Slide 1:

Improving Access to Medicaid for Homeless People

National Health Care for the Homeless Council
Pat Post, MPA

P.O. Box 60427
Nashville, TN 37206-0427
615/ 226-2292
council@nhchc.org

Slide 2:

Why Does Medicaid Matter?

• Helps pay for primary and preventive care services, which reduce costly specialty and hospital care.
• Improves access to secondary and tertiary care; (Primary care isn’t enough to meet health care needs of chronically homeless people.)
• Provides coverage for prescription medications;
• Helps people manage disabling conditions that precipitate and prolong homelessness.

Slide 3:

Reality Check

• Most homeless people do not qualify for Medicaid under current policy.
• Few state Medicaid programs cover nondisabled adults; those that do may not cover needed services.
• For many homeless people, SSI (disability assistance) is the only door to Medicaid.

Slide 4:

Homeless Service Users

• 66% single adults
• 23% minor children
• 11% custodial parents
• 55% uninsured
  (64% HCH clients)
• 30% on Medicaid
  (20% HCH clients)
• 11% SSI

FOR MORE INFO...

Burt, Martha. 1996 National Survey of Homeless Assistance Providers & Clients. Urban Institute, 1999. BPHC. 2002 UDS data.

Slide 5:

Eligible but Not Enrolled

• Nearly 1/3 of uninsured homeless clients may be eligible for Medicaid but are not enrolled.
• Aggressive outreach & advocacy can enable 10-30% of uninsured homeless clients to obtain Medicaid coverage.

FOR MORE INFO...

Post, Patricia. Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaid. Nat’l HCH Council, 2001: www.nhchc.org/Publications/CasualtiesofComplexity.pdf

Slide 6:

WHO Is Eligible but Not Enrolled?

Disabled persons

• have difficulty getting on SSI-related Medicaid

Women

• fail to apply for Medicaid spend-down
• lose or fail to apply for TANF-Medicaid

Children

• don’t apply (immigrants, unaccompanied minors)
• apply for SCHIP but not Medicaid
• lose coverage when parent rolls off TANF

Slide 7:

WHY Eligible but Not Enrolled?

Failed to apply

• Thought they weren’t eligible
• Impaired capacity to apply

Didn’t complete enrollment

• Failed to receive mailed information
• Insufficient documentation
• Didn’t show up for personal interview

Slide 8:

WHY Eligible but Not Enrolled?

Eligibility denied

• Didn’t have required documentation

Inappropriately disenrolled

• Failed to receive/respond to recertification notice
• Lack of required documentation to confirm continued eligibility
• Lost benefits in violation of due process rights

Slide 9:

Enrollment Barriers

System inadequacies

• Lack of outreach & application assistance
• Ineffective communication of requirements
• Lengthy, confusing application forms/process
• Delayed eligibility determination
• Poorly trained eligibility workers with negative attitudes toward applicants

Slide 10:

Enrollment Barriers

• Problems related to homelessness
• Transience, lack of transportation
• Cognitive/functional impairment
• Low educational/literacy level, LEP
• Low priority for health care except in an emergency

Slide 11:

Enrollment Barriers

Other deterrents

• Inaccessible eligibility workers
• Violation of enrollees’ due process rights
• Inappropriate information sharing with INS

Slide 12:

Medicaid Access, Homelessness

• Remove enrollment barriers for eligible homeless people.
• Expand eligibility for homeless adults.
• Provide comprehensive benefits including mental/behavioral health services.
• Ensure access to covered services and stable housing.

Slide 13:

What States Can Do

Three primary strategies:

• Be able to identify applicants/enrollees as homeless.
• Be willing to change certain procedures when applicants are known to be homeless.
• Use third-party representatives to facilitate enrollment and access to covered services.

Slide 14:

Models that Work

• Data field in Medicaid MIS to identify/track homeless beneficiaries - Boston, NYC, CT
• Outreach/presumptive eligibility for persons with disabilities - Maryland, Chicago
• Homeless Unit in SSA field office to identify/address reasons for delayed/denied disability claims - Boston
• HCH providers as liaisons for homeless applicants and enrollees - Massachusetts

Slide 15:

Simplify Application/Enrollment

• Reduce documentation requirements: allow self-declaration of residency & income (verified by audits or data matching with State records)
• Eliminate face-to-face interview & asset test
• Standardize/expedite eligibility determination
• Outstation eligibility workers at FQHCs
• Verify eligibility once annually

Slide 16:

Ensure Service Access

• Tailor services to meet the needs of people experiencing homelessness – integrated medical and psychosocial services
• Specify expectations for the delivery of services to homeless enrollees in contracts with managed care organizations/ providers

FOR MORE INFO...

GWU Center for Health Services Policy & Research. Purchasing Specifications: Medicaid Managed Care for Individuals Who Are Homeless, June 2000: www.gwhealthpolicy.org/newsps/Home/

Slide 17:

Expand Coverage

• Use cost savings from administrative simplification and coordination to expand Medicaid eligibility and covered services
• Most cost-effective strategy to prevent and end chronic homelessness: universal health coverage, affordable housing, living wage for those able to work, adequate disability benefits for those who cannot