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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Sungwoo Lim, Qi Gao, Elsa Stazesky, Tejinder P. Singh, Tiffany G. Harris, Amber Levanon Seligson
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-017-2816-9) contains supplementary material, which is available to authorized users.

Abstract

Background

A rapid increase of Medicaid expenditures has been a serious concern, and housing stability has been discussed as a means to reduce Medicaid costs. A program evaluation of a New York City supportive housing program has assessed the association between supportive housing tenancy and Medicaid savings among New York City housing program applicants with serious mental illness and chronic homelessness or dual diagnoses of mental illness and substance use disorder, stratified by distinctive Medicaid expenditure patterns.

Methods

The evaluation used matched data from administrative records for 2827 people. Sequence analysis identified 6 Medicaid expenditure patterns during 2 years prior to baseline among people placed in the program (n = 737) and people eligible but not placed (n = 2090), including very low Medicaid coverage, increasing Medicaid expenditure, low, middle, high, and very high Medicaid expenditure patterns. We assessed the impact of the program on Medicaid costs for 2 years post-baseline via propensity score matching and bootstrapping.

Results

The housing program was associated with Medicaid savings during 2 years post-baseline (−$9526, 95% CI = −$19,038 to -$2003). Stratified by Medicaid expenditure patterns, Medicaid savings were found among those with very low Medicaid coverage (−$15,694, 95% CI = −$35,926 to -$7983), increasing Medicaid expenditures (−$9020, 95% CI = −$26,753 to -$1705), and high Medicaid expenditure patterns (−$14,450, 95% CI = −$38,232 to -$4454). Savings were largely driven by shorter psychiatric hospitalizations in the post-baseline period among those placed.

Conclusions

The supportive housing program was associated with Medicaid savings, particularly for individuals with very low Medicaid coverage, increasing Medicaid expenditures, and high Medicaid expenditures pre-baseline.
Zusatzmaterial
Additional file 1: A flow chart of sample selection process. This file illustrates how exclusion criteria were applied in order to generate a final evaluation sample. (DOCX 20 kb)
12913_2017_2816_MOESM1_ESM.docx
Additional file 2: Covariates included in the propensity score models. This file contains a list of covariates that were included in the propensity score models. (DOCX 19 kb)
12913_2017_2816_MOESM2_ESM.docx
Additional file 3: Summary of balance of baseline characteristics between placed and unplaced people before and after propensity score matching. This file shows performance of propensity score matching in balancing baseline characteristics between placed and unplaced people. (DOCX 13 kb)
12913_2017_2816_MOESM3_ESM.docx
Additional file 4: Weighted mean psychiatric inpatient costs among placed versus unplaced persons with very low coverage, emerging user, and second-highest user patterns. This file shows weighted mean psychiatric inpatient costs among placed and unplaced persons, stratified by three trajectory groups, including very low coverage, emerging user, and second-highest user patterns. (DOCX 12 kb)
12913_2017_2816_MOESM4_ESM.docx
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