Medicaid and Service Use Among Homeless Adults

Expansions of Medicaid eligibility intend to improve access to care, and to shift care from emergency rooms and inpatient hospital care to more appropriate sites. We examine the effect of Medicaid recipiency on the level and site of medical service utilization using data from 1985 and 1987 surveys of New York City homeless single men and women. Simple regressions of Medicaid on the use of health services among homeless adults indicate that Medicaid significantly increases the likelihood that these individuals receive services, especially emergency and inpatient hospital services. We test this result in further analyses that control for health status, use instrumental variables procedures, and examine differences between a similar population in 1985 and 1987. These analyses suggest that Medicaid neither increases nor diminishes access to emergency rooms. We find some evidence that suggests that Medicaid does improve access to non-hospital medical care.