Enrollment Issues For Specific Populations: People Experiencing Homelessness

1. Enrollment Issues For Specific Populations:People Experiencing Homelessness Barbara DiPietro, Director of Policy

2. 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

3. 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

4. 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.

5. 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

6. Insurance Disparities

7. Enrollment improvements No requirement for a home address! No interviews Annual re-determination up to 5 years Assistance available Must be accessible (disability, language, etc.) NO PAPER DOCUMENTATION! Electronic verification of identity & citizenship Simplified categories No wrong door Single (short) application Based on income

8. Frontline: 10 Proven Strategies • Place enrollment assisters at service venues (soup kitchens, shelters, encampments, employment centers) • Conduct *repeated* outreach & education • Prepare to spend more time on education than on actual enrollment • Ask what health services someone needs & tailor insurance discussion around access to those • Ensure outreach workers are culturally competent, trained on homeless services & have info on area resources

9. Frontline: 10 Proven Strategies • Hold group discussions about health insurance and eligibility changes • Follow up with 1:1 opportunities (in private) to discuss individual circumstances & conduct enrollment • Explain what changes are happening • Broader eligibility, easier enrollment • Explain what doesn’t change • VA, Medicare, those currently eligible for Medicaid • Access to health center services not dependent on insurance status • Don’t stop with enrollment; focus on engagement in services

10. 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)

11. 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 capacityin communities • How can primary care, behavioral health & specialty care systems expand to meet local needs? • Plan for transitionto Marketplace plans as income increases • How do deductibles, co-pays & co-insurance remain affordable at modest incomes?

12. State policy actions (cont’d) • SuspendMedicaid (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 accessas well as enrollment • How can data be used to ensure access and/or plan for expanded services?

13. 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

14. 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/