TOPLINE: 

Regular Medicaid home visits before extreme heat events did not significantly affect emergency department (ED) visits among individuals aged 65 years or older, but they may have facilitated timely care-seeking for heat symptoms, a cohort study found.

METHODOLOGY:

• Researchers conducted a retrospective cohort study and linked Medicare and Medicaid claims with zip-code-level weather data for 597,388 community-dwelling, dual-eligible adults aged 65 years or older (mean age, 77.2 years; 70.9% women) across the US between May and October in 2018 and 2019.
• An extreme heat day was defined as a day when the maximum temperature exceeded 90°F. Consecutive extreme heat days were grouped into extreme heat events, which lasted 1-5 days.
• Outcomes were compared between participants who experienced at least one extreme heat event (mean age, 79.2 years; 23.6% Black individuals) and received at least one weekly Medicaid home visit in the month preceding an extreme heat event and those who did not receive visits (mean age, 76.9 years; 20.6% Black individuals).
• The primary outcome was all-cause ED visits per 1000 enrollees during heat events and the following 2 days.

TAKEAWAY:

• Daily ED visits per 1000 enrollees increased from 1.94 before heat events to 3.23 during heat events and the following 2 days in the home visit group and from 2.25 to 3.50 in the comparison group, with no significant difference between the groups.
• Regional analysis revealed similar patterns across climate zones, except in the Southeast US, where ED visits were significantly greater among those with home visits (difference, 0.27; 95% CI, 0.07-0.48).
• Mortality during heat events and the following 2-day period remained identical in the home visit and comparison groups.

IN PRACTICE:

"We found that regular Medicaid home visits prior to heat events were not associated with changes in ED visits during heat events among older dual-eligible enrollees," the authors wrote.

"While these findings suggest that home visits did not reduce acute care use during extreme heat, they could mean that such visits facilitated appropriate care-seeking when heat-related symptoms arose," they added.

SOURCE:

The study was led by Hyunjee Kim, PhD, Center for Health Systems Effectiveness, Oregon Health Science University, Portland, Oregon. It was published online on January 15, 2026, in JAMA Network Open.

LIMITATIONS:

The study was limited by potential selection bias. Unmeasured factors such as air conditioning access, informal caregiver availability, and neighborhood cooling infrastructure may have influenced the outcomes. The inability to examine mortality as an outcome due to design limitations also prevented the assessment of whether home visits mitigated the ultimate harm of heat events.

DISCLOSURES:

The study was funded by the National Institute on Aging. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.