Homeless and nonhomeless VA service users likely eligible for Medicaid expansion

1. Homeless and nonhomeless VA service users likely eligible for Medicaid expansion Jack Tsai, PhD; Robert A. Rosenheck, MD

2. Aim • Use administrative data on 2010 VA service users to: • Estimate how many homeless and nonhomeless VA service users may be eligible for 2014 Medicaid expansion (LEME). • Compare LEME and not LEME by homeless status on sociodemographic characteristics and medical and psychiatric diagnoses. • Relevance • Results will estimate VA service users to be affected by Affordable Care Act’s (ACA’s) Medicaid expansion and explore their characteristics and health needs.

3. Method • Analyzed administrative data on 3.8 million VA service users under age 65 in 2010 to identify number and characteristics of those who are homeless vs nonhomeless and LEME.

4. Results • 1.2 million (21%) VA services users are LEME if all states implement expansion. • Homeless service users twice as likely to be LEME than nonhomeless users (64% vs 30%). • Both homeless and nonhomeless LEME VA service users were physically healthier but more likely to have substance use disorders and posttraumatic stress disorder than those not LEME.

5. Conclusion • Many VA service users are LEME, particularly those who are homeless and/or have mental health needs. • Cross-system use of VA and Medicaid-funded services may be advantageous for veterans with extensive medical and psychiatric needs but also risks fragmented care. • Information and education for VA clinicians and patients about possible implications of ACA are important.