Care for the Homeless has joined the National Health Care for the Homeless Council (where our Executive Director, Bobby Watts, currently serves as Board President) and 22 other national, regional or local organizations across the country that provide services to or advocate for people experiencing homelessness, to file a set of reactions and recommendations regarding eligibility and enrollment in an expanded Medicaid program under the Affordable Care Act (“ACA”). The filing submitted to the Centers for Medicare and Medicaid Services on February 21st designed to make the Medicaid process and exchanges operated under the ACA more effective, more efficient and to enable greater access for homeless people and in turn cut costs of the program.
The recommendations deal with the special needs of poor and unstably housed persons. For example, one recommendation suggests flexibility in documentation requirements and provision of assistance in meeting enrollment requirements for those experiencing homelessness, victims of domestic violence, those with limited English proficiency and those displaced from disasters (such as Hurricane Sandy), who often have difficulty providing certain documents or getting through the enrollment process.
The filing also argues for including those suffering from substance abuse disorder as medically frail. Scientific research supports the biochemical basis for addiction and dependence in certain medically vulnerable people as is recognized in the current Diagnostic and Statistical Manual of Mental Disorders, the standard psychiatric reference used by mental health professionals.
Care for the Homeless, in reacting to proposed rules, opposed out of pocket costs on patients in deep poverty because “we know from decades of service provision” that any copays, premiums or cost sharing directly results in denying access to the very population most in need and in the poorest health. “On most days,” we wrote, “a single $4 charge is unaffordable to most people experiencing homelessness, who live at the lowest income levels…copays of $50 or $100 for inpatient care are unrealistic for this population; that they might be able to pay 50% of one day’s cost of hospitalization is an absurdly unrealistic thought.”
Providing homeless people with access to adequate health care, including appropriate preventative services, assures better health outcomes and reduced overall health care costs. Those are the goals of the Affordable Care Act.