Health Aff (Millwood). 2013 Sep;32(9):1552-9. doi: 10.1377/hlthaff.2013.0228.
Homeless adults may gain access to health services under the Affordable Care Act's Medicaid expansion, which takes effect in 2014. This study analyzed the health coverage, health status, and health services use of 725 chronically homeless adults with disabilities in eleven cities in the United States. Nearly three-quarters of the chronically homeless adults in this study with incomes below the threshold for the Medicaid expansion were not enrolled in Medicaid. Fifty-three percent were uninsured or relied solely on state or local assistance, and 21 percent had other coverage that included Department of Veterans Affairs health care. The findings on differences in health status and service use across groups suggest that the Medicaid expansion offers important opportunities to increase coverage and access to care for chronically homeless adults. There may be potential savings for states that expand Medicaid, as people transition from state and local assistance to more comprehensive services under Medicaid. Targeted outreach and assistance to enroll eligible homeless people will be necessary. A broad range of physical and mental health services will be required, including case management to coordinate services.
无家可归的成年人可能会根据平价医疗法案的医疗补助扩大计划获得医疗服务，该计划将于 2014 年生效。本研究分析了美国 11 个城市的 725 名残疾慢性无家可归成年人的健康保险覆盖范围、健康状况和医疗服务使用情况。本研究中收入低于医疗补助扩大门槛的近四分之三的慢性无家可归残疾成年人没有参加医疗补助。53%的人没有保险，或者只依赖州或地方援助，21%的人有其他包括退伍军人事务部医疗保健的保险。不同群体在健康状况和服务使用方面的差异发现表明，医疗补助扩大计划为增加慢性无家可归成年人的覆盖范围和获得医疗服务提供了重要机会。对于扩大医疗补助的州来说，可能会有潜在的节省，因为人们从州和地方援助过渡到医疗补助下更全面的服务。有必要针对符合条件的无家可归者进行有针对性的外展和援助，以帮助他们参保。将需要广泛的身心健康服务，包括病例管理以协调服务。
