Improving Access to Medicaid for Homeless People

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					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
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
 FOR MORE INFO...

  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
  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/CasualtiesofComplexity.pdf
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 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
   emergency
  Enrollment Barriers

Other deterrents

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


          SOURCE:

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
 homeless
 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
 records)
 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
  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/
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