J Rural Health. 2026 Mar;42(2):e70167. doi: 10.1111/jrh.70167.
ABSTRACT
PURPOSE: This study examined whether the Supportive Services for Veteran Families (SSVF) program has a differential impact on healthcare utilization and costs among rural and urban Veterans experiencing housing instability. Understanding geographic variation in program effects is important for guiding implementation and resource allocation within the Veterans Affairs (VA) healthcare system.
METHODS: We conducted a retrospective cohort study using national VA administrative data from October 1, 2018 to September 30, 2023. Veterans were classified as SSVF participants or eligible non-SSVF Veterans based on indicators of housing instability. A target trial emulation framework with inverse probability weighting was used to adjust for baseline differences. Rurality was defined using Rural-Urban Commuting Area codes applied to Veterans’ residential addresses recorded in VA administrative data. Weighted longitudinal models estimated quarterly changes in healthcare utilization and costs and tested whether effects varied by rurality.
FINDINGS: SSVF enrollment was associated with reductions in inpatient utilization and costs and modest increases in outpatient visits, resulting in overall decreases in total VA healthcare costs. Emergency department use showed small reductions among urban Veterans and little measurable change among rural Veterans. Overall patterns of healthcare utilization and spending were similar across rural and urban Veterans, and statistical tests did not indicate significant rural-urban differences in SSVF effects.
CONCLUSIONS: SSVF participation was associated with shifts away from inpatient care and toward greater outpatient engagement among Veterans experiencing housing instability. These patterns were observed among both rural and urban Veterans, suggesting that the healthcare benefits of housing stabilization programs are similar across geographic settings.
PMID:42153335 | DOI:10.1111/jrh.70167
