title: Frequent Emergency Department Visits and Hospitalizations Among Homeless People With Medicaid: Implications for Medicaid Expansion.
abstract: OBJECTIVE
  We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless.
  
  
  METHODS
  We included 6494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. We used negative binomial regression to examine variables associated with frequent utilization.
  
  
  RESULTS
  Approximately one third of the study population had at least 1 hospitalization and two thirds had 1 or more ED visits. More than 70% of hospitalizations and ED visits were incurred by only 12% and 21% of these members, respectively. Homeless individuals with co-occurring mental illness and substance use disorders were at greatest risk for frequent hospitalizations and ED visits (e.g., incidence rate ratios [IRRs] = 2.9-13.8 for hospitalizations). Individuals living on the streets also had significantly higher utilization (IRR = 1.5).
  
  
  CONCLUSIONS
  Despite having insurance coverage, homeless Medicaid members experienced frequent hospitalizations and ED visits. States could consider provisions under the Patient Protection and Affordable Care Act (e.g., Medicaid expansion and Health Homes) jointly with housing programs to meet the needs of homeless individuals, which may improve the quality and cost effectiveness of care.
authors.affiliation: Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Lin
authors.affiliation: Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Monica
authors.initials: M
authors.lastname: Bharel
authors.affiliation: Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: Wen-Chieh Lin, Jianying Zhang, and Elizabeth O'Connell are with the Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury. Wen-Chieh Lin is also with and Robin E. Clark is with Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. At the time of the study Monica Bharel was with the Boston Health Care for the Homeless Program and Boston Medical Center, Boston, MA. Jianying Zhang and Robin E. Clark are also with Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Robin E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States