Searching for the Right Fit: Homelessness and Medicaid Managed Care   Finding A Better Way   Can Managed Care Work for Homeless People?: Guidance for State Medicaid Programs Lost in the Medicaid Maze Barriers to Medicaid An Unrelenting Challenge Fee for Service vs. Medicaid Managed Care

In 1990, Care for the Homeless' Executive Director, Susan L. Neibacher, contributed to Under the Safety Net, a book that recorded the many lessons learned from the national Health Care for the Homeless Program which mobilized forces in nineteen big cities to reach out and bring critically needed services to homeless people. The article published by the United Hospital Fund, Homeless People and Health Care: An Unrelenting Challenge discussed how collaboration between public and voluntary agencies was necessary to solve the complex problems of serving disenfranchised people during times of fiscal restraint. Care for the Homeless (then the New York City Health Care for the Homeless Program) also summarized the program's knowledge about the special needs of homeless people and the difficulties of providing services to this vulnerable population.

In 1998, the Bureau of Primary Health Care (U.S. Public Health Service) asked the National Health Care for the Homeless Council to examine the issue of the impact of Medicaid managed care on homeless people. Taking the lead, Care for the Homeless published two policy papers that dealt with the challenges of providing managed care insurance coverage for homeless people:

In 2000, we received funding from the United Hospital Fund for a study of Medicaid application practices, which we undertook with the collaboration of the Commission on the Public's Health System and the Greater Upstate Law Project. A report on the study entitled Barriers to Medicaid: Challenges & Opportunities for New York (2001) shows many instances where city and state procedures and documentation requirements far exceed Federal regulations, in effect denying Medicaid to eligible people.

During the summer of 2002, when Disaster Relief Mediciad transition was well underway, the New York City Task Force on Medicaid Managed Care sent survey teams out to Medicaid offices to talk to people about their experiences trying to obtain Medicaid. As Task Force members, Care for the Homeless worked closely with Community Service Society of New York and the Gay Men's Health Crisis to publish an issue brief on the data gathered, Lost in the Medicaid Maze: Voices From the Frontlines of New York City's Public Insurance Programs (2002).

The Medicaid system, fee-for-service and managed care, are complex and tricky to comprehend. Care for the homeless has long recognized the difficulties that both Medicaid beneficiaries and many service providers have in understanding the differences between Medicaid fee-for-service and Medicaid managed care. In an effort to clear up many confusions, we created the easy-to-read fact sheet fee-for-service vs managed care.