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. 2021 Jan 21;31(1):89-96.
doi: 10.18865/ed.31.1.89. eCollection 2021 Winter.

Homelessness and Medicaid Churn

Isaac Dapkins  1   2 , Saul B Blecker  2
Affiliations

Homelessness and Medicaid Churn

Isaac Dapkins et al. Ethn Dis. .

Abstract

Objectives: To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code.

Design: Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indicator for homelessness.

Main outcome measures: Any interruption in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identification numbers (CIN) for continuity.

Methods: Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017.

Results: ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrated linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016-2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experienced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn.

Conclusions: Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness.

Keywords: Access to Care; Coverage Gap; Homelessness; Medicaid Churn; Social Determinants of Health; Value-based Care.

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Conflict of interest statement

Competing Interests: None declared.

Figures

Figure 1.
Figure 1.. Lack of housing / homelessness in New York State Medicaid claims, 2006-2017
See this image and copyright information in PMC

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