Do Medicaid Expenditures Increase After Adults Exit Permanent Supportive Housing?

The effects of homelessness and permanent supportive housing (PSH) on healthcare utilization have been well documented. Prior research on the association between PSH entry and Medicaid expenditures indicates that such housing support could result in savings to Medicaid programs; however, whether changes occur in healthcare use and expenditures after individuals exit PSH is unknown. If efficiency gains from PSH persist after the individual leaves, the savings to payers such as Medicaid may continue even after the costs to provide housing for a PSH recipient have ended. We used linked Medicaid and housing data from Pennsylvania to examine changes in the level and composition of Medicaid expenditures for 580 adult enrollees during the 12 months before and after exit from PSH, adjusting for relevant covariates. In adjusted analyses, we estimated that monthly spending declined by $255.96 (95% CI: $358.70, $154.40) in the first quarter post exit and by $271.50 (95% CI: $394.30, $146.50) in the fourth quarter. Our findings suggest that PSH may have sustained budgetary benefits to state Medicaid agencies even for beneficiaries exiting the program. However, more research is needed to understand whether these reductions in expenditures last beyond 12 months and do not reflect underuse of care that may be important for managing health over the long term.