Health care outcomes of homelessness prevention programs in veterans experiencing housing instability

IMPORTANCE: Homelessness is associated with negative health outcomes and increased health care costs. The United States Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) program provides housing-related financial assistance and other supports to veterans experiencing housing instability; however, little is known regarding short-term assistance interventions with a prevention focus. 

OBJECTIVE: To estimate potential impacts of the SSVF program in mortality and health care cost outcomes over 3 years following program entry. 

DESIGN, SETTING, AND PARTICIPANTS: Using observational data, outcomes were compared between veterans who enrolled in SSVF with those who did not for each month from October 2015 to December 2018. A propensity score for SSVF enrollment was calculated using observable characteristics including demographics, housing history, health care cost history, comorbidities, and geography. Using inverse probability of treatment weighting-a propensity score-based method that creates a pseudopopulation in which treatment groups are balanced on observed covariates-the potential impacts of SSVF enrollment in mortality were estimated using a Cox proportional hazards regression and health care costs with a generalized linear model over the 3 years following the trial index date. Data were from the VA electronic health record for a cohort of veterans receiving care in the VA system. Each trial drew on veterans with evidence of homelessness in structured and unstructured medical records during the previous month. Data were analyzed from November 1, 2023, to September 9, 2025. 

EXPOSURE: The exposure was enrollment in the SSVF program, from the Homeless Management Information System data. 

MAIN OUTCOME: The main outcomes were all-cause mortality and VA health care costs. 

RESULTS: The cohort consisted of 693 383 patient-trials with 26 649 (3.8%) enrolling in SSVF (mean [SD] age, 52.7 [12.6] years; 89.6% male) and 666 734 (96.5%) in the no SSVF group (mean [SD] age, 53.8 [13.0] years; 90.8% male). Enrollment in SSVF was associated with a decrease in the risk of mortality (hazard ratio, 0.87; 95% CI, 0.82-0.92). In addition, enrollment in SSVF was associated with an increase in outpatient costs ($7534; 95% CI, $6767-$8302) and a decrease in inpatient costs (-$10 020; 95% CI, -$13 644 to -$6396). 

CONCLUSIONS AND RELEVANCE: In this study, federal prevention solutions to homelessness were associated with improved health outcomes and lower inpatient costs, which should inform national policy debates within and beyond the VA.