Medicaid
Medicaid ensures access to ongoing, comprehensive health care for many homeless families and individuals. Having a trusted and reliable source of care is especially important for homeless people as their rates of chronic illness and disability, behavioral health problems, and co-existing disorders are two to three times the rate for the general population.

People without stable housing are more likely to suffer from poor nutrition, increased exposure to the elements and communicable diseases. They are far more likely to have diabetes, cardiovascular diseases and asthma. Displacement from their homes and communities create additional barriers to accessing health care from usual sources.

New York’s Medicaid program provides coverage to more than 55 percent of homeless families and individuals, significantly more than the national average for homeless people receiving Medicaid. Enrolling homeless people in Medicaid reduces health care costs for New York State. Medicaid allows health care for the homeless health centers to target scarce federal funds for the uninsured and provide better care for more people without insurance. And homeless people enrolled in Medicaid are more likely to attend to acute health needs and chronic conditions, which would otherwise become exacerbated and result in higher cost emergency room care.

Medicaid facilitates referral to specialty care and is a link to a wide array of social and housing services homeless people need. Medicaid provides access to behavioral health and substance abuse services for homeless men, women and children. Many homeless people have health or mental health disorders which contributed to their becoming homeless or result from the stress of being homeless. Many have experienced domestic or family violence. Children are especially vulnerable to the long lasting effects of having been homeless and frequently experience homelessness as adults. Medicaid helps them access mental health services which may be the best form of homeless prevention. Medicaid also provides access to substance abuse treatment and facilitates immediate placement when the person is ready for it.

In New York, Medicaid helps homeless people become healthy and stable, and better able to assume and sustain responsibility.

MEDICAID MANAGED CARE
In 1997, New York State received an 1115 Waiver from the federal government that restricted the rights of Medicaid beneficiaries to choose any provider that accepts Medicaid. In other words, the federal government gave New York State permission to require Medicaid beneficiaries to access most of their health care services through managed care plans, also called health plans.

Preceding this State legislation, Care for the Homeless issued two ground-breaking reports that documented how difficult managed care systems are for homeless people. Around the same time, we joined forces with other New York City health care advocates in The New York City Task Force on Medicaid Managed Care. Both our reports and our work on the Task Force led to homeless people being designated as an exempt population, or those who will retain the right to choose between Medicaid fee-for-service or a Medicaid health plan. New York City is the only city in the United States that recognizes homeless people as exempt from Medicaid managed care.

Also in 1997, The New York City Task Force on Medicaid Managed Care conducted a study and released a report on obudsman-like programs for managed care consumers. We worked intimately as a Task Force member in the completion of this study. As a result, two years later, the New York City Council funded the much needed, comprehensive Managed Care Consumer Assistance Program (MCCAP), administered by the Community Service Society of New York, to address consumer issues about managed care.

The New York City Task Force is a coalition of nearly 200 individuals and organizations. Task Force members include advocates for children, adolescents, women, the elderly, the homeless, people with disabilities and chronic conditions, including those with HIV and mental illness, and other low-income populations. Members also include community-based providers of health care and social services and Medicaid beneficiaries. The Task Force is a significant force in assuring that low-income New Yorkers have access to health care. Since 1996, a Care for the Homeless staff member has served on the Steering Committee for this coalition.

Care for the Homeless also participates with a group that regularly meets with key officials of the federal Center for Medicare and Medicaid Services (CMS), New York City and State Department of Health and New York City Human Resource Administration. Advocates in this group monitor and report on the progress or problems with Medicaid managed care in New York City.