What the comparison does—and does not—show
The study’s comparison helps define the limits of its findings. The housed patients’ costs later fell below those of MetroHealthPlus enrollees who had similarly high healthcare use and costs at the outset but remained homeless. They did not fall below costs for the broader homeless population enrolled in MetroHealthPlus, Gothamist reported. These group comparisons describe changes over time; on their own, they do not establish that housing caused those changes.
The analysis covered Medicaid claims for 259 New Yorkers who received help finding apartments or supportive housing through NYC Health and Hospitals. The health system and Wakely Consulting Group conducted the research to assess healthcare use after participants entered housing, according to Gothamist.
How use of hospital care changed
Gothamist’s account of the analysis reported that, in the first two years after housing placement, participants’ emergency department visits declined by about 40% and inpatient stays by 36%. Their average annual time in the hospital fell from 10 days to five. Monthly inpatient-care spending per person went from $1,278 before placement to $492 in the first year housed, while average healthcare costs declined by nearly $17,000 per person over the first two years, the outlet reported.
Spending on doctors’ visits and other non-emergency services, including substance-use treatment, increased after participants were housed, Gothamist reported. That change describes a different mix of services used; the figures alone do not explain why it changed.
The housing services behind the study
Housing for Health, launched under the Adams administration, helps patients find permanent housing. NYC Health and Hospitals also develops supportive housing and transitional options for patients leaving inpatient care without a place to go, according to Gothamist.
The hospital system says more than 1,200 patients and their families have found housing through the initiative. Participants placed in affordable or supportive housing pay no more than 30% of their income toward rent, and the program plans to create more than 650 affordable homes on hospital land, according to NYC Health + Hospitals. Its services also include medical respite for medically vulnerable patients discharged from acute care, with access to medical services and housing case management, as described by the system on its Housing for Health page.
What Medicaid coverage does—and does not show
Separately from this study, NYC Health says organizations that join Social Care Networks may be reimbursed for certain eligible social services under the state’s Medicaid 1115 waiver, according to NYC Health. That policy description does not establish that Medicaid paid rent or financed the housing placements in the study.
Findings from other cities
Other evaluations have also reported lower healthcare or public-service costs after housing, though their results do not settle what caused the changes. A Portland pilot involving 98 homeless residents with high healthcare use found that the 58 participants with Medicaid had average annual Medicaid expenditures $8,724 lower in the year after moving into housing, according to AJMC.
A RAND evaluation of Los Angeles County’s Housing for Health program included 890 people housed through June 2015. It reported average public-service costs of $38,146 per participant in the year before housing and $15,358 in the year after; after supportive-housing expenses were included, the report calculated a 20% offset for direct service costs. RAND said a comparison group would be needed for stronger conclusions about whether the program caused the changes, according to its evaluation.
