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6th April
written by Lisa Stand

Today’s guest post was written by Alliance senior policy analyst Lisa Stand.

I am a lot more familiar with health care issues than with homelessness and housing. But, now that I’ve been at the Alliance for five months, I’m starting to see the forest and the trees, the big picture of the current State of Homelessness and the amazing talented and committed people who are ending homelessness one person at a time. More often than not, that same person was just the very same one health care advocates had in mind as they worked to pass the Affordable Care Act.

So why, when it comes to implementation, are there sometimes disconnects between housing and health care in the safety net?

One word: Medicaid.

Beginning in 2014, almost everyone with very low incomes ($10,800 for an individual) will be eligible for Medicaid – no matter where they go for treatment or support. That’s going to be a change for those chronically homeless individuals without Medicaid disability coverage or other insurance. Changes may be in store, also, for the programs that care for them. Suddenly, both patients and communities will be able to utilize Medicaid dollars they never had access to before – so Medicaid is the current topic in strategies to serve individuals in permanent supportive housing. The question is how?

Medicaid is unlike any other program, in so many ways. To mention one, it really does have its own language – an entire system of terms and concepts.

Here is an example: “Provider.” For someone steeped in Medicaid and unfamiliar with housing, “provider” – unless it’s an institution – has nothing to do with where people spend the night. In Medicaid-ese (and the rest of the health care world), a “provider” has a Medicaid number and offers mostly primary health care for the majority of under-65 enrollees – who number in the tens of millions. My point is that in the context of a conversation about Medicaid, it’s good to assume that “provider” means something very specific.

Another example: in the mainstream health care world, “outreach” tends to mean public education or large-scale targeting to defined segments of the population – for enrollment or to encourage healthy behaviors. Without experience working with strategies for housing homeless people, “street” outreach is not a top-of-mind concept in the mainstream health care world, including much of Medicaid.

These and other topics will be covered in a series of webinars the Allinace is hosting to help walk through the effects that health care reform will have on communities, agencies, and people assisting homeless – and especially chronically homeless – people and families.

The first of this series will take place on May 4 at 2 p.m. ET: “Talking Medicaid: First Steps in Building Effective Homelessness – Health Care Partnerships.” The webinar will provide a basic introduction to the Medicaid program.

Click here for more information and to register.

Image Courtesy of London Vision Clinic


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  2. Josh

    We all know healthcare even at it’s basic level can be quite expensive, and with many homeless exposed to the elements throughout the year this can cause problems if they don’t get the care they need. With this plan it will be good to know that more people will be able to get under this umbrella of help to get the care they need. It is also interesting to note that this plan will be coming about in the face of the proposed $1 trillion dollar cut in the Medicaid plan.

  3. 11/04/2011

    Hi, Josh Great comment!

    You raise really important points. Living without shelter carries certain health risks, from stress and the elements. New basic Medicaid benefits will give people and clinics a better base to address chronic conditions and complications, such as diabetes and chest ailments. With Medicaid coverage, it is also easier to have injuries timely treated, and to find preventive care. That’s for sure. We don’t fully know how or even if behavioral health care will change everywhere — it depends on federal regulations and state policies, as well as innovations at the front line. Stay tuned.

    To your second point — it’s critical for the public and our elected officials to understand how Medicaid helps people, and that certain funding cuts would be more costly for taxpayers in the long run. Check out the Alliance website for data to make the case that housing and services work to end homelessness.