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The Good News Within the President's Health Reform Proposal

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While there has been much debate in Congress and in the media about health care reform, the administration's proposal contains good news for those of us engaged in preventing and ending homelessness.

The proposal would provide that nearly all people experiencing homelessness would become eligible for health insurance through the federal Medicaid program. It is a common misconception that all homeless or even low-income people are already eligible for Medicaid. In fact, homeless single adults, youth who have "aged out" of the foster care system and people who battle addictions are rarely eligible for Medicaid. This means that hospitals, behavioral health clinics and community health centers who serve these populations are frequently uncompensated for their services.

The administration's proposal includes expanding Medicaid to everyone who earns below 133 percent of the federal poverty level. Currently, permanent supportive housing projects across the country are constantly trying to find funding to pay for mental health services, substance abuse treatment, primary health care and intensive case management services. Expanded Medicaid insurance coverage will allow supportive housing providers to focus on providing services, rather than chasing after funding.

It is important that legislation also include provisions that would allow for better coordination of care for people with multiple disabilities. If the Senate bill is passed by the House, states will be encouraged to create Medicaid benefit plans that focus on serving people who have multiple, chronic conditions. The federal government would even provide states with 90 percent of the costs of serving these high-needs patients. The Senate bill also establishes the Community-based Collaborative Care Network program which would support creation of teams of health providers to coordinate and integrate health care services, manage chronic conditions and reduce expensive emergency department use.

The 'team approach' to health care management is especially important for people living on the street, who frequently receive most, if not all, of their health care in emergency rooms. People who overuse emergency department services because they lack better health care alternatives are often referred to as "frequent users." Health reform would improve our systems' capacity to serve frequent users by improving coordination of services and ensuring Medicaid reimbursement for the health care specialists, mental health and addiction services providers, housing providers and other service providers whose services are essential to many homeless people.

This 'team approach' is already making a difference for people like Melissa (not her real name), who is currently being served within a program specifically designed for frequent users. Last week, she shared with us:

"I was homeless for about five years and was a frequent user of the emergency department. ... I have a daughter, but she wasn't living with me because I was homeless. I ended up going to the emergency department all the time to get medication for high blood pressure, asthma and my arthritis.

One day, one of the nurses at the emergency department recognized that I was coming in on a regular basis and she gave me a card with the phone number to the project for frequent users. ... I called and the case manager ... she told me that I needed to see a doctor because of all my health problems. ... The doctor I saw was very patient, really listened to me and took the time to explain everything to me. ... [but] even though I was keeping my doctor appointments, I still wasn't taking my medication regularly because of my addiction to drugs and because I was still homeless and didn't have a safe place to keep it.

But my case manager stuck with me and kept encouraging me to go into recovery. It took me about a year before I finally decided I was ready. ... I went to a residential recovery program ... on April 3rd, I will have been in recovery for a whole year.

I still go to the clinic to get medical care and I see a psychiatrist and a social worker there, too. Being able to get all my services at one location has been an incredible blessing -- medical, support, being linked to housing, a pleasant smile, and to be accepted with open arms and in a loving way. Everyone works together to make sure I get great care and they give me the push to make sure I keep moving forward.

Now ... I'm going to be moving into my own apartment. I know I won't have to go back to the streets. I'm hoping my teenage daughter will be able to come and stay with me and that my life will get back to normal."

When we pass health reform, we'll be able to provide comprehensive, coordinated supportive services to many, many more homeless people with multiple disabilities, like Melissa. That's good news worth talking about.