How Medicaid Can Help Homeless and At-Risk Individuals

written by Lisa Stand
April 29, 2013

Today’s blog post comes from Senior Policy Analyst Lisa Stand’s presentation at a conference of the Congressional Black Caucus, Health Braintrust, in Washington, DC, on Tuesday, April 23.

At least three vulnerable groups could benefit from the Affordable Care Act (ACA) in ways that could reduce homelessness and risks of homelessness: chronically homeless individuals; young people aging out of foster care; and ex-offenders, also known as homecomers.

Chronically Homeless

Of the 634,000 people who were experiencing homelessness on a given night in 2012, slightly fewer than 100,000 were chronically homeless. As a group, chronically homeless individuals tend to have high rates of mental illness and substance-related disorders. And they frequently have injury, trauma, chronic medical conditions and disability. These conditions may be preexisting or acquired during homeless episodes.

Youth aging out of foster care

Some 30,000 young adults exit foster care every year when they reach the age of majority, the age they are recognized as adults by state law. They also tend to have behavioral health needs, lack insurance coverage, and be disconnected from family, social and economic supports – all of which puts them at risk of homelessness or unstable housing situations.


In 2011, around 688,000 people were released from federal and state prisons. Further, an estimated 5 million people are currently in a post-prison status such as pre-release, probation or parole. These homecomers mirror the prison population – predominantly people of color, and predominantly male.  They are typically uninsured and may be disconnected from housing, at least at the time of their release. Among them are a group of men and women who struggle with mental illness and substance-related issues, which may be related to their involvement in criminal justice systems. Upon release from prison or jail, they have high health care needs.

Changes under the ACA

Here is how changes to Medicaid under the ACA could help these vulnerable groups. First, Medicaid expansion, which is optional for states, could potentially cover all uninsured men with incomes under $15,000 – meaning most chronically homeless people and homecomers would have better access to medical and behavioral health care. Second, under the ACA states must extend coverage to former foster youth until age 26, which will give these young people additional time to receive ongoing treatments and services. Third, signing up for Medicaid  will be easier  across the country, as states must remove barriers to enrollment.

The ACA will not end homelessness! Housing is the primary intervention to solve homelessness. However, vulnerable people also need supports and services to be stable in housing. Medicaid can help individuals, and covering them will help strained communities by adding resources for services that accompany housing assistance. The proof will be in implementation, starting next year.

Challenges include gaining portability of Medicaid across state lines for former foster youth and enrolling all Medicaid-eligible homeless people in the proper benefits. For more information about homelessness and health care reform, click here and here.

Image courtesy of donbuciak.