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. |
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| Appendix A, Table 3: Costs and Revenues at Health Care for HCH Projects and Other Health Centers by State Medicaid Expansion Status, 2013-2014 |
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| 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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