Enrolling the Homeless in Medicaid Is as Hard as It Sounds

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Medicaid expansion could be extremely beneficial to homeless people, who often have higher rates of alcohol and substances abuse problems, along with chronic diseases like diabetes, cancer and HIV/AIDS. Housing advocates also argue that expanded Medicaid could help reduce homelessness, according to The New York TimesBut how do you enroll someone with no phone, no email address, no permanent residence, no income for travel, and no trust in government programs? 

That's the problem facing housing advocates and social workers, who are trying to help as many people as possible enroll.  Currently a lot of Medicaid programs, in addition to income caps, also limit the program to those with disabilities or dependents. Date released last week by the Department of Housing and Urban Development shows that of the approximately 610,000 homeless people in the country, 36 percent are part of families. For the rest, qualifying for disability insurance means filling out a lot of paperwork — which can be tough for people with mental illness, language barriers and/or low literacy rates, the Kaiser Family Foundation reported last year. 

But even now, as Obamacare continues to go into effect, there are a few more hurdles for the homeless. First, not every state is expanding Medicaid, which poses a problem for people living in those states as well as people who'd be insured in one state and uninsured in the next. Also, Kaiser explains that the best way to help those skeptical of government programs enroll requires a big time commitment, sometimes months or years of gaining a person's trust, helping fill out forms, finding documentation, and assisting with transportation. And even after a person is enrolled, experts are worried there won't be enough doctors next year who accept Medicaid.

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But, if the homeless and housing advocates can get around those obstacles, they wouldn't be the only ones to benefit — it would be good for hospitals and state budgets, too. People are healthier when they have insurance to get preventative care and homeless people, like most uninsured Americans, don't go to the hospital until they're very, very sick. “They show up when they’re sicker,” Jennifer Ho, a senior adviser at HUD, told the Times. “They stay longer. And it’s harder to discharge them because they don’t have a place to go.” Besides fewer uninsured, extremely sick homeless people visiting the emergency room, Medicaid could help create a cheaper, better "safety net," as the Times called it, for the homeless.

Officials at the National Alliance to End Homelessness told the Times that Medicaid expansion could also free up money for nonprofits to put towards housing instead of health care. In New York City, the connection between housing, health care and cost savings has been acknowledged. In October, the city broke ground on a 12-story housing complex for the homeless funded by Medicaid money. The justification for the building, a 2011 initiative by Gov. Andrew Cuomo, was that the chronically homeless often have the most expensive medical bills, due to diseases that are made worse by living outside. Paying for housing instead of emergency room bills is cheaper and a better use of the money.  

This article is from the archive of our partner The Wire.