Care for the Homeless Files Medicaid Process Recommendations
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.
