Kaiser Permanente Northern California Division of Research, Oakland.
School of Public Health, University of California, Berkeley.
JAMA Health Forum. 2024 Sep 6;5(9):e242802. doi: 10.1001/jamahealthforum.2024.2802.
Housing deposits and tenancy supports have become new Medicaid benefits in multiple states; however, evidence on impacts from these specific housing interventions is limited.
To evaluate the association of rental housing deposits and health care use among Medicaid beneficiaries receiving social needs case management as part of a Whole-Person Care (Medicaid 1115 waiver) pilot program in California.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study compared changes in health care use among a group of adults who received a housing deposit between October 2018 and December 2021 along with case management vs a matched comparison group who received case management only in Contra Costa County, California, a large county in the San Francisco Bay Area. All participants were enrolled in health and social needs case management based on elevated risk of acute care use. Data analysis took place from March 2023 to June 2024.
Rental housing deposit funds that covered 1-time moving transition costs. Funds averaged $1750 per recipient.
Changes in hospitalizations, emergency department visits, primary care visits, specialty care visits, behavioral health visits, psychiatric emergency services, or detention intakes during the 6 months before vs 6 months after deposit receipt. Changes 12 months before and after deposit receipt were examined as a sensitivity analysis.
Of 1690 case management participants, 845 received a housing deposit (362 [42.8%] <40 years old; 422 [49.9%] male) and 845 received case management only (367 [43.4%] <40 years old; 426 [50.4%] male). In adjusted analyses, deposit recipients had no statistically significant differential changes in health care use for any measure compared to participants who received case management alone. Twelve-month sensitivity analyses yielded consistent results.
In this cohort study, compared to case management only, housing deposits with case management were not associated with short-term changes in health care use. There may be other unmeasured health benefits or downstream benefits from greater case management engagement. States considering housing deposits as an expanded Medicaid benefit may need to temper expectations about short-term health care use impacts.
住房押金和租赁补贴已成为多个州新的医疗补助（Medicaid）福利项目；然而，关于这些特定住房干预措施的影响证据有限。
评估加利福尼亚州全人关怀（Medicaid 1115 豁免）试点项目中，接受社会需求案例管理的医疗补助受助人获得租金住房押金与医疗保健使用之间的关联。
设计、环境和参与者：本队列研究比较了加利福尼亚州康特拉科斯塔县（旧金山湾区的一个大型县）一组在 2018 年 10 月至 2021 年 12 月期间获得住房押金的成年人与仅接受案例管理的对照组相比，在健康保健使用方面的变化。所有参与者都因急性护理使用风险较高而接受健康和社会需求案例管理。数据分析于 2023 年 3 月至 2024 年 6 月进行。
住房押金资金可一次性用于支付搬迁过渡费用。每位接受者的平均资金为 1750 美元。
在获得押金前 6 个月和获得押金后 6 个月期间，住院、急诊就诊、初级保健就诊、专科就诊、行为健康就诊、精神科急诊服务或拘留入院的变化。还检查了押金获得前 12 个月和后 12 个月的变化作为敏感性分析。
在 1690 名接受案例管理的参与者中，845 人获得住房押金（362 人<40 岁；422 人男性），845 人仅接受案例管理（367 人<40 岁；426 人男性）。在调整后的分析中，与仅接受案例管理的参与者相比，住房押金接受者在任何衡量标准上的医疗保健使用均无统计学意义上的差异变化。12 个月的敏感性分析结果一致。
在这项队列研究中，与仅接受案例管理相比，住房押金与案例管理相结合并没有与短期医疗保健使用的变化相关联。可能还有其他未被测量的健康益处或更大的案例管理参与带来的下游益处。考虑将住房押金作为扩大医疗补助（Medicaid）福利的州可能需要降低对短期医疗保健使用影响的期望。
