Changes in healthcare costs and utilization for Medicaid recipients who received supportive housing through a payer-community-based housing partnership

OBJECTIVE: To evaluate healthcare cost and utilization changes among Medicaid and dually eligible participants of a supportive housing program implemented by a managed care organization and community-based organization. 

STUDY SETTING AND DESIGN: Healthcare claims were reviewed retrospectively for 80 program participants in one urban Pennsylvania county between 1/1/2018 and 9/28/2023 who had ≥6 months of claims data in both pre- and post-housing periods. Eligibility included age >18 years, Medicaid/Special Needs Plan enrollment, and housing need. Due to limited housing units, potential participants were prioritized by medical need and history of unplanned care. 

DATA SOURCES AND ANALYTIC SAMPLE: Healthcare cost and utilization were compared during pre- (i.e., 12 months before housing initiation) and post-periods (i.e., 12 months after housing initiation). 

PRINCIPAL FINDINGS: Compared to the pre-period, significantly lower medical (-40.4%, p = 0.004), emergency department (-62.7%, p = 0.02), and total (-33.3%, p = 0.02) costs of care were observed in the post-period. Significantly lower primary care (-50.0%, p = 0.0003), specialist (-31.3%, p = 0.02), and emergency department (-50.0%, p = 0.03) utilization were also observed. 

CONCLUSIONS: Healthcare cost and utilization among medically complex individuals were lower with supportive housing. Future evaluations with randomized designs can address the potential causal impact of supportive housing as a healthcare intervention on specific outcomes.