Homeless Advocates Keep Eye on Big Picture, as ACA Benefits Roll Out

written by Lisa Stand
September 16, 2013

It seems like everyone who works or volunteers in community services is talking about enrollment in health care plans under the Affordable Care Act (ACA). The Alliance has been joining in. Surely the ACA has enormous potential to help people experiencing homelessness, and homeless advocates can help unlock that potential. That’s why we blogged in August about 5 Things You Can Do Now to be a part of what’s happening as enrollment begins October 1.

Today, we want to focus on two questions that will stay front and center, going forward into 2014 when new ACA benefits take effect:

What’s in store for people who experience homelessness if their states are not expanding Medicaid, as the ACA allows?

The ACA offers federal funding for states to cover all uninsured adults under 138 percent of the poverty level (about $15,000 a year for individuals). In effect, states that expand Medicaid will be offering benefits to nearly every homeless person not already covered. States can take this step in a later year if they have not done so for 2014. So it is critical to add the voice of homeless advocacy to efforts to expand Medicaid in all states – and the sooner the better for communities working to end chronic homelessness.

People who care about ending homelessness should make sure their state leaders – and the general public – understand how many vulnerable homeless people are losing out unless the state opts to expand. Furthermore, Medicaid expansion can strengthen capacity to prevent and end homelessness by bringing new resources to communities struggling with poverty, homelessness, and health care disparities.

In any case, this is a good time to focus on those who are eligible now but are not in Medicaid for one reason or another. Very vulnerable homeless people often face barriers to enrolling in critical programs such as Supplemental Security Income (SSI) and Medicaid, even though they qualify. In all states, the ACA is making enrollment procedures easier to navigate.

What’s next for communities working to address homelessness in states that are expanding Medicaid?

Enrolling in Medicaid is only one step. Many new enrollees, especially people experiencing homelessness, will need help using their benefits to access services and manage their care. Homeless service agencies in many places are reaching out to community health centers, local health departments, and other providers to talk about the impact of Medicaid coverage for their clients. Each can learn from one another about new ways to deliver effective services to people with complex needs.

And – just as important – communities have a unique opportunity to revisit the big picture in their plans to end homelessness. Health care reform brings new resources, especially from Medicaid. Other changes are happening, too – for instance in mental health and substance abuse programs that are also affected by the ACA. This may mean changes in the way services are provided and paid for. Therefore, many homeless advocates are working with community partners to understand these changes and consider new approaches to housing and recovery for people with the most needs.