Moving to Better Health Care? Evidence from the Impact of Medicaid Expansion on Homeless Individuals in the U.S.

Primary author: Ashutosh Kumar
Faculty sponsor: Ben Cowan

Primary college/unit: Agricultural, Human and Natural Resource Sciences
Campus: Pullman


Homeless individuals grapple with varied health problems but have limited access to health care. This study extends the literature on health care and homelessness and provides the first causal evidence of the impact of the Medicaid expansion on migration of homeless individuals from non-expansion to expansion states. The Medicaid expansion, adopted by 26 states and Washington DC and rejected by 24 states in January 2014, expanded coverage to previously uninsured homeless individuals. Besides health care, the expansion equipped homeless service providers with extra flexibility to tackle homelessness through several supportive services and housing-related activities, absent in non-expansion states. Using the state level data, released by the Department of Housing and Urban Development (HUD), on the homeless population from 2009-2018, estimates from a difference-in-differences model suggest migration of homeless individuals, where expansion states saw statistically significant 4.4 percent increase, while non-expansion states simultaneously experienced a 22.6 percent decline. Furthermore, utilizing the difference in coverage status of homeless individuals vis-a-vis homeless people in families (who had pre-expansion coverage), estimates from a triple difference (DDD) model also confirm a significant migration. Previous studies documenting the positive impact of Medicaid expansion on a number of outcomes – improved coverage and health care utilization, reduced financial hardships and medical bills sent to collection, and increased household savings – compliment the results of this study. This paper provides additional evidences that Medicaid expansion had no significant impact on the number of homeless veterans or on indicators like bankruptcy, unemployment rate and poverty rate.