Homelessness and Medicaid Churn

Abstract

Objectives: To identify ICD-10-CM di­agnostic codes associated with the social de­terminants of health (SDOH), determine fre­quency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code.Design: Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indica­tor for homelessness.Methods: Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017.Main Outcome Measures: Any interrup­tion in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identi­fication numbers (CIN) for continuity.Results: ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrat­ed linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016- 2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experi­enced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn.Conclusions: Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness. Ethn Dis.2021;31(1):89-96; doi:10.18865/ ed.31.1.89

Association of Coded Housing Instability and Hospitalization in the US

“…This study relied on 5 imperfect and underutilized ICD-10 Z59-codes that, according to the literature, are likely more specific than sensitive indicators of housing instability. 41 , 42 , 43 , 44 , 45 The Z59-codes likely capture the most extreme experience of housing instability: homelessness. Studies 26 , 41 , 43 , 46 , 47 , 48 , 49 have also shown that these and other SDOH-related Z-codes (Z55-65) inconsistently map to SDOH screening instruments.…”

“…Fourth, housing instability definitions widely vary and no standardized measure exists. This study relied on 5 imperfect and underutilized ICD-10 Z59-codes that, according to the literature, are likely more specific than sensitive indicators of housing instability . The Z59-codes likely capture the most extreme experience of housing instability: homelessness.…”

Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy

“…Unhoused status was identified from the use of ICD-10 Clinical Modification ( ICD-10-CM ) code Z59.0 (eTable 1 in Supplement 1). This study followed prior analyses that used the same coding schema, as recommended by the National Health Care for the Homeless Council . The code was unchanged in the ICD-10-CM schema throughout the study period.…”

A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health

“…The most common SDOH domains screened for in children include the family context and economic stability, usually followed by referrals and/or interventions to address identified SDOHs [21]. Furthermore, greater use of the Centers for Medicare and Medicaid Services (CMS) Z codes associated with SDOH during patient encounters has been reported over time, notably for homelessness, which may lead to improved care coordination and identify opportunities to advance health equity [22,23].…”