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Barriers to Medicaid Enrollment for Homeless People

Barriers to Medicaid Enrollment for Homeless People. National Health Care for the Homeless Council Pat Post, MPA P.O. Box 60427 Nashville, TN 37206-0427 615/ 226-2292 council@nhchc.org. Project Goals. Identify obstacles to Medicaid enrollment for eligible homeless people.

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Barriers to Medicaid Enrollment for Homeless People

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  1. Barriers to Medicaid Enrollmentfor Homeless People National Health Care for the Homeless Council Pat Post, MPA P.O. Box 60427 Nashville, TN 37206-0427 615/ 226-2292 council@nhchc.org

  2. Project Goals • Identify obstacles to Medicaid enrollment for eligible homeless people. • Describe how HCH projects are addressing these obstacles. • Recommend strategies to surmount or remove them.

  3. Methodology • 33 HCH grantees surveyed, Nov-Dec 2000 • Detailed analyses provided by 8 projects in 7 states: KY, MA, NH, NY, TN, TX, WI Bureau of Primary Health Care/HRSA/DHHS FUNDING SUPPORT:

  4. Findings • Nearly one-third of homeless clients are thought to be eligible for Medicaid but not enrolled. • Aggressive outreach & advocacy can enable 10-30% of uninsured homeless clients to obtain Medicaid coverage. • Most homeless people do not qualify for coverage under current Medicaid policy. Post, Patricia. Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaid.Nat’l HCH Council, 2001: www.nhchc.org/CasualtiesofComplexity.pdf FOR MORE INFO...

  5. 30% on Medicaid (20% HCH clients) 11% SSI 55% uninsured (64% HCH clients) 66% single adults 23% minor children 11% custodial parents Homeless Service Users FOR MORE INFO... Burt, Martha. 1996 National Survey of Homeless Assistance Providers & Clients. Urban Institute, 1999. BPHC. 1999 UDS data.

  6. Who Is Eligible but NOT Enrolled? Children • don’t apply (immigrants, unaccompanied minors) • lose coverage when parent rolls off TANF • apply for SCHIP but not Medicaid Women • fail to apply for Medicaid spend-down • lose or fail to apply for TANF-Medicaid Disabled persons • have difficulties getting on SSI-related Medicaid

  7. WHY Eligible but Not Enrolled? Failed to apply • Thought they weren’t eligible • Impaired capacity to apply Didn’t complete enrollment • Failed to receive mailed information • Problem getting required documentation • Didn’t show up for personal interview

  8. WHY Eligible but Not Enrolled? Eligibility denied • Didn’t have required documentation Inappropriately disenrolled • Failed to receive/respond to reverification notice • Didn’t present required documentation at reverification • Lost benefits in violation of due process rights

  9. Enrollment Obstacles System Inadequacies • Lack of outreach & application assistance • Ineffective communication of requirements • Lengthy application forms & process • Delayed eligibility determination • Poorly trained eligibility workers with negative attitudes toward applicants

  10. Enrollment Obstacles Problems Related to Homelessness • Transience • Cognitive/ functional impairment • Low educational capacity • Low priority for health coverage except in an emergency

  11. Enrollment Obstacles Actions Deterring Enrollment • Failure to outstation eligibility workers • Violation of due process rights • Inappropriate sharing of applicant information with INS SOURCE: Schlosberg, Claudia. National Health Law Program, 1997, 1998

  12. Getting More Clients on Medicaid What HCH Projects Are Doing: • Assistance with applications and obtaining required documentation • On-site presumptive eligibility approval by staff • On-site eligibility determination by outstationed Medicaid workers • Aggressive advocacy and follow-up

  13. Recommendations Client Education & Advocacy: • Educate clients about Medicaid. • Assist with applications and appeals. • Document all impairments in detail. • Monitor housing and insurance status. • Identify and address enrollment barriers. FOR MORE INFORMATION: O’Connell, James. Determining Disability. Nat’l HCH Council, 1997.

  14. Recommendations Policy & Procedural Change: • Expand Medicaid eligibility. • Simplify application/enrollment process. • Standardize & streamline eligibility determination. • Reduce documentation requirements. • Verify eligibility once annually. • Outstation more eligibility workers.

  15. For More Information Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaidby Patricia Post National HCH Council, 2001. Available online at: www.nhchc.org/CasualtiesofComplexity.pdf

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