07 Feb Study Addresses Health Insurance Needs of Homeless Young Adults
MedicalResearch.com
Hailey Winetrobe, MPH, CHES
Project Manager
NIDA Transitions to Housing Study
School of Social Work
University of Southern California
MedicalResearch: What is the background for this study? What are the main findings?
Response: Homeless young adults are a very vulnerable population with high healthcare needs. However, because of their housing instability and very low income, many homeless young adults may not have health insurance and/or access to healthcare services. Prior research regarding this population’s health insurance coverage was mostly outdated. Additionally, with the implementation of the Affordable Care Act (ACA), homeless young adults may now qualify for health insurance coverage (i.e., if there is a relationship, by being a dependent on their parent’s health insurance until 26 years old; and via Medicaid expansion in states choosing to expand). As such, this study aimed to update homeless young adults’ rates of health insurance coverage prior to the full implementation of the ACA (i.e., before Medicaid expansion) and to determine if there was an association between insurance and use of healthcare services.
We found that 70% of homeless young adults did not have health insurance in the prior year. Of those with health insurance, 46% reported coverage through their parents, and 34% through Medicaid (not mutually exclusive). Over half (52%) of the sample received healthcare in the prior year. Furthermore, in a multivariable logistic regression model controlling for demographic characteristics, homeless young adults with health insurance, compared to their peers who did not have health insurance, had 11 times the odds of receiving healthcare in the prior year.
MedicalResearch: What should clinicians and patients take away from your report?
Response: Clinicians and other healthcare providers should encourage homeless young adult patients without health insurance to enroll in coverage, as insurance coverage is the only factor that is associated with receiving care. Common sources of healthcare for this population include emergency departments, community clinics, hospitals, and private doctors’ offices. These facilities should have referrals in place to assist uninsured homeless young adults to enroll in health insurance. Moreover, because homeless young adults often have difficulties in accessing care, clinicians should treat each visit as an opportunity to provide comprehensive healthcare services while being mindful of the barriers associated with any potential follow-up care.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Response: As this study was conducted prior to the full implementation of the ACA and in a state that has now expanded Medicaid, new studies should investigate the health insurance coverage of homeless young adults nationwide. It would be interesting to see how coverage rates vary in states that have opted to expand Medicaid versus those that chose not to expand. Future research may utilize medical records to examine the specific healthcare services (e.g., preventive care, chronic care) that homeless young adults are obtaining and how their health insurance (or lack thereof) may be impacting their receipt of services.
Citation:
Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA
J Public Health first published online January 28, 2015 doi:10.1093/pubmed/fdv001
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Last Updated on February 7, 2015 by Marie Benz MD FAAD