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Am J Public Health. 2013 Dec;103 Suppl 2:S311-7. doi: 10.2105/AJPH.2013.301421. Epub 2013 Oct 22.

Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act.

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  • 1Monica Bharel is with the Boston Health Care for the Homeless Program and the Department of Medicine, Massachusetts General Hospital and Boston Medical Center, Boston. Wen-Chieh Lin, Jianying Zhang, Elizabeth O'Connell, and Robin E. Clark are with the Center for Health Policy and Research, University of Massachusetts Medical School, Boston. Wen-Chieh Lin and Robin E. Clark are with the Department of Family Medicine and Community Health, University of Massachusetts Medical School. At the time of the study, Robert Taube was with the Boston Health Care for the Homeless Program.



We studied 6494 Boston Health Care for the Homeless Program (BHCHP) patients to understand the disease burden and health care utilization patterns for a group of insured homeless individuals.


We studied merged BHCHP data and MassHealth eligibility, claims, and encounter data from 2010. MassHealth claims and encounter data provided a comprehensive history of health care utilization and expenditures, as well as associated diagnoses, in both general medical and behavioral health services sectors and across a broad range of health care settings.


The burden of disease was high, with the majority of patients experiencing mental illness, substance use disorders, and a number of medical diseases. Hospitalization and emergency room use were frequent and total expenditures were 3.8 times the rate of an average Medicaid recipient.


The Affordable Care Act provides a framework for reforming the health care system to improve the coordination of care and outcomes for vulnerable populations. However, improved health care coverage alone may not be enough. Health care must be integrated with other resources to address the complex challenges presented by inadequate housing, hunger, and unsafe environments.

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