Medicaid Expansion a Big Leap Forward for People Experiencing Homelessness

by John Connolly - Insure the Uninsured Project

A recent report from researchers at the Kaiser Family Foundation and the National Health Care for the Homeless Council examined the experiences of four clinics for people experiencing homelessness in the wake of the Medicaid expansion in 2014. Each of the clinics was in a different state; three were in states that expanded Medicaid, and one was not. Unsurprisingly, the researchers found that many of the clinics’ previously uninsured patients and clients who are homeless have gained health coverage though Medicaid. New health coverage has made a substantial difference in individuals’ access to care, particularly in their ability to get timely, needed treatments. Not only can individuals get more regular access to services, they can now have important, life-saving surgeries that they delayed, and fill prescriptions—with ongoing, regular access to these medications—that they previously could not. These newly available treatments have been virtually indispensible for controlling many individuals’ behavioral health conditions.

The expansion in coverage has also made a big difference for the health service providers of people experiencing homelessness. While donations and grants previously funded many services, the Medicaid program provides a stable source of reimbursement for many needed treatments. Moreover, the clinics can now channel more resources into care coordination, the patient experience, and quality improvement. Medicaid payments do not always cover the cost of all of the services that the new enrollees need, but the program’s payments are now a central, stable source of reimbursement.

Clinics’ frontline workers and administrators still noted that having their patients and clients auto-enrolled in managed care led to some difficulties. For example, the clinics that individuals used as their usual source of care were not always in managed care plans’ networks, causing discontinuities in care. Staff have also had to dedicate more time to billing procedures, prior authorization requirements, and coordinating services with specialists outside of their clinic facilities. These issues similarly caused some interruptions in the continuity of care. Furthermore, administrators noted that they struggled to become credentialed in managed care plans provider networks.

Frontline staff remain focused on ensuring that as many individuals get enrolled as possible, which can sometimes be very difficult with a transient population. Additionally, these workers were mindful of reaching out to individuals to remind them that they need to renew their coverage when necessary. Providing this type of targeted, proactive outreach and assistance can be very difficult when patients’ contact information may not be available.

The findings of the report demonstrate quite clearly that the Medicaid expansion has been a huge help for both very vulnerable, ill patients and essential, financially strapped safety net providers. In addition, while the relationships between managed care plans and skilled-care providers for the homeless are sometimes difficult, they will be increasingly important to making coverage work for these new beneficiaries. This group does not fit the social and health profile of traditional Medicaid beneficiaries. They have very different health needs, and they will utilize care very differently. Managed care plans must become more skilled at doing outreach and delivering care to these enrollees. Enlisting and supporting providers like those highlighted in this study will be very important to managed care plans, as they engage beneficiaries to improve their health and quality of life, and control the overall cost of care.