Medical respite for people experiencing homelessness: Financial impacts with alternative levels of Medicaid coverage

Medical respite (MR) programs provide medical care, social services, and a safe place to recuperate for people experiencing homelessness after hospital discharge. We examined the financial impact of MR on hospitals and insurers in states with varying Medicaid coverage. Urban case-study hospitals were selected from a state with Medicaid expansion under the Affordable Care Act (Connecticut) and without expansion (Florida). We calculated costs and savings from MR to hospitals and payers from the hospitals' financial data. These hospitals currently incur losses of 26% (Conn.) to 48% (Fla.) on inpatient care costs of patients experiencing homelessness. Medical respite would reduce these losses by reducing the index length of stay by two days, subsequent emergency department visits by 45%, and subsequent inpatient admissions by 35%, offsetting $1.81 in hospital costs for each dollar invested in MR. With appropriate sharing of costs between hospitals and payers, both would save money from MR.