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Homelessness , Reports and Publications , Supportive Housing

Policy Brief Describes Homeless Health Care Challenges

16 December 2014
National Health Care for the Homeless Council

The National Health Care for the Homeless Council released a policy brief in November 2014 - Living and Working in the Coverage Gap: Homeless Health Care in States Yet to Expand Medicaid – which presents challenges in providing medical care to those experiencing homelessness.

The report describes how 23 states in the nation have not expanded Medicaid eligibility for lower income households – those at or below 138% of the federal poverty level – a threshold that most persons experiencing homelessness fall below.  The report estimates that this failure to expand eligibility has left 4.5 million people not able to afford health coverage.

People who are homeless are highly vulnerable and have higher rates of chronic disease and history of trauma than those who are housed. Without Medicaid expansion, many people who are homeless cannot afford health care coverage and are forced to choose between meeting other basic needs and taking care of their health.

The report outlines findings from interviews with providers and outreach workers about challenges and opportunities when working in states that have not expanded Medicaid eligibility.

Challenges include:

  • Access to care is challenging for those without insurance
  • Resources for those without insurance are rare and have strict requirements
  • Eligibility for affordable coverage does not meet the needs of those experiencing homelessness

Providers suggested non-expansion states focus their efforts on:

  • Strengthening existing collaborations and develop new partnerships
  • Explore state and local policy advancements
  • Target outreach and enrollment resources
  • Educate providers and consumers
  • Build infrastructure to bill third-party payers

Click here for the full policy brief.