{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:41:07Z","timestamp":1787312467610,"version":"build-2736575974"},"reference-count":81,"publisher":"Duke University Press","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Context: As inequality grows, politically powerful health care institutions\u2014namely Medicaid and health systems\u2014are increasingly assuming social policy roles, particularly related to solutions to homelessness. Medicaid and health systems regularly interact with persons experiencing homelessness who are high users of emergency health services and who experience frequent loss of or inability to access Medicaid services because of homelessness. This research examines Medicaid and health system responses to homelessness, why they may work to address homelessness, and the mechanisms by which this occurs.<\/jats:p>\n                  <jats:p>Methods: The authors collected primary data from Medicaid policies and the 100 largest health systems, along with national survey data from local homelessness policy systems, to assess scope and to measure mechanisms and factors influencing decision-making.<\/jats:p>\n                  <jats:p>Findings: Nearly one third of states have Medicaid waivers targeting homelessness, and more than half of the 100 largest health systems have homelessness mitigation programs. Most Medicaid waivers use local homelessness policy structures as implementing entities. A plurality of health systems rationalizes program existence based on the failure of existing structures.<\/jats:p>\n                  <jats:p>Conclusions: Entrenched health care institutions may bolster local homelessness policy governance mechanisms and policy efficacy. Reliance on health systems as alternative structures, and implementing entities in Medicaid waivers, may risk shifting homelessness policy governance and retrenchment of existing systems.<\/jats:p>","DOI":"10.1215\/03616878-11567700","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T02:00:50Z","timestamp":1727402450000},"page":"307-336","source":"Crossref","is-referenced-by-count":4,"title":["Entrenched Opportunity: Medicaid, Health Systems, and Solutions to Homelessness"],"prefix":"10.1215","volume":"50","author":[{"given":"Charley E.","family":"Willison","sequence":"first","affiliation":[{"name":"Cornell University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naquia A.","family":"Unwala","sequence":"additional","affiliation":[{"name":"Cornell University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Klasa","sequence":"additional","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"2025022418524633400_jhppl11567700C1","unstructured":"Agency for Healthcare Research and Quality. 2021. \u201cCompendium of U.S. Health Systems, 2018.\u201d March. https:\/\/www.ahrq.gov\/chsp\/data-resources\/compendium-2018.html."},{"key":"2025022418524633400_jhppl11567700C2","unstructured":"AHA (American Hospital Association). 2021. \u201cHousing and Health: A Roadmap for the Future.\u201d March. https:\/\/www.aha.org\/system\/files\/media\/file\/2021\/03\/housing-and-health-roadmap.pdf."},{"issue":"9","key":"2025022418524633400_jhppl11567700C3","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1377\/hlthaff.2018.05071","article-title":"Can Medicaid Expansion Prevent Housing Evictions?","volume":"38","author":"Allen","year":"2019","journal-title":"Health Affairs"},{"issue":"1","key":"2025022418524633400_jhppl11567700C4","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1177\/00027162221113983","article-title":"Community Supervision, Housing Insecurity, and Homelessness","volume":"701","author":"Augustine","year":"2022","journal-title":"Annals of the American Academy of Political and Social Science"},{"issue":"2","key":"2025022418524633400_jhppl11567700C5","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1086\/714829","article-title":"Mobility-Related Barriers to Accessing Homeless Services: Implications for Continuums of Care and Coordinated Entry","volume":"14","author":"Aykanian","year":"2023","journal-title":"Journal of the Society for Social Work and Research"},{"issue":"8","key":"2025022418524633400_jhppl11567700C6","doi-asserted-by":"crossref","DOI":"10.1001\/jamainternmed.2016.2615","article-title":"Reducing Homelessness by Embracing Housing as a Medicaid Benefit","volume":"176","author":"Bamberger","year":"2016","journal-title":"JAMA Internal Medicine"},{"key":"2025022418524633400_jhppl11567700C7","article-title":"Johns Hopkins Collaborates on Plan to House, Care for Baltimore's Homeless Population","author":"Burgunder","year":"2019"},{"issue":"1","key":"2025022418524633400_jhppl11567700C8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/1468-0009.12446","article-title":"Medicaid Utilization and Spending among Homeless Adults in New Jersey: Implications for Medicaid-Funded Tenancy Support Services","volume":"98","author":"Cantor","year":"2020","journal-title":"Milbank Quarterly"},{"key":"2025022418524633400_jhppl11567700C9","unstructured":"Cedars-Sinai Medical Center. 2022. \u201cCedars-Sinai Gives Record $36.5M to Los Angeles Community.\u201d July22. https:\/\/www.cedars-sinai.org\/newsroom\/cedars-sinai-gives-record-365m-to-los-angeles-community\/."},{"key":"2025022418524633400_jhppl11567700C10","unstructured":"CMS (Centers for Medicare and Medicaid Services). 2021. \u201cOpportunities in Medicaid and CHIP to Address Social Determinants of Health (SDOH).\u201d January7. https:\/\/www.medicaid.gov\/sites\/default\/files\/2022-01\/sho21001_0.pdf."},{"key":"2025022418524633400_jhppl11567700C11","unstructured":"CMS (Centers for Medicare and Medicaid Services). 2022. \u201cAll-State Medicaid and CHIP Call.\u201d December6. https:\/\/www.medicaid.gov\/sites\/default\/files\/2022-12\/covid19allstatecall12062022.pdf."},{"key":"2025022418524633400_jhppl11567700C12","unstructured":"CMS (Centers for Medicare and Medicaid Services). 2024. 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