CSHP Medicaid-Related Portfolio

Addressing Homelessness

New Jersey Medicaid and housing officials authorized CSHP, with funding from Medicaid and The Nicholson Foundation, to study related policy implications and options. The study found that individuals with behavioral or physical disabilities who had experienced only limited time without a suitable place to live still had greater emergency department and inpatient hospital utilization. 

Assessing these findings, CSHP concluded that the adoption of Medicaid tenancy support services could help individuals achieve more long-term, stable housing, possibly contributing to better health outcomes while reducing spending on avoidable health care interventions.

Informed by this research, New Jersey Medicaid officials included tenancy-support and sustaining provisions and other services in their request for a §1115 demonstration renewal starting in 2023. Federal officials approved the new demonstration, authorizing a comprehensive initiative providing intensive outreach, care management, and housing transition and tenancy support to an array of individuals covered through Medicaid who were at risk of becoming unhoused.

Impact on Health Care Access

• Medicaid spending on hospital emergency and inpatient services declines when homeless services users are placed in permanent supportive housing.
• While designed to be a long-term resource for people with chronic homelessness, some permanent supportive housing residents are ready to successfully transition to stable community housing and strong connections to essential health services.
• Initiatives that effectively bridge health care and homeless services share for key features: they initiate outreach where clients are, they match client preferences with available options, they maintain intensive client interactions, and they often co-locate health and housing services.

Building on its growing expertise in intersectional health and homelessness issues, CSHP also received a National Institute on Minority Health and Health Disparities (NIMHD) grant from the National Institutes of Health in 2021 for a new study. This research, conducted in collaboration with investigators from the Rutgers School of Social Work and the University of Pittsburgh School of Public Health, examined linked 2011-2022 homelessness services and Medicaid administrative data from New Jersey and Pennsylvania. 

Under the NIMHD grant and with additional support from the Robert Wood Johnson Foundation and the National Alliance to End Homelessness, CSHP and its collaborators also examined how homelessness shapes suboptimal health care utilization, how permanent supportive housing can help reduce avoidable hospital utilization and improve utilization of essential community-based health services, and how service and health care delivery organizations can collaborate to improve the health and wellbeing of people experiencing homelessness.

Housing-Related Projects

• Role of Homelessness and Supportive Housing in Healthcare Disparities among Adults in Medicaid - National Institute on Minority Health and Health Disparities (NIMHD/NIH)

There is ample evidence that homelessness is associated with inadequate access to essential health services and that African American, Hispanic/Latinx, and rural populations are at high risk for homelessness or its consequences. However, there is insufficient knowledge about gaps in use of specific health services among homeless adults, whether such gaps are greater among minority and rural populations, and the potential of permanent supportive housing (PSH) programs to mitigate these gaps. This study aims to: 1) quantify the contribution of homelessness to gaps in essential health services use among Medicaid beneficiaries by race/ethnicity and rural residential status; 2) evaluate the extent to which the gaps are mitigated by placement in PSH programs; and 3) identify Medicaid and PSH policy and programmatic strategies for improving access to essential health services and reducing associated racial/ethnic and rural disparities. Learn more.

• The Impact of Homelessness and Housing Services on Maternal And Infant Health - National Institute of Child Health and Human Development (NICHD/NIH)

This project assesses how homelessness affects maternal and infant health outcomes among Medicaid enrollees and evaluates the extent to which Permanent Supportive Housing (PSH) and Rapid Rehousing (RRH) have a positive impact on these outcomes.  Birth outcomes are measured using the Medicaid Management Information System (MMIS) and birth records, and history of homeless services use is measured in the Homeless Management Information System (HMIS) data.  NJ Hospital Discharge Data Collection System (HDDCS) records are used to assess utilization during gaps in Medicaid coverage and compare to outcomes in non-Medicaid populations. Learn more.

• Evaluation of the NJ Familycare Comprehensive Demonstration Renewal: Housing Data Component - NJ Division of Medical Assistance And Health Services (DMAHS)

CSHP has been selected by DMAHS to evaluate the 1115 NJ FamilyCare Waiver Demonstrations, the most recent of which was approved on October 16, 2025.  The “Housing Data Linkage” is intended to support data requirements for one of the thirteen components of the current waiver evaluation. Data produced under this “Housing Data Linkage” will be used for Component 8 of the waiver, “Tenancy and Housing Supports”. For this component, New Jersey is implementing a multifaceted, integrated housing strategy for Medicaid beneficiaries that incorporates enhancements to infrastructure, coverage for additional targeted services, and coordination across State and community resources involved in the provision of health and housing services. The “Housing Data Linkage” will be used for analyses of the degree to which persons at risk of housing instability receive Medicaid Tenancy and Housing Supports services and healthcare and housing outcomes for those who receive this intervention. Learn more.

• Preventing Overdose in Supportive Housing: Stepped Wedge Randomized Controlled Trial of a Multi-Sector, Upstream Intervention - National Institute On Drug Abuse (NIDA/NIH) 

Currently in the design phase with implementation scheduled to begin in 2027, this project will implement and rigorously test a time-limited, multi-component intervention based on evidence-based overdose prevention practices in Permanent Supportive Housing (PSH) in New York and New Jersey. Led by investigators at the NYU School of Medicine, CSHP will undertake analysis related to the New Jersey portion of the study. Working with community partners, the NYU/CSHP investigators will use a rigorous stepped-wedge randomized controlled trial design to evaluate impact on overdose outcomes. Linked Medicaid Management Information System (MMIS) and Homeless Management Information System (HMIS) data will be used to measure key PSH program characteristics and overdose outcomes. New Jersey data will be used exclusively by CSHP investigators, and only aggregated findings will be shared with NYU collaborators. Learn more.

Articles

• Enich, M., Chakravarty, S., Palatucci, J. S., & Cantor, J. C. (2025). "Classification of Homelessness in Medicaid Claims and Homeless Services Administrative Records: Application of a Concordance Analysis Framework." AJPM Focus, 4(5), 100354.
• Enich, M., Tiderington, E., & Cantor, J. C. (2025). "Physician explanation of Z-coded homelessness in medicaid claims." Health Services and Outcomes Research Methodology.
• DeLia, D., Nova, J., Chakravarty, S., Tiderington, E., Kelly, T., & Cantor, J. C. (2021). "Effects of Permanent Supportive Housing on Health Care Utilization and Spending Among New Jersey Medicaid Enrollees Experiencing Homelessness." Medical Care, 59(Suppl 2), S199–S205.
• Thompson, F. J., Farnham, J., Tiderington, E., Gusmano, M. K., & Cantor, J. C. (2021). "Medicaid Waivers and Tenancy Supports for Individuals Experiencing Homelessness: Implementation Challenges in Four States." The Milbank Quarterly, 99(3), 648–692.
• Yedidia, M. J., & Cantor, J. C. (2025). Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross‐Sector Initiatives. The Milbank Quarterly, 103(4), 1135–1160. https://doi.org/10.1111/1468-0009.70056.

Presentations

• Palatucci et al. "Impact of Permanent Supportive Housing on the Level and Composition of Medicaid Spending", Presentation. AcademyHealth Annual Research Meeting, Seattle, WA, 2026.
• Tiderington et al. "Disparities In Observed Homeless Services Use Following Exit from Permanent Supportive Housing," Presentation. AcademyHealth Annual Research Meeting, Seattle, WA, 2026.
• Donahoe et al. "Homelessness and Medicaid: A Two-State Comparison of Health Care Services Use and Spending Among Unhoused Versus Housed Medicaid Enrollees," Presentation. AcademyHealth Annual Research Meeting, Seattle, WA, 2026.
• Tiderington et al. "Permanent Supportive Housing Exits Among Medicaid-Enrolled Adults: Differences in Healthcare Utilization Patterns and Likelihood of Returns to Homelessness By Exit Type," Presentation. AcademyHealth Annual Research Meeting, Minneapolis, MN, 2025.
• Palatucci et al. "Changes in Medicaid Enrollment Associated with the ACA Eligibility Expansion Among Adults Experiencing or at-Risk of Homelessness," Presentation. AcademyHealth Annual Research Meeting, Baltimore, MD, 2024.
• Cantor & Tiderington. "Connecting Health and Homeless Services for Medicaid Beneficiaries," Presentation. Monarch Housing Associates Conference, Somerset, NJ, 2024.

Reports

• Cantor, Joel C., Tallia, Alfred F., Koller, Margaret, DeLia, Derek, Farnham, Jennifer J. & Rutgers Biomedical and Health Sciences (RBHS) Working Group on Medicaid High Utilizers. (2016). "Analysis and Recommendations for Medicaid High Utilizers in New Jersey." Rutgers Center for State Health Policy.
• Thompson, F. J., Cantor, J. C., Farnham, J., Gusmano, M. K., & Tiderington, E. (2019). Medicaid Demonstration Waivers with Housing Supports: An Interim Assessment. Rutgers Center for State Health Policy.
• Tiderington, E., Palatucci, J.S., Cole, E. & Cantor, J.C. (2026). "Investigating Predictors of Successful Exits from Permanent Supportive Housing." National Alliance to End Homelessness (NAEH).