{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T04:03:03Z","timestamp":1783051383593,"version":"3.54.6"},"reference-count":93,"publisher":"Duke University Press","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Context: Homeless policy advocates viewed Medicaid expansion as an opportunity to enhance health care access for this vulnerable population. We studied Medicaid expansion implementation to assess the extent to which broadening insurance eligibility affected the functioning of municipal homelessness programs targeting chronic homelessness in the context of two separate governance systems.<\/jats:p>\n               <jats:p>Methods: We employed a comparative case study of San Francisco, California, and Shreveport, Louisiana, which were selected as exemplar cases from a national sample of cities across the United States. We conducted elite interviews with a range of local-level stakeholders and combined this data with primary-source documentation.<\/jats:p>\n               <jats:p>Findings: Medicaid expansion did not substantially enhance the functioning of homelessness programs and policies because of Medicaid access challenges and governance conflicts. Administrative burden and funding limitations contributed to limited provider networks, inadequate service coverage, and lack of linkages between Medicaid enrollment and homelessness programming. Governance conflicts reinforced these functional challenges, with homelessness under the administration of local municipalities and nongovernmental organizations while states administer Medicaid.<\/jats:p>\n               <jats:p>Conclusions: Improving access to health care services for persons experiencing homelessness cannot occur without intentional coordination between sectors and levels of government and thus necessitates the development of targeted policies and programs to overcome these challenges.<\/jats:p>","DOI":"10.1215\/03616878-9349142","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T01:59:13Z","timestamp":1622599153000},"page":"1019-1052","source":"Crossref","is-referenced-by-count":10,"title":["Technically Accessible, Practically Ineligible: The Effects of Medicaid Expansion Implementation on Chronic Homelessness"],"prefix":"10.1215","volume":"46","author":[{"given":"Charley E.","family":"Willison","sequence":"first","affiliation":[{"name":"Cornell University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Lillvis","sequence":"additional","affiliation":[{"name":"University at Buffalo, State University of New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Mauri","sequence":"additional","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip M.","family":"Singer","sequence":"additional","affiliation":[{"name":"University of Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","published-online":{"date-parts":[[2021,5,21]]},"reference":[{"key":"2021111520222392800_jhppl9349142C1","doi-asserted-by":"crossref","unstructured":"Alderwick\n              Hugh\n            \n          , Hood-RonickCarlyn M., and GottliebLaura M.2019. \u201cMedicaid Investments to Address Social Needs in Oregon and California.\u201d Health Affairs38, no. 5. doi.org\/10.1377\/hlthaff.2018.05171.","DOI":"10.1377\/hlthaff.2018.05171"},{"key":"2021111520222392800_jhppl9349142C2","doi-asserted-by":"crossref","unstructured":"Bamberger\n              Joshua\n            \n          . 2016. \u201cReducing Homelessness by Embracing Housing as a Medicaid Benefit.\u201d JAMA Internal Medicine176, no. 8: 1051\u201352. doi.org\/10.1001\/jamainternmed.2016.2615.","DOI":"10.1001\/jamainternmed.2016.2615"},{"key":"2021111520222392800_jhppl9349142C3","unstructured":"Berkeley Law Policy Advocacy Clinic. 2018. \u201cHomeless Exclusion Districts: How California Business Improvement Districts Use Policy Advocacy and Policing Practices to Exclude Homeless People from Public Space.\u201d www.law.berkeley.edu\/wp-content\/uploads\/2018\/09\/SSRN-id3221446.pdf (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C4","unstructured":"Birstow\n              Miki\n            \n          . 2018. \u201cNavigation Centers: What Do Neighbors Have to Fear?\u201d May. hsh.sfgov.org\/wp-content\/uploads\/2020\/01\/Navigation-Center-Neighborhood-Impacts-Final-Report-1.pdf."},{"key":"2021111520222392800_jhppl9349142C5","doi-asserted-by":"crossref","unstructured":"Burden\n              Barry C.\n            \n          , CanonDavid T., MayerKenneth R., and MoynihanDonald P.2012. \u201cThe Effect of Administrative Burden on Bureaucratic Perception of Policies: Evidence from Election Administration.\u201d Public Administration Review72, no. 5: 741\u201351. doi.org\/10.1111\/j.1540-6210.2012.02600.x.","DOI":"10.1111\/j.1540-6210.2012.02600.x"},{"key":"2021111520222392800_jhppl9349142C6","doi-asserted-by":"crossref","unstructured":"Busch\n              Susan H.\n            \n          , MearaEllen, HuskampHaiden A., and BarryColleen L.2013. \u201cCharacteristics of Adults with Substance Use Disorders Expected to Be Eligible for Medicaid under the ACA.\u201d Psychiatric Services64, no. 6: 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13: 1349\u201357. doi.org\/10.1001\/jama.2009.414.","DOI":"10.1001\/jama.2009.414"},{"key":"2021111520222392800_jhppl9349142C48","unstructured":"Louisiana DOH (Department of Health). 2017a. \u201cDepartment of Health and Department of Corrections Team Up to Provide Health Care Coverage for Newly Released Offenders.\u201d Healthy Louisiana, March1. ldh.la.gov\/index.cfm\/newsroom\/detail\/4170."},{"key":"2021111520222392800_jhppl9349142C49","unstructured":"Louisiana DOH (Department of Health). 2017b. \u201cJustice-Involved Pre-Release Enrollment Program Manual: Healthy Louisiana.\u201d January30. ldh.la.gov\/assets\/medicaid\/DOC\/Justice-involved-pre-release-enrollment-program-manual_10192017.pdf."},{"key":"2021111520222392800_jhppl9349142C50","unstructured":"Louisiana DOH (Department of Health). 2017c. \u201cPermanent Supportive Housing (PSH).\u201d www.dhh.louisiana.gov\/index.cfm\/page\/1732 (accessed June28, 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doi.org\/10.1176\/appi.ps.201400078.","DOI":"10.1176\/appi.ps.201400078"},{"key":"2021111520222392800_jhppl9349142C56","unstructured":"Matheny\n              Erin\n            \n          , TaylorBarbara, RichardsonLane, ZeguraAndrew, and LamondElizabeth. 2013. \u201cA Single Night Counts: Homelessness in Louisiana.\u201d static1.squarespace.com\/static\/53332a2de4b025b2a3c554ca\/t\/53ecdccde4b04a8ebc02f220\/1408031949831\/2013+LA+State+Homeless+Census+Report.pdf (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C57","unstructured":"Mazzara\n              Alicia\n            \n          . 2018. \u201cTrump Plan to Raise Minimum Rents Would Put Nearly a Million Children at Risk of Homelessness.\u201d Center on Budget and Policy Priorities, April27. www.cbpp.org\/blog\/trump-plan-to-raise-minimum-rents-would-put-nearly-a-million-children-at-risk-of-homelessness-0."},{"key":"2021111520222392800_jhppl9349142C58","doi-asserted-by":"crossref","unstructured":"Metraux\n              Stephen\n            \n          , TregliaDan, and O'TooleThomas P.2016. \u201cMigration by Veterans Who Received Homeless Services from the Department of Veterans Affairs.\u201d Military Medicine181, no. 10: 1212\u201317. doi.org\/10.7205\/MILMED-D-15-00504.","DOI":"10.7205\/MILMED-D-15-00504"},{"key":"2021111520222392800_jhppl9349142C59","unstructured":"Morton\n              Matthew H.\n            \n          , DworskyAmy, and SamuelsGina M.2017. \u201cMissed Opportunities: Youth Homelessness in America, National Estimates.\u201d Voices of Youth Count. voicesofyouthcount.org\/wp-content\/uploads\/2017\/11\/VoYC-National-Estimates-Brief-Chapin-Hall-2017.pdf (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C60","doi-asserted-by":"crossref","unstructured":"Moynihan\n              Donald\n            \n          , HerdPamela, and HarveyHope. 2014. \u201cAdministrative Burden: Learning, Psychological, and Compliance Costs in Citizen-State Interactions.\u201dJournal of Public Administration Research and Theory25, no. 1: 43\u201369. pdfs.semanticscholar.org\/d1ac\/965b3706965c899c53e21fb54265931e88b4.pdf.","DOI":"10.1093\/jopart\/muu009"},{"key":"2021111520222392800_jhppl9349142C61","doi-asserted-by":"crossref","unstructured":"Moynihan\n              Donald\n            \n          , HerdPamela, and RibgyElizabeth. 2016. \u201cPolicymaking by Other Means: Do States Use Administrative Barriers to Limit Access to Medicaid?\u201d Administration and Society48, no. 4: 497\u2013524. doi.org\/10.1177\/0095399713503540.","DOI":"10.1177\/0095399713503540"},{"key":"2021111520222392800_jhppl9349142C62","volume-title":"Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes among People Experiencing Chronic Homelessness","author":"NASEM (National Academies of Sciences, Engineering, and Medicine)","year":"2018"},{"key":"2021111520222392800_jhppl9349142C63","unstructured":"NLCHP (National Law Center on Homelessness and Poverty). 2015. \u201cHomelessness in America: Overview of Data and Causes.\u201d January. nlchp.org\/\/wp-content\/uploads\/2018\/10\/Homeless_Stats_Fact_Sheet.pdf."},{"key":"2021111520222392800_jhppl9349142C64","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780199989805.001.0001","volume-title":"Housing First: Ending Homelessness, Transforming Systems, and Changing Lives","author":"Padgett","year":"2015"},{"key":"2021111520222392800_jhppl9349142C65","unstructured":"Paradise\n              Julia\n            \n          , and RossDonna Cohen. 2017. \u201cLinking Medicaid and Supportive Housing: Opportunities and On-the-Ground Examples.\u201d Kaiser Family Foundation, January. files.kff.org\/attachment\/Issue-Brief-Linking-Medicaid-and-Supportive-Housing-Opportunities-and-On-the-Ground-Examples."},{"key":"2021111520222392800_jhppl9349142C66","unstructured":"Ragin\n              Charles\n            \n          . 2015. \u201cFuzzy Set\/Qualitative Comparative Analysis.\u201d www.socsci.uci.edu\/~cragin\/fsQCA\/ (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C67","unstructured":"Rahaim\n              John\n            \n          , RodgersAnMarie, SwitzkyJoshua, OjedaTeresa, PetersonPedro, PappasJames, AmbatiSvetha, DowPaige, and ChenGary. 2018. \u201cSan Francisco Housing Needs and Trends Report.\u201d San Francisco Planning Department, July. default.sfplanning.org\/publications_reports\/Housing-Needs-and-Trends-Report-2018.pdf."},{"key":"2021111520222392800_jhppl9349142C68","doi-asserted-by":"crossref","unstructured":"Rinker\n              Brian\n            \n          . 2019. \u201cFinding Shelter and Support along the Road to Better Health.\u201d Health Affairs38, no. 8: 1252\u201356. doi.org\/10.1377\/hlthaff.2019.00840.","DOI":"10.1377\/hlthaff.2019.00840"},{"key":"2021111520222392800_jhppl9349142C69","doi-asserted-by":"crossref","unstructured":"Robinson\n              Tony\n            \n          . 2019. \u201cNo Right to Rest: Police Enforcement Patterns and Quality of Life Consequences of the Criminalization of Homelessness.\u201d Urban Affairs Review55, no. 1: 41\u201373. doi.org\/10.1177\/1078087417690833.","DOI":"10.1177\/1078087417690833"},{"key":"2021111520222392800_jhppl9349142C70","volume-title":"Qualitative Interviewing: The Art of Hearing Data","author":"Rubin","year":"2011"},{"key":"2021111520222392800_jhppl9349142C71","unstructured":"San Francisco Budget and Legislative Analyst. 2016. \u201cPerformance Audit of Homeless Services in San Francisco.\u201d June13. hsh.sfgov.org\/wp-content\/uploads\/2016\/06\/Homeless-Services-in-SF-BLA-Report-June-13-2016.pdf."},{"key":"2021111520222392800_jhppl9349142C72","unstructured":"San Francisco DHSH (Department of Homelessness and Supportive Housing). 2019. \u201cLocal Homeless Coordinating Board.\u201d hsh.sfgov.org\/lhcb\/local-homeless-coordinating-board-about-us\/ (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C73","unstructured":"San Francisco DPH (Department of Public Health). 2017. \u201cWhole Person Care California Medi-Cal 2020 Waiver.\u201d April18. www.sfdph.org\/dph\/hc\/HCAgen\/HCAgen2017\/April18\/2017AprilWPCOverviewISCv041017handoutofpresentation.pdf."},{"key":"2021111520222392800_jhppl9349142C74","unstructured":"SHADAC (State Health Access Data Assistance Center). 2018. \u201cAssessment and Synthesis of Selected Medicaid Eligibility, Enrollment, and Renewal Processes and Systems in Six States.\u201d October19. www.macpac.gov\/wp-content\/uploads\/2018\/11\/Assessment-and-Synthesis-of-Selected-Medicaid-Eligibility-Enrollment-and-Renewal-Processes-and-Systems-in-Six-States.pdf."},{"key":"2021111520222392800_jhppl9349142C75","unstructured":"Snyder\n              Elizabeth\n            \n          . 2016. \u201cMedicaid and Prisoner Reentry: Suspension Is the New Black.\u201d Kansas Journal of Law and Public Policy27, no. 1. lawjournal.ku.edu\/wp-content\/uploads\/2020\/08\/Snyder-V26I1.pdf (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C76","doi-asserted-by":"crossref","unstructured":"Sommers\n              Benjamin D.\n            \n          , GourevitchRebecca, MayloneBethany, BlendonRobert J., and EpsteinArnold M.2016. \u201cInsurance Churning Rates for Low-Income Adults under Health Reform: Lower than Expected but Still Harmful for Many.\u201d Health Affairs35, no. 10: 1816\u201324. doi.org\/10.1377\/hlthaff.2016.0455.","DOI":"10.1377\/hlthaff.2016.0455"},{"key":"2021111520222392800_jhppl9349142C77","doi-asserted-by":"crossref","unstructured":"Stanhope\n              Victoria\n            \n          , and DunnKerry. 2011. \u201cThe Curious Case of Housing First: The Limits of Evidence Based Policy.\u201d International Journal of Law and Psychiatry34, no. 4: 275\u201382. doi.org\/10.1016\/j.ijlp.2011.07.006.","DOI":"10.1016\/j.ijlp.2011.07.006"},{"key":"2021111520222392800_jhppl9349142C78","doi-asserted-by":"crossref","unstructured":"Stergiopoulos\n              Vicky\n            \n          , GozdzikAgnes, MisirVachan, SkosirevaAnna, ConnellyJo, SarangAseefa, WhislerAdam, HwangStephen W., O'CampoPatricia, and McKenzieKwame. 2015. \u201cEffectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial.\u201d PLoS ONE, July15. doi.org\/10.1371\/journal.pone.0130281.","DOI":"10.1371\/journal.pone.0130281"},{"key":"2021111520222392800_jhppl9349142C79","doi-asserted-by":"crossref","unstructured":"Stringfellow\n              Erin J.\n            \n          , KimTheresa W., GordonAdam J., PollioDavid E., GruczaRichard A., AustinErika L., JohnsonN. Kay, and KerteszStefan G.2016. \u201cSubstance Use among Persons with Homeless Experience in Primary Care.\u201d Substance Abuse37, no. 4: 534\u201341. doi.org\/10.1080\/08897077.2016.1145616.","DOI":"10.1080\/08897077.2016.1145616"},{"key":"2021111520222392800_jhppl9349142C80","unstructured":"Thompson\n              Frank J.\n            \n          , CantorJoel C., FarnhamJennifer, GusmanoMichael K., and TideringtonEmmy. 2019. \u201cCenter for State Health Policy Medicaid Demonstration Waivers with Housing Supports: An Interim Assessment.\u201d Rutgers Center for State Health Policy, July. www.cshp.rutgers.edu\/Downloads\/11550.pdf."},{"key":"2021111520222392800_jhppl9349142C81","volume-title":"Segregation by Design: Local Politics and Inequality in American Cities","author":"Trounstine","year":"2019"},{"key":"2021111520222392800_jhppl9349142C82","doi-asserted-by":"crossref","unstructured":"Tsai\n              Jack\n            \n          , RosenheckRobert A., CulhaneDennis P., and ArtigaSamantha. 2013. \u201cMedicaid Expansion: Chronically Homeless Adults Will Need Targeted Enrollment and Access to a Broad Range of Services.\u201d Health Affairs32, no. 9: 1552\u201359. doi.org\/10.1377\/hlthaff.2013.0228.","DOI":"10.1377\/hlthaff.2013.0228"},{"key":"2021111520222392800_jhppl9349142C83","doi-asserted-by":"crossref","unstructured":"Tsai\n              Jack\n            \n          , and WilsonMichal. 2020. \u201cCOVID-19: A Potential Public Health Problem for Homeless Populations.\u201d Lancet Public Health5, no. 4: e186\u201387. doi.org\/10.1016\/S2468-2667(20)30053-0.","DOI":"10.1016\/S2468-2667(20)30053-0"},{"key":"2021111520222392800_jhppl9349142C84","unstructured":"University of California Berkeley School of Law HRC (Human Rights Center). 2017. \u201cPunishing the Poorest: How San Francisco's Criminalization of Homelessness Perpetuates Poverty.\u201d www.sanfranciscopolice.org\/sites\/default\/files\/Documents\/PoliceCommission\/PoliceCommission120617-Homeless120617.pdf (accessed June28, 2021)."},{"key":"2021111520222392800_jhppl9349142C85","unstructured":"US House of Representatives. 2019. \u201cH.R. 1329 Medicaid Reentry Act.\u201d February25. www.congress.gov\/116\/bills\/hr1329\/BILLS-116hr1329ih.pdf."},{"key":"2021111520222392800_jhppl9349142C86","unstructured":"Verma\n              Seema\n            \n          . 2018. \u201cCMS Approves North Carolina's Innovative Medicaid Demonstration to Help Improve Health Outcomes.\u201d Health Affairs (blog), October24. www.healthaffairs.org\/do\/10.1377\/hblog20181024.406020\/full\/."},{"key":"2021111520222392800_jhppl9349142C87","unstructured":"Wachino\n              Vikki\n            \n          . 2015. \u201cCoverage of Housing-Related Activities and Services for Individuals with Disabilities.\u201d CMCS Informational Bulletin, June26. www.medicaid.gov\/federal-policy-guidance\/downloads\/cib-06-26-2015.pdf."},{"key":"2021111520222392800_jhppl9349142C88","unstructured":"Wagner\n              Robin\n            \n          . 2017. \u201cLouisiana Permanent Supportive Housing.\u201d Paper presented at the NASHP Annual Conference, National Academy for State Health Policy, Portland, OR, October 23\u201325. nashp.org\/wp-content\/uploads\/2017\/06\/R-Wagner-19.pdf."},{"key":"2021111520222392800_jhppl9349142C89","unstructured":"Ware\n              Dazara\n            \n          , and DennisDeborah. 2013. \u201cBest Practices for Increasing Access to SSI\/SSDI upon Exiting Criminal Justice Settings.\u201d Substance Abuse and Mental Health Administration, January. soarworks.samhsa.gov\/sites\/soarworks.prainc.com\/files\/Best_Practices_CJ_Systems.pdf."},{"key":"2021111520222392800_jhppl9349142C90","unstructured":"Warfield\n              Matt\n            \n          , DipietroBarbara, and ArtigaSamantha. 2016. \u201cHow Has 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