Barriers to Medicaid EnrollmentBarriers to Medicaid Enrollmentfor Homeless Peoplefor Homeless People

National Health Care for the Homeless Council Pat Post, MPA

P.O. Box 60427Nashville, TN 37206-0427615/ 226-2292council@nhchc.org

Project GoalsProject Goals

Identify obstacles to Medicaid enrollment for eligible homeless people.

Describe how HCH projects are addressing these obstacles.

Recommend strategies to surmount or remove them.

MethodologyMethodology

33 HCH grantees surveyed, Nov-Dec 2000

Detailed analyses provided by 8 projects in 7 states: KY, MA, NH, NY, TN, TX, WI

Bureau of Primary Health Care/HRSA/DHHS

FUNDING SUPPORT:

FindingsFindings

Nearly one-third of homeless clients are thought to be eligible for Medicaid but not enrolled.

Aggressive outreach & advocacy can enable 10-30% of uninsured homeless clients to obtain Medicaid coverage.

Most homeless people do not qualify for coverage under current Medicaid policy.

Post, Patricia. Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaid. Nat’l HCH Council, 2001:www.nhchc.org/CasualtiesofComplexity.pdf

FOR MORE INFO...

Homeless Service UsersHomeless Service Users

30% on Medicaid(20% HCH clients)

11% SSI55% uninsured

(64% HCH clients)

Burt, Martha. 1996 National Survey of Homeless Assistance Providers & Clients. Urban Institute, 1999.BPHC. 1999 UDS data.

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66% single adults23% minor children11% custodial parents

Who Is Eligible but NOT Enrolled?Who Is Eligible but NOT Enrolled?

Childrendon’t apply (immigrants, unaccompanied minors)lose coverage when parent rolls off TANFapply for SCHIP but not Medicaid

Womenfail to apply for Medicaid spend-downlose or fail to apply for TANF-Medicaid

Disabled personshave difficulties getting on SSI-related Medicaid

WHY Eligible but Not Enrolled?WHY Eligible but Not Enrolled?

Failed to applyThought they weren’t eligibleImpaired capacity to apply

Didn’t complete enrollmentFailed to receive mailed informationProblem getting required documentationDidn’t show up for personal interview

WHY Eligible but Not Enrolled?WHY Eligible but Not Enrolled?

Eligibility deniedDidn’t have required documentation

Inappropriately disenrolledFailed to receive/respond to reverification notice Didn’t present required documentation at

reverificationLost benefits in violation of due process rights

Enrollment ObstaclesEnrollment Obstacles

System InadequaciesLack of outreach & application assistanceIneffective communication of requirementsLengthy application forms & processDelayed eligibility determinationPoorly trained eligibility workers with negative attitudes toward applicants

Enrollment ObstaclesEnrollment Obstacles

Problems Related to HomelessnessTransience Cognitive/ functional impairmentLow educational capacityLow priority for health coverage except in

an emergency

Enrollment ObstaclesEnrollment Obstacles

Actions Deterring Enrollment

Failure to outstation eligibility workers Violation of due process rightsInappropriate sharing of applicant information

with INS

Schlosberg, Claudia. National Health Law Program, 1997, 1998

SOURCE:

Getting More Clients on MedicaidGetting More Clients on Medicaid

What HCH Projects Are Doing:Assistance with applications and obtaining required

documentation On-site presumptive eligibility approval by staffOn-site eligibility determination by outstationed Medicaid

workersAggressive advocacy and follow-up

RecommendationsRecommendations

Client Education & Advocacy:Educate clients about Medicaid.Assist with applications and appeals.Document all impairments in detail. Monitor housing and insurance status. Identify and address enrollment barriers.

O’Connell, James. Determining Disability. Nat’l HCH Council, 1997.

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RecommendationsRecommendations

Policy & Procedural Change:Expand Medicaid eligibility.Simplify application/enrollment process.Standardize & streamline eligibility determination.Reduce documentation requirements.Verify eligibility once annually.Outstation more eligibility workers.

For More InformationFor More Information

Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaid by Patricia Post

National HCH Council, 2001.

Available online at: www.nhchc.org/CasualtiesofComplexity.pdf