The Affordable Care Act's Medicaid expansion is expected to provide coverage to 9 million people in the states that have accepted it. Among the newly eligible are thousands of homeless people who have often lost their homes because of out of control health care costs, or who need extensive medical care because of their inadequate living conditions. But without a Medicaid expansion in Texas, there will be no new resources for the over 1 million people who would have been eligible – many of whom are at risk of homelessness and some of whom are already homeless.
There are close to 30,000 homeless people in Texas, according to a report recently released by HUD. Over 5,000 of these are considered to be chronically homeless, and over 2,000 are unaccompanied homeless children and youth. Though Texas's homeless population has been declining (down by close to 4,500 in the past year), it is still one of the five states that together account for more than half of the homeless population in the US. (To see how your city fares, the Texas Tribune has an interactive feature showing the homeless population in each metro area in Texas.)
Read about the link between health care and homelessness, and the role the Medicaid expansion could play, after the jump.As important as access to health care is for the already-homeless, it is equally important as a measure to prevent low-income people from becoming homeless. According to the National Coalition for the Homeless:
“Poor health is both a cause and a result of homelessness…A serious injury or illness in the family could result in insurmountable expenses for hospitalizations, tests, and treatment. For many, this forces a choice between hospital bills or rent.
Health care is even more of a problem for people who are already homeless. Homeless people are three to six times more likely to become ill than housed people. Homelessness precludes good nutrition, good personal hygiene, and basic first aid, adding to the complex health needs of homeless people. Additionally, conditions which require regular, uninterrupted treatment, such as tuberculosis and HIV/AIDS, are extremely difficult to treat or control among those without adequate housing.”
That's where the Medicaid expansion comes into play. According to the New York Times, “Housing advocates say they believe that the Medicaid expansion has the potential to reduce rates of homelessness significantly, both by preventing low-income Americans from becoming homeless as a result of illness or medical debt and by helping homeless people become eligible for and remain in housing.”
Expanding Medicaid is also expected to significantly reduce the cost of caring for the homeless, who are heavy users of hospital emergency rooms. Because most homeless people are uninsured, “They show up [to emergency rooms]when they're sicker. They stay longer. And it's harder to discharge them because they don't have a place to go,” according to a HUD official. Medicaid also provides more than just access to basic health care services. It also provides benefits especially helpful to the homeless, like mental health and substance abuse services and case management.
But enrolling homeless people in Medicaid isn't easy. Many do not have e-mail addresses, phone numbers or permanent addresses, many aren't aware of the Affordable Care Act or what they're eligible for, and some are wary of government programs. But in general, these are barriers that can be overcome with dedicated outreach. Except in Texas, where we face the added road block of a governor who won't even expand this life-saving program.