After Massachusetts changed its eligibility criterion for homeless families seeking emergency shelter in 2012, an influx of children began to show up in emergency departments—many without medical problems.

In the November 2018 issue of Pediatrics, a study, “Pediatric Emergency Department Visits for Homelessness After Shelter Eligibility Policy Change,” attributes the change to a regulation that began requiring families to document homelessness. One new means to do this was for Massachusetts families to prove that their children had spent a night in a place “not meant for human habitation,” and emergency departments are one of the locations that met that description.

The study, to be published online Oct. 15, reviewed records of children age 18 and younger who arrived at an emergency department between March 2010 and February 2016 because of homelessness. Researchers found the overall rate of emergency department visits for homelessness per month increased over four times compared with the period before the policy change.

Of the 312 emergency department visits for homelessness, 95% occurred after the 2012 policy change, and 65% of the children had no medical complaint. The authors compare the average payment of an emergency department visit, at $557, to a night at an emergency assistance shelter, which is about $117, and suggest that more effective policies be considered for housing homeless families.

AAP Past President Benard Dreyer, MD, weighs in on the nation’s homeless crisis and the health impact on children in a solicited commentary, “A Shelter is Not a Home: The Crisis of Family Homelessness in the United States,” to be published in the same issue.