs Among Chronically Homeless Individuals

Kevin Brennan
Kathryn Buggs
Pete Zuckerman
Singumbe Muyeba
Alexis D. Henry
John Gettens
Parag Kunte
December 2020


Housing First programs and associated support services reduced health care-related expenditures for the Massachusetts Medicaid program.


In the Housing First model, people experiencing homelessness receive housing before support services, and accepting those services is not a requirement for staying housed. This study reviews the effects of Housing First — as well as services from the Community Support Program for those Experiencing Chronic Homelessness — on the Massachusetts' Medicaid program costs and health care utilization.


People who received housing in the Housing First model had significantly lower average per patient per year health care costs ($25,614) and lower rates of all-cause inpatient and emergency department visits, when compared to a control group ($30,881). Although individuals who received this intervention accrued higher mental-health related costs, the nearly $9,000 in savings on inpatient services kept their total costs lower than people in the comparison group. Although the intervention cohort had more mental health encounters than the comparison cohort, these mental health services may have mitigated higher use of more costly inpatient and emergency hospital services in the intervention group.


The findings of this report affirm other evidence showing that the Housing First approach, along with community-based support services, can achieve improved utilization and cost outcomes. 

Posted to The Playbook on