Requiring Proof of Youth Homelessness Adds Costs to Health Systems

Does a screening requirement for homeless families seeking shelter create unintended costs? In 2012, Massachusetts passed a law requiring homeless families seeking shelter to prove that they had recently stayed somewhere not meant for human habitation. Hospital emergency department discharge paperwork can provide such proof. This study explored the trends of emergency department use for shelter by homeless youth before and after the eligibility criteria was passed into law and to measure the financial impact it had on the health care system.

Researchers conducted a retrospective analysis of deidentified medical records of homeless children and young adults from birth to age 21 seeking shelter at a pediatric emergency department in Boston from 12 months before the eligibility rule to four years after the rule went into effect. They analyzed the number of visits, length of stay, insurance claims, and hospital charges before and after the policy change. Researchers found a significant increase in emergency department use for homelessness after the policy change. The results indicate that policymakers should consider the potential unintended health care costs of shelter eligibility policies and identify housing strategies that can prevent emergency department visits by families experiencing homelessness.

Key findings

• The researchers identified 1,078 visits to the emergency department by 916 children and young adults for the primary reason of “homelessness.”
• Visits to the emergency department for homeless children and young adults increased from an average of 3 per month to 17 per month after the 2012 policy change.
• Visits after the 2012 policy change took more than 8,500 hours of emergency department time and cost more than $200,000 of Medicaid funds.
• The total cost incurred by these visits could have funded 1,594 shelter nights at the state average shelter rate of $130 per family per night.

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