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How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs

Appendix A, Table 1: Health Coverage Distribution of Patients at HCH Projects, 2013-2014
  Medicaid Other Public Private Uninsured
  2013 2014 Percentage Point Change 2013 2014 Percentage Point Change 2013 2014 Percentage Point Change 2013 2014 Percentage Point Change
States that Had Expanded as of 2014
Arkansas 3% 29% 26% 4% 3% -1% 1% 15% 14% 91% 53% -38%
Arizona 28% 55% 27% 8% 7% -1% 6% 7% 1% 59% 31% -27%
California 34% 53% 18% 12% 9% -3% 2% 3% 1% 51% 35% -16%
Colorado 25% 58% 33% 5% 8% 2% 1% 1% 0% 69% 34% -35%
Connecticut 56% 63% 8% 8% 9% 1% 5% 6% 1% 31% 22% -10%
District of Columbia 64% 59% -5% 12% 14% 2% 1% 3% 2% 23% 25% 2%
Delaware 38% 54% 16% 6% 6% 1% 5% 5% -1% 52% 35% -16%
Hawaii 62% 64% 2% 8% 9% 1% 4% 4% 0% 26% 23% -3%
Iowa 32% 50% 18% 6% 6% 0% 8% 12% 4% 55% 32% -22%
Illinois 32% 51% 19% 5% 6% 0% 4% 5% 1% 59% 38% -21%
Kentucky 12% 43% 31% 6% 6% 1% 2% 4% 2% 81% 46% -35%
Massachusetts 57% 63% 7% 19% 18% 0% 3% 4% 1% 22% 15% -7%
Maryland 22% 74% 52% 7% 8% 1% 0% 0% 0% 71% 18% -54%
Michigan 41% 51% 10% 6% 7% 1% 6% 7% 1% 47% 35% -12%
Minnesota 67% 65% -2% 7% 6% -1% 1% 2% 1% 25% 27% 2%
North Dakota 17% 15% -2% 5% 5% -1% 6% 23% 17% 73% 58% -15%
New Hampshire 15% 32% 17% 9% 12% 3% 2% 8% 7% 75% 47% -27%
New Jersey 28% 51% 22% 4% 5% 1% 5% 6% 1% 62% 37% -25%
New Mexico 12% 39% 27% 2% 6% 3% 6% 6% -1% 80% 50% -30%
Nevada 12% 33% 21% 3% 6% 2% 10% 6% -4% 74% 55% -19%
New York 57% 61% 4% 6% 6% 1% 4% 4% 0% 33% 29% -4%
Ohio 18% 45% 26% 5% 6% 1% 1% 2% 0% 75% 48% -27%
Oregon 28% 53% 25% 10% 8% -2% 3% 3% 0% 59% 36% -23%
Rhode Island 16% 71% 55% 4% 7% 2% 3% 6% 3% 77% 17% -60%
Vermont 70% 74% 4% 12% 13% 1% 6% 5% -1% 13% 8% -4%
Washington 45% 65% 20% 8% 8% 0% 3% 6% 3% 45% 21% -24%
West Virginia 1% 62% 60% 0% 1% 1% 0% 0% 0% 98% 37% -61%
States that Had Not Expanded as of 2014
Alaska 20% 18% -3% 21% 13% -8% 7% 7% 0% 51% 62% 11%
Alabama 14% 16% 2% 4% 4% 0% 2% 2% 0% 80% 78% -2%
Florida 19% 18% -1% 5% 7% 2% 2% 3% 1% 74% 72% -2%
Georgia 2% 5% 3% 2% 2% 1% 0% 1% 1% 96% 92% -4%
Idaho 7% 8% 1% 6% 4% -2% 1% 2% 1% 86% 86% 0%
Indiana 20% 30% 10% 3% 4% 1% 1% 3% 2% 76% 62% -13%
Kansas 14% 40% 25% 1% 2% 1% 2% 3% 0% 82% 56% -26%
Louisiana 52% 44% -8% 3% 4% 1% 5% 6% 1% 40% 46% 6%
Maine 28% 28% 0% 8% 7% -1% 2% 3% 0% 62% 62% 1%
Missouri 19% 21% 2% 4% 6% 2% 4% 7% 3% 73% 66% -7%
Mississippi 29% 22% -7% 6% 5% -1% 8% 17% 9% 57% 56% -1%
Montana 12% 14% 2% 6% 9% 3% 17% 4% -13% 65% 73% 8%
North Carolina 16% 20% 4% 9% 8% -1% 7% 9% 2% 68% 62% -5%
Nebraska 6% 7% 1% 3% 3% 0% 1% 2% 1% 90% 88% -2%
Oklahoma 7% 14% 6% 3% 4% 1% 0% 2% 2% 90% 81% -9%
Pennsylvania 44% 46% 2% 8% 8% 0% 3% 4% 0% 45% 42% -2%
South Carolina 18% 20% 2% 9% 10% 1% 9% 10% 1% 65% 60% -4%
South Dakota 15% 12% -3% 3% 4% 1% 4% 5% 1% 78% 79% 2%
Tennessee 10% 15% 4% 5% 6% 1% 2% 3% 1% 83% 76% -7%
Texas 10% 13% 3% 3% 4% 1% 1% 2% 1% 86% 82% -4%
Utah 22% 29% 7% 4% 5% 0% 0% 0% 0% 74% 67% -7%
Virginia 6% 7% 1% 6% 6% 1% 6% 10% 4% 82% 77% -5%
Wisconsin 26% 32% 6% 1% 5% 5% 0% 3% 2% 73% 59% -13%
Wyoming 4% 3% -1% 7% 6% -1% 0% 2% 2% 89% 89% 0%
SOURCE: KCMU and National Health Care for the Homeless Council analysis of 2013-2014 Uniform Data System data.

 

Appendix A, Table 2: Patient Volume at HCH Projects and Other Health Centers by State Medicaid Expansion Status, 2013-2014
HCH Projects Other Health Centers
  Expansion States Non-Expansion States Expansion States Non-Expansion States
  2013 2014 % Change 2013 2014 % Change 2013 2014 % Change 2013 2014 % Change
Number of Centers 156 165 6% 90 99 10% 588 632 7% 527 557 6%
Patients (millions) 0.62 0.61 -1% 0.23 0.24 3% 13.2 13.7 4% 7.7 7.9 3%
Patient Visits (millions) 3.41 3.36 -1% 1.11 1.12 1% 52.5 56.3 7% 26.7 27.8 4%
NOTE: For embedded HCH Projects, data associated with the HCH project was included in the HCH Projects group and data associated with serving the broader population was included in the Other Health Centers group. Because they have data included in both categories, embedded HCH projects are included in the count of the number of centers for both the HCH Projects and Other Health Centers. As a result, the sum of the number of centers in this table is greater than the total number of centers for each year. In 2013, there were a total of 1,173 health centers, including 188 embedded HCH projects; in 2014, there were a total of 1,249 health centers, including 204 embedded HCH projects.

SOURCE: KCMU and National Health Care for the Homeless Council analysis of 2013 – 2014 Uniform Data System data.

 

Appendix A, Table 3:
Costs and Revenues at Health Care for HCH Projects and Other Health Centers by State Medicaid Expansion Status, 2013-2014
HCH Projects Other Health Centers
  Expansion States Non-Expansion States Expansion States Non-Expansion States
  2013 2014 % Change 2013 2014 % Change 2013 2014 % Change 2013 2014 % Change
Number of Centers 43 44 2% 15 16 7% 588 632 7% 527 557 6%
Costs (millions) $328.4 $339.2 3% $42.3 $46 9% $10,234.4 $11,477.5 12% $4,821.7 $5,346.2 11%
Medical Care 53% 50% 52% 52% 62% 61% 63% 61%
Clinical 27% 30% 31% 29% 27% 28% 29% 30%
Enabling Services 19% 20% 17% 19% 12% 12% 8% 9%
Revenues (millions) $328.9 $352.4 7% $47.7 $48.5 2% $10,453.4 $11,871.1 14% $4,844.5 $5,444.5 12%
BPHC Grant 19% 21% 60% 54% 14% 14% 24% 25%
Other Federal Grants 5% 4% 4% 5% 3% 2% 3% 3%
Non-Federal Grants 31% 24% 20% 27% 14% 12% 12% 12%
Third Party Payments 36% 43% 5% 3% 59% 63% 49% 49%
Self-Pay 2% 1% 2% 1% 5% 4% 8% 8%
Other 8% 8% 9% 10% 4% 4% 3% 3%
NOTES: Data for HCH Projects only includes stand-alone HCH projects. All data for embedded HCHs is included with the Other Health Centers group because data for the HCH Project could not be separated from other health center data. Medical care includes costs for medical care personnel; laboratory and X-ray; and other direct medical care costs (e.g., staff recruitment, equipment depreciation, medical supplies, professional dues and subscriptions, continuing medical education and travel associated with CME). Other clinical care includes staff and related costs for dental, mental health, substance abuse, pharmacy, vision, and services rendered by other professional personnel (e.g., chiropractors, naturopaths, occupational and physical therapists, speech and hearing therapists, and podiatrists). Enabling services includes staff and related costs for case management, outreach, transportation, translation and interpretation, education, eligibility assistance—including pharmacy assistance program eligibility, environmental risk reduction, and other services that support and assist in the delivery of primary care and facilitate patient access to care.

SOURCE: KCMU and National Health Care for the Homeless Council analysis of 2013 – 2014 Uniform Data System data.

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