Improving Access to Medicaid for Homeless People by nau11061


									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
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
Reality Check

 Most homeless people do not qualify for
  Medicaid under current policy
 Few State Medicaid programs cover
  nondisabled adults, and those that do may
  not cover needed services
 For many homeless people, SSI (disability
  assistance) is the only door to Medicaid
Homeless Service Users

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

  Burt, Martha. 1996 National Survey of Homeless Assistance
    Providers & Clients. Urban Institute, 1999.
  BPHC. 2002 UDS data.
 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
Post, Patricia. Casualties of Complexity: Why Eligible Homeless
  People Are Not Enrolled in Medicaid. Nat’l HCH Council, 2001:
WHO Is Eligible but Not Enrolled?
Disabled persons
    have difficulty getting on SSI-related Medicaid
  fail to apply for Medicaid spend-down
  lose or fail to apply for TANF-Medicaid

  don’t apply (immigrants, unaccompanied minors)
  apply for SCHIP but not Medicaid
  lose coverage when a parent rolls off TANF
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
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
 Enrollment Barriers
System inadequacies
 Lack   of outreach and application assistance
 Ineffective   communication of requirements
 Lengthy,   confusing application forms/process
 Delayed    eligibility determination
 Poorlytrained eligibility workers with
 negative attitudes toward applicants
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
  Enrollment Barriers

Other deterrents

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


Schlosberg, Claudia. National Health Law Program, 1997, 1998
 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
What States Can Do

Three primary strategies:
   able to identify applicants/enrollees as
 Be
 Bewilling to adapt certain procedures to
 accommodate persons known to be homeless
 Usethird-party representatives to facilitate
 enrollment and access to covered services
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
Simplify Application/Enrollment

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

GWU Center for Health Services Policy & Research. Purchasing
  Specifications: Medicaid Managed Care for Individuals Who Are
  Homeless, June 2000:
Expand Coverage

 Usecost 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

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