Given the inflationary increases in housing (particularly rental) prices we are experiencing, Bohnhoff et al’s recently published article, “Permanent Supportive Housing and Healthcare Utilization,” is timely (10.1542/peds.2022-059833).
The authors begin their study by identifying known negative associations between homelessness and health outcomes, and highlight how providing homes and support services (case management, childcare, employment assistance, substance use disorder treatment, etc.) can mitigate chronic homelessness and Medicaid spending in adult populations. Reviewing administrative data from Medicaid and housing programs, the authors endeavored to determine if health care utilization changed as a function of having received a permanent supporting housing service (as compared to similarly matched children who didn’t receive such a service) from over 3,800 children under 18 in over 80% of Pennsylvania counties in this retrospective case control natural experiment.
While the only overall change in healthcare utilization observed was increased dental visits among all children who received permanent supporting housing (as compared to those who didn’t), the authors also found a reduction in emergency department (ED) visits among a subset of children 0–5-year-olds who had a chronic medical condition.
Drawing a direct link between housing and dental usage is complicated by many associated variables that may change when a family is housed. One shortcoming of the article was that there was no mention of types of supportive services the individual participants received as a part of permanent supportive housing which can include a broad range such as provision of childcare, receiving case management services, and/or transportation. Additionally, the type of housing received (shelter vs. apartment/house, whether case management and/or medical transportation was included) is not delineated which may make it difficult to definitively draw conclusions on all such services as a group without further subgroup analysis. Finally, one must keep in mind that this study was conducted over a 5-year period which may not capture longer-term outcomes and changes.
Although there was no overall significant change in non-dental healthcare visits, it should be noted that the most prevalent chronic childhood disease is dental caries and left untreated, dental infections can have significant morbidity and mortality. And as timely as this article is regarding homelessness, one must also be aware that federal matching funds for Medicaid will be reduced starting on March 31, 2023 as part of the Consolidated Appropriations Act, which may make it more difficult for people of modest/minimal incomes to obtain Medicaid. Having a stable home address may make it easier for Medicaid to contact families and keep them enrolled. Future studies are needed to determine what impact the aforementioned change to Medicaid may have on healthcare utilization.
