Progress of California's Effort to Improve Outcomes of Care for Homeless Medicaid Patients Under a Section 1115 Medicaid Waiver Program

Abstract

Research ObjectiveThe current Section 1115 Medicaid Waiver in California includes the Whole Person Care (WPC) pilot program, designed to improve care coordination for high‐cost, high‐utilizing populations, with special emphasis on the homeless. Pilots link homeless and other patients to housing, food, benefits, and similar services with the goals of improving health outcomes. We examined the impact of WPC in the first two years of the program on health care utilization of homeless enrollees.Study DesignWe conducted difference‐in‐difference (DD) analyses using a generalized mixed‐effect model to compare the 2‐year change in the pre‐ and postperiod among key outcome measures using an intervention‐control methodology. We developed a model for identifying homeless Medicaid patients in a control sample that matched the characteristics of WPC enrollees. We examined the (1) likelihood of hospitalization, (2) likelihood of emergency department (ED) visits, (3) number of ED visits, outpatient follow‐up after hospitalization for mental illness in (4) 7 days and (5) 30 days, and (6) initiation and (7) engagement of alcohol and other drug dependence treatment.Population StudiedThe DD model included 133 998 person‐years among the WPC homeless enrollees and 201 523 person‐years among the control group.Principal FindingsThe analyses (table below) showed that the predicted probability of hospitalization and ED visits and predicted number of ED visits declined for WPC homeless enrollees from before to after WPC enrollment, with a greater reduction for WPC enrollees than the control group in the same time period. Changes in other outcomes were not significant.ConclusionsEarly analyses indicated reductions in ED visits and hospitalizations among homeless WPC enrollees compared to the control group but not the other outcomes examined. Improvements in outcomes were likely due to pilot's effort to assess homeless patients' needs and linkages to housing and other needed social services.Implications for Policy or PracticeReductions in ED visits and hospitalizations are likely indicators of better outcomes and have significant implications for cost reduction under the Medicaid program. Our findings provide the needed evidence that provision of housing support and other social services may improve health outcomes among homelessness patients who frequently have higher level of need for care.Primary Funding SourceCalifornia Department of Health Care Services.