{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:06:26Z","timestamp":1789740386279,"version":"4.0.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R36DA062645"],"award-info":[{"award-number":["R36DA062645"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K01DA054328"],"award-info":[{"award-number":["K01DA054328"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>States have expanded Medicaid waiver-based housing support programs, but evidence on outcomes in safety-net settings is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated health care utilization and spending associated with Massachusetts Medicaid's Flexible Services Program housing supports (FSP-H), provided to Accountable Care Organization (ACO) members with housing-related needs and qualifying health risks (2021-2024). Within a Boston-based safety-net health system, we linked FSP-H data to claims and electronic health records. Using staggered difference-in-differences, we compared monthly probability of inpatient and emergency department (ED) utilization and per-patient spending in FSP-H recipients (n = 340) vs a contemporaneous comparison group with documented housing-related needs who were FSP-H-ineligible because they were in non-ACO plans (n = 425). We conducted clinical risk-based subgroup analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, FSP-H receipt was not associated with significant changes in monthly probability of inpatient utilization (\u22123.3 percentage points, P = 0.223), ED utilization (\u22121.5 percentage points, P = 0.569), or monthly spending (\u2212$634, P = 0.053). Massachusetts Medicaid's Flexible Services Program housing supports (FSP-H) was significantly associated with lower monthly inpatient utilization in the substance use disorder and frailty subgroups and with lower monthly spending in the frailty subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings offer evidence for state Medicaid plans implementing or adapting housing programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag244","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:22:18Z","timestamp":1788517338000},"source":"Crossref","is-referenced-by-count":0,"title":["Medicaid waiver-based housing supports in a safety-net setting: utilization and spending outcomes"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4916-4319","authenticated-orcid":false,"given":"Nicole C","family":"McCann","sequence":"first","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5863-1804","authenticated-orcid":false,"given":"Heather E","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Boston Medical Center , Boston, MA 02118 ,","place":["United States"]},{"name":"Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1789-1009","authenticated-orcid":false,"given":"Stephanie","family":"Ettinger de Cuba","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 ,","place":["United States"]},{"name":"Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Population Health, Boston Medical Center , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2952-1059","authenticated-orcid":false,"given":"Paulina","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Population Health, Boston Medical Center , Boston, MA 02118 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118 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