Moving to Better Healthcare? Estimating the Impact of Medicaid Expansion on Homelessness

60 Pages Posted: 4 May 2021 Last revised: 18 Jul 2022

Date Written: April 29, 2021


Recent homelessness figures in the United States show a puzzling trend of aggregate decline but lopsided changes across states. This study examines the puzzle through healthcare access and provides the first causal evidence of the Medicaid expansion’s impact on homeless adults’ location. Using the state and county-level data on the homeless population from 2010-2017, the estimates from a difference-in-differences model show a significant 10% post-expansion increase in homeless individuals per capita in states that adopted Medicaid expansion. Furthermore, utilizing the difference in homeless individuals’ coverage status vis-a-vis homeless people in families, estimates from a triple difference (DDD) model also confirm the post-expansion increase in homelessness in expansion states. This study contributes further by uniquely utilizing county-level data to provide subsample analysis on metropolitan counties and counties located at state borders. Results from the state, county, and border-county-discontinuity design reveal the evidence of homeless individuals’ migration from non-expansion to expansion states. Two mechanisms explain the migration process: post-expansion coverage eligibility of previously uninsured homeless individuals and the increased ability of homeless service providers in expansion states in offering healthcare and housing-related services. This paper concludes by measuring the state spending on Medicaid to demonstrate the implications of these findings on state welfare policymaking and fiscal expenditure.

Keywords: Homeless, Healthcare, Medicaid, Affordable Care Act, Public Health Insurance

JEL Classification: H51, I32, I38, I140, I180, R28

Suggested Citation

Kumar, Ashutosh, Moving to Better Healthcare? Estimating the Impact of Medicaid Expansion on Homelessness (April 29, 2021). Available at SSRN: or

Ashutosh Kumar (Contact Author)

Washington State University ( email )

School of Economic Sciences
Hulbert Hall 101
Pullman, WA WA 99164
United States

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