ENROLLMENT ISSUES FOR SPECIFIC POPULATIONS:PEOPLE EXPERIENCING

HOMELESSNESSBarbara DiPietro, Director of Policy

ROLE OF HCH PROJECTS(AND OTHER HEALTH CENTERS)

• In 2012, 246 HCHs served 837,000 people→ 1.1 million total homeless patients served by entire health center program

• Provide primary care, addictions and support services to those who are homeless

• Engage in outreach & enrollment in benefits where eligible

• Identify underserved populations and engage them in care

• Partner with others in community to ensure comprehensive approach

ROLE OF NATIONAL HCH COUNCIL

• Unite the best practices in homeless health care• Provide training and TA to HCH grantees (and

others)• Support the HCH Community in its work to serve

vulnerable population• Engage in research, policy analysis and advocacy

w/on behalf of providers and consumers• Strive to prevent and end homelessness

IMPORTANCE OF TARGETED FOCUS ON HOMELESS POPULATION

• Vulnerable population in poor health→ High rates and co-occurring presence of illness &

disability, chronic & acute disease, trauma & mental illness & addiction, injuries & infectious conditions• Asthma, diabetes, high blood pressure, skin rashes,

depression, schizophrenia, alcoholism, brain injury, bronchitis, hepatitis C, TB, etc.

• Intensive services needs→ Primary care, specialty care, behavioral health, case

management, care coordination, case management, supportive housing, medical respite care, transportation, etc.

IMPORTANCE OF TARGETED FOCUS ON HOMELESS POPULATION

• Multi-system involvement→ Health care, shelter & housing, employment, income/food

benefits, legal help, energy assistance, child care, etc.

• Lack of housing complicates health care→ Competing priorities for food & shelter, historically not

well-served by mainstream agencies/settings, at-risk for violence & exploitation, tend not to self-present for care/assistance, may stay in remote areas

• Insurance disparities→ Historically not eligible for Medicaid (or can’t navigate

system)→ Lack of coverage limits access to comprehensive care

INSURANCE DISPARITIES

ENROLLMENT IMPROVEMENTS

1. NO PAPER DOCUMENTATION!

2. Electronic verification of identity & citizenship

3. Simplified categories4. No wrong door5. Single (short)

application6. Based on income

6. No requirement for a home address!

7. No interviews8. Annual re-

determination up to 5 years

9. Assistance available10. Must be accessible

(disability, language, etc.)

FRONTLINE: 10 PROVEN STRATEGIES

1. Place enrollment assisters at service venues (soup kitchens, shelters, encampments, employment centers)

2. Conduct *repeated* outreach & education

3. Prepare to spend more time on education than on actual enrollment

4. Ask what health services someone needs & tailor insurance discussion around access to those

5. Ensure outreach workers are culturally competent, trained on homeless services & have info on area resources

FRONTLINE: 10 PROVEN STRATEGIES

6. Hold group discussions about health insurance and eligibility changes

7. Follow up with 1:1 opportunities (in private) to discuss individual circumstances & conduct enrollment

8. Explain what changes are happening→ Broader eligibility, easier enrollment

9. Explain what doesn’t change → VA, Medicare, those currently eligible for Medicaid→ Access to health center services not dependent on

insurance status10. Don’t stop with enrollment; focus on engagement in

services

THE DANGER OF THE “COVERAGE GAP” FOR THIS POPULATION

The gap: Those earning <100% FPL not eligible for new insurance options (though may be Medicaid-eligible under current rules)

•Lack of trust already inhibits service engagement•Made worse with more “false promises” of eligibility•Anticipate confusion and stress when clients deemed ineligible•Mitigate confusion with “truth-in-advertising” at provider level•Explain that this is a state-level decision•Register clients to vote (in compliance with National Voter Registration Act)

STATE POLICY ACTIONS

• Assign appropriate providers & ensure networks→ Is PCP accessible, willing & capable to serve assigned individual?

→ Are provider networks adequate to ensure access for entire community?

• Increase service capacity in communities→ How can primary care, behavioral health & specialty care

systems expand to meet local needs?

• Plan for transition to Marketplace plans as income increases→ How do deductibles, co-pays & co-insurance remain affordable

at modest incomes?

STATE POLICY ACTIONS (CONT’D)

• Suspend Medicaid (rather than terminate)→ How to seamlessly reconnect those exiting institutions?

• Maximize state Medicaid options→ What populations (e.g., MH or SUD) or additional services (e.g.,

supported housing, dental, case management) are needed?

• Implement SOAR approach to SSI/SSDI (disability)→ How can access to insurance facilitate better documentation for

disability?

• Evaluate access as well as enrollment→ How can data be used to ensure access and/or plan for expanded

services?

PREVENT & END HOMELESSNESS:POSSIBILITIES THROUGH THE ACA• Prevent: Insurance reforms & affordable

marketplace plans will prevent bankruptcies, address health conditions earlier, prevent “slide” into homelessness due to illness & medical debt

• End: Connect to needed health services to address health problems, improve health outcomes, work on housing & income from more stable place, allow for services in supportive housing

CONTACT & RESOURCES• Barbara DiPietro, Director of Policy:

bdipietro@nhchc.org • Website: www.nhchc.org • Twitter: @NatlHCHCouncil & @BarbaraDiPietro • Resources: Enrollment toolkit, ACA policy briefs

& webinars, outreach training & TA, consumer & frontline worker FAQs, library of publications, government documents, dedicated outreach page

Health Reform Webpages:http://www.nhchc.org/policy-advocacy/reform/