The relationship between food and housing insecurity and healthcare use among Virginia Medicaid expansion members: Considering the neighborhood context.

Objective: To understand relationships between healthcare use and food and housing insecurity in Medicaid expansion members, as well as whether these relationships differ by rurality or residential segregation.

Data sources and study setting: Database of Virginia Medicaid expansion members from the Department of Medical Assistance Services. Sample included individuals who enrolled January-June 2019, were aged 19-64 years, remained continuously enrolled for 12 months, and completed a Medicaid Member Health Screening (MMHS) conducted within the first 3 months of enrollment (n = 14,735).

Study design: Retrospective cohort study. Outcomes included any primary care visits (PC) and any emergency department (ED) visits in the first 12 months of enrollment. The MMHS sample was weighted to represent all Medicaid expansion members (n = 234,296). Separate multivariable linear probability models regressed having any PC or ED visits on food and housing insecurity controlling for individual and neighborhood characteristics. Models were then stratified by rurality and racial residential segregation.

Data collection: None.

Principal findings: Food insecurity was negatively associated with having any PC visit (-2.9 percentage points (PP); p-value <0.01) and positively associated with having any ED visit (7.0 PP; p-value <0.001). No significant relationships between PC or ED visits and housing insecurity were found. Suburban and urban individuals with food insecurity were significantly less likely to have any PC visit (p < 0.05 each). Medicaid expansion members living in disproportionately low-income or mixed-income neighborhoods experiencing food insecurity were also less likely to have any PC visits (p < 0.05), and the same was not true for those living in disproportionately high-income neighborhoods.

Conclusions: Food insecurity among Medicaid expansion members is associated with less primary care and more emergency department use, but these relationships differ by the neighborhoods in which members live. Medicaid agency efforts that coordinate medical and social service benefits and also consider local context may further increase access to necessary and appropriate care.