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

摘要 有充分的证据表明，无家可归与基本保健服务不足有关 非洲裔美国人、西班牙裔/拉丁裔和农村人口面临无家可归和/或 后果然而，对使用特定类型医疗保健方面的差距了解不够 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， 永久性支持性住房（PSH）计划的潜力，以缩小差距。本研究旨在：1） 量化无家可归者对医疗补助计划中基本卫生服务使用差距的贡献 2）评估差距的程度， 通过安置在PSH计划中缓解;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相关的种族/族裔和农村 差距。本研究将克服以往研究的不足，采用新的大规模，人口- 基于长期的数据，结合综合定量和定性研究方法。这项研究将 利用10年（2011-2020年）的无家可归者联系服务和医疗补助行政管理来实现前两个目标 新泽西和宾夕法尼亚的数据。无家可归对保健差距和不平等的影响 将通过比较社区和医院的广泛使用和支出来衡量 在经历无家可归的成年人中提供健康服务，以匹配那些没有 无家可归。将通过比较医疗保健使用趋势和种族/民族差异来评价PSH 和农村居民身份的人中， 没有收到这样的安置。将制定具体的可采取行动的战略，以改进政策和做法， 在与前线PSH专业人员的焦点小组中确定，在此期间将分享定量结果 和讨论

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.