The Role of Homelessness and Supportive Housing in Healthcare Disparities among Adults in Medicaid

摘要 有充分的证据表明，无家可归与获得基本卫生服务的机会不足有关 非洲裔美国人、西班牙裔/拉丁裔和农村人口无家可归和/或无家可归的风险很高 后果。然而，对于特定类型的医疗保健的使用差距，知识不足 在无家可归的成年人中，这种差距在少数民族和农村人口中是否更大，以及 永久性支持性住房(PSH)计划的潜力，以缓解差距。本研究旨在：1) 量化无家可归对医疗补助中基本健康服务使用差距的贡献 按种族/族裔和农村居住状况分列受益者；2)评估差距的程度 通过在PSH计划中的放置来缓解；以及3)确定Medicaid和PSH政策和计划 改善获得基本保健服务的机会和减少与种族/族裔和农村有关的战略 差距。这项研究将克服以往研究中的缺陷，使用新的大范围、人口- 基于长期数据，结合定量与定性相结合的研究方法。这项研究将 利用10年(2011-2020)的联系无家可归者服务和医疗补助行政管理来实现前两个目标 新泽西州和宾夕法尼亚州的数据。无家可归者对医疗保健差距和差距的贡献 将通过比较广泛的社区和医院的利用率和支出来衡量 无家可归的成年人与匹配的医疗补助受益人之间的卫生服务 无家可归。PSH将通过比较医疗保健使用的趋势和种族/民族的差异来进行评估 获得住房安置的成年人在类似情况下的农村居住状况 没有收到过这样的安置。改进政策和实践的具体可行战略将是 在与一线PSH专业人员的焦点小组中确定，在此期间将分享量化结果 并进行了讨论。

Abstract There is ample evidence that homelessness is associated with inadequate access to essential health services and that African American, Hispanic/Latinx and rural populations are at high risk for homelessness and/or its consequences. However, there is insufficient knowledge about gaps in use of specific types of healthcare among homeless adults, whether such gaps are greater among minority and rural populations, and the potential of permanent supportive housing (PSH) programs to mitigate the gaps. This study aims to: 1) quantify the contribution of homelessness to gaps in essential health services use among Medicaid beneficiaries by race/ethnicity and rural residential status; 2) evaluate the extent to which the gaps are mitigated by placement in PSH programs; and 3) identify Medicaid and PSH policy and programmatic strategies for improving access to essential health services and reducing associated racial/ethnic and rural disparities. This study will overcome shortcomings in prior research by using novel large scale, population- based, long-term data, combined with integrated quantitative-qualitative research methods. The study will address the first two aims using 10 years (2011-2020) of linked homeless services and Medicaid administrative data for New Jersey and Pennsylvania. The contribution of homelessness to healthcare gaps and disparities will be measured by comparing utilization and spending for a broad spectrum of community-based and hospital health services among adults experiencing homelessness to matched Medicaid beneficiaries who have not been homeless. PSH will be evaluated by comparing trends in healthcare use and disparities by race/ethnic and rural residential status among those receiving housing placements to adults in similar circumstances who did not receive such placements. Specific actionable strategies for improving policy and practice will be identified in focus groups with front-line PSH professionals during which quantitative findings will be shared and discussed.