Associations of Homelessness With Primary Care and Acute Care Utilization Among Medicaid-Enrolled Youth

Bibliographic Data

ID9103698
AuthorsDahai Yue (0000-0002-1525-6776, Department of Health Policy and Management, University of Maryland, College Park, MD, corresponding author), Elizabeth Chuang (0000-0001-9227-3273, University of California, Berkeley), Emmeline Chuang (School of Social welfare, University of California, Berkeley), Weihao Zhou (0000-0003-1338-5256, Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, CA), Elsie A Essien (Department of Health Policy and Management, University of Maryland, College Park, MD, corresponding author), Young-Eun Lee (0000-0002-1392-0514, University of Maryland, College Park, corresponding author), Youngeun Lee (0000-0001-7115-534X, Department of Health Policy and Management, University of Maryland, College Park, MD), Brenna O’Masta (Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, CA), Nadereh Pourat (0000-0001-5118-1188, Department of Health Policy and Management, University of California, Los Angele, CA)
Year2024
Volume62
Issue10
Pages631-638
Publication date2024-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002009
PMID38775677
OpenAlexW4398204790
LanguageEN
Citations received1
References cited31

BACKGROUND: Youth comprise one-third of the US homeless population. However, little is known about how homelessness affects health care utilization. OBJECTIVE: Examine associations of homelessness with hospitalization, primary care, and ED visits, varying by race/ethnicity, among Medicaid-enrolled youth. RESEARCH DESIGN: A cross-sectional analysis was conducted using California Medicaid claims data on youth beneficiaries with complex needs. We examined the number of hospitalizations, preventable and nonpreventable ED, and primary care visits using a multivariate regression. We further explored the differential associations by race/ethnicity. RESULTS: Approximately 17% of our sampled youth experienced homelessness in 2018 (N=90,202). Compared with their housed counterparts, youth experiencing homelessness had a 1.9 percentage point (pp) higher likelihood of frequent ED visits (95% CI: 1.7-2.2) but a 2.9 pp lower probability of any primary care visits (95% CI: -3.9 to -1.9). Homelessness was associated with 221 more ED visits (95% CI: 182-260), 100 more preventable ED visits (95% CI: 84-116), 19.9 more hospitalizations (95% CI: 12-27), but 56 fewer primary care visits (95% CI: -104 to -7), per 1000 youth. The associations of homelessness with total ED visits, preventable ED visits, and needed and nonpreventable ED visits were all higher among Whites and, particularly, Blacks than for Hispanics and Asians. CONCLUSIONS: Medicaid-enrolled youth who experienced homelessness had more overall ED, preventable ED, and hospital visits, but fewer primary care visits than their housed peers. Our results suggest promoting primary care use should be considered among strategies to improve health and reduce costs

Family medicine · Health care · Medicaid · Political science · Primary care · Family Support in Illness · Food Security and Health in Diverse Populations · Homelessness and Social Issues · Medicine · Gerontology

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