Housing Insecurity, Behavioral Health Disorders, and Acute Care Utilization: A Cross-Sectional Study of Medicaid Members in the Portland, Oregon Metropolitan Area

Housing insecurity and substance use disorder (SUD) are critical public health issues in the United States with significant implications for health outcomes. This study evaluated the intersection of housing insecurity, SUD, and serious mental illness (SMI) among Medicaid enrollees in an urban center in Oregon. Using data from Health Share of Oregon, we identified three distinct cohorts—individuals with housing insecurity, those with SUD/Psychotic Disorders, and those with both conditions. Key outcomes included inpatient admission rates, average lengths of stay, and 30-day readmissions. The findings indicate that housing insecure individuals show greater acute care utilization. Inpatient admissions for housing insecure individuals with SUD/Psychotic Disorders were nearly three times higher than those without housing insecurity (29.2% vs. 12.2%), with corresponding increases in ambulatory-sensitive hospitalizations and 30-day readmissions. The length of stay also significantly increased with housing insecurity, indicating compounding health challenges. Effective interventions should address both housing and healthcare needs, including comprehensive case management and low-barrier access to physical, behavioral, and mental health services. These strategies could mitigate acute care utilization and improve overall health outcomes for these vulnerable populations.