A Word from Our Partners about the ACA and Chronic Homelessness

written by Lisa Stand
March 20, 2012

It has been two years since passage of the Affordable Care ActNext week, key parts of the ACA will be debated in Supreme Court oral arguments. The nine Justices will hear from lawyers on both sides – those who are challenging and those who are defending the law. Yet it could be several months (at least) before we know how the highest court in the land decides.

Whatever happens, there is no denying that the ACA has been helping people, as we noted in ourMarch 6 blog. As we also noted, some of the ACA’s greatest promises are still unfolding for the nation’s most vulnerable people who still lack health care coverage. The Medicaid expansion, for instance, will not take effect until January 1, 2014 – assuming this part of the law is upheld by the Supreme Court. Even so, progress is being made.

For this week’s ACA blog, the Alliance asked some of our national partners how they view the impact of the ACA. Here’s what we heard:

From Barbara DiPietro of the National Health Care for the Homeless Council:

“Homelessness is hazardous to your health.  Poor health causes homelessness, and in many cases, the experience of homelessness creates new health care conditions and exacerbates existing ones.  It is very difficult to become stable in employment or housing when there are untreated health care conditions.

Under the ACA, serving the most vulnerable homeless people will require more capacity in community health centers, especially Health Care for the Homeless (HCH) projects, as the graph below indicates. Nationally, there are currently 1,130 health center grantees that saw 20 million patients in 2010.  Of these, 223 are HCH grantees, which saw 805,000 individuals.”

The ACA allocates $11 billion over 5 years to health centers, with a goal of doubling the patients seen by 2015 to 40 million people. Unfortunately, to date, Congressional appropriations have not fulfilled these goals.  For fiscal year 2011, there was no increase.  In fiscal year 2012, there was a $200 million increase.

Using the modest increases to date, HRSA has issued 67 new access point grants that would create new sites for patients to access—16 of these were specifically to HCH grantees.  In total, these new access grants will facilitate service capacity for an estimated 262,000 new patients, most are very low income.

As the ACA is implemented, the need for health center investments intensifies.  If we can’t expand capacity, those with Medicaid cards won’t have a timely and reliable place to call their health care home. The ACA not only helps people access health insurance, but it also facilitates a growth in non-profit, privately administered, community health care services. Health centers directly employ 130,000 people, but there are many, many indirect jobs as well (contractors who clean buildings, provide maintenance, do contractual services, etc.). In this way, the ACA health center investments help further two national goals:  grow health care capacity and increase employment rates at the local level.

From Peggy Bailey at the Corporation for Supportive Housing:

“Years of living on the streets often leave people battling chronic medical conditions. When they find a home in supportive housing, they can need significant health care service–beyond those available in standard medical benefit packages. Health reform gives states the opportunity to provide comprehensive and integrated benefits to their most vulnerable citizens, giving them access to the breadth of services they need. Thanks to the Affordable Care act, hundreds of homeless people who previously had no health insurance are now Medicaid eligible in DC, CT, MN and WA. That’s progress that improves lives while helping service providers lower uncompensated care costs.”

From Andrew Sperling at the National Alliance on Mental Illness (NAMI):

“One of the four issues that the US Supreme Court will consider next week when it takes up the constitutionality of the Affordable Care Act is whether or not it is within Congress’s limited powers to require states to expand Medicaid eligibility up to 138Q% of the federal poverty level.  This expansion of Medicaid eligibility is a critical provision for homeless individuals living with serious mental illness.  Once Medicaid expansion becomes effective in 2014, in most states these individuals will no longer have to meet the very high eligibility standard for Supplemental Security Income (SSI) in order to qualify for Medicaid.”  (NAMI recently signed onto a “Friend of the Court” brief urging the Supreme Court to uphold lower court rulings rejecting challenges to the Medicaid expansion.  You can view this briefonline. )

If the Court upholds these rulings and allows Medicaid expansion to go forward in 2014, NAMI, NAEH and our allies will face a new challenge – convincing states to include appropriate benefits in the “benchmark” plans that will be made available to this new “expansion population” in Medicaid.  For example, it will be critical for these plans to include intensive case management services (including assertive community treatment) and services in supportive housing to ensure that the complex needs of single individuals with mental illness and a history of chronic homelessness are met.

Thanks from the Alliance to Barbara, Peggy, and Andrew – for your thoughts on the ACA and for being great partners, with your organizations, in ending homelessness! Please visit their websites and ours to learn more about how health care reform can change the way you work to end homelessness in your community.

 For information about advocating for affordable, high-quality health care in general, you might visitFamilies USA and Health Care for America Now. To find out about the ACA in your state, check outthese resources from the Henry J. Kaiser Family Foundation.