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Re-Run: Chronic Homelessness and Medicaid
December 7, 2011
HUD Secretary Shaun Donovan recently called Medicaid “our greatest chance to make the biggest difference for the most people to move the needle on all of homelessness.”
Why? Perhaps because Medicaid is getting ready to sign up millions more low-income people. Because of the Affordable Care Act, all uninsured citizens with incomes under $15,000 per year will be eligible for Medicaid starting in 2014. That means vulnerable people who have been experiencing homelessness without access to health care will have one less barrier to housing stability.
And what a big barrier lack of coverage can be! Studies show that chronically homeless people tend to be physically burdened by conditions like cardiovascular disease, HIV/AIDS, diabetes, and untreated injuries. These illnesses often compound mental illness and substance use disorders, which are themselves made worse by homelessness.
Access to health care – including behavioral health care – can make an enormous difference for someone living on the street, or even a person barely hanging on with health-related burdens in subsidized or market housing. The most basic medical benefits pay for physicians, prescription drugs, lab tests, mental health services, and much more. Uninsured poor people who now line up for such services in busy emergency rooms will finally be able to get this treatment in community settings on a regular basis. For people with very high health care needs, better access to care and improved health status can make permanent supportive housing a more realistic goal, or make losing one’s home less of a threat to begin with.
The Affordable Care Act will definitely help vulnerable homeless individuals who now lack the access to services that health insurance provides. Community-based systems of care will benefit in turn. By one national estimate, Medicaid funding will increase by 27 percent in the first years of the expansion. This means new revenues in every state and every local system now receiving Medicaid funds. Strategic use of these new resources could lead to expanded capacity to solve chronic homelessness.
Of course, there is a long way to go before these promises of health care reform reach the front door of homelessness assistance programs. Federal administrators and state policymakers have yet to define key elements — such as basic benefits – or create programs to guarantee access for the hard-to-find and hard-to-serve.
More worrisome are the recurring moments when the powers-that-be in Washington think about drastic cuts to entitlements like Medicaid. Medicaid already helps millions of low-income people. It is already the foundation of critical safety net systems in every state. Cutting services now will increase vulnerability to homelessness. Delaying the expansion, which is absolutely critical to ending chronic homelessness, would be a serious setback for housing policy as well.