title: Homeless and nonhomeless VA service users likely eligible for Medicaid expansion.
abstract: Administrative data on the population of Department of Veterans Affairs (VA) service users in 2010 under the age of 65 (n = 3,841,225) were analyzed to identify the number and characteristics of homeless and nonhomeless VA service users who are likely to be eligible for the Medicaid expansion (LEME) option under the Affordable Care Act. Results showed that, estimating conservatively, about 1.2 million (21%) current VA users are LEME if all states implement the expansion. Homeless service users were twice as likely to be eligible than nonhomeless users (64% vs 30%). VA service users who are LEME, regardless of housing status, were physically healthier than those not LEME but were more likely to have substance use disorders and posttraumatic stress disorder. These findings suggest that many VA service users are LEME, particularly those who are homeless and/or have mental health needs. Cross-system use of VA and Medicaid-funded services may be advantageous for veterans with extensive medical and psychiatric needs but also risks fragmented care. Information and education for VA clinicians and their patients about possible implications of the Affordable Care Act may be important.
authors.affiliation: Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs New England Healthcare System, West Haven, CT; and Department of Psychiatry, Yale School of Medicine, New Haven, CT;
authors.forename: Jack
authors.initials: J
authors.lastname: Tsai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D004608:Eligibility Determination; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Affordable Care Act; Department of Veterans Affairs; Medicaid; cross-system use; health services; homelessness; posttraumatic stress disorder; psychiatric disorders; substance use disorder; veterans