Early Impacts of the Medicaid Expansion for the Homeless Population Presented by the Kaiser Family Foundation Monday, December 15, 2014

Associate Director, KCMU Kaiser Family Foundation Washington, D.C. Samantha Artiga

The slides and the recording will be posted online by or before tomorrow morning. Everyone who RSVP’d for today’s briefing will receive an when they’re posted. You’ll be able to find them at the following link: kff.org/medicaid/event/web-briefing-early-impacts-of-the-medicaid- expansion-for-the-homeless-population/ Today’s Web Briefing Will Be Recorded

You can type your questions via chat at any time (bottom left hand corner of your screen). At the end of the speakers’ presentations, we will answer questions that you submitted via chat. Q&A – You Can Ask Questions At Any Time Via Chat

Director of Policy National Health Care for the Homeless Council Baltimore, MD Barbara DiPietro, Ph.D.

Note: Medicaid includes CHIP and other public Coverage. Sources: HRSA, 2013 National Homeless Data, Table 4: Selected Patient Characteristics; Health Resources and Services Administration, 2013 National Health Center Data; and U.S. Census Bureau, Current Population Survey Data, The Homeless Population had Significantly Higher Uninsured Rates Compared to Other Groups Pre-ACA Health Insurance Coverage for Health Care for the Homeless Patients Compared to Other Groups, 2013:

Source: data reported by National Health Care for the Homeless study sites, The Medicaid Expansion Led to Significant Increases in Coverage Among Patients of Homeless Providers Percent of Visits with Insured Clients by Study Site, January 2013-July 2014

Outreach conducted through a broad range of venues Clients generally eager to enroll and access services Nearly all homeless clients eligible for Medicaid at sites in expansion states Individuals needed substantial assistance to enroll Clients unsure how to use new benefit and access health services Outreach and Enrollment Experiences

Improved access to care Broader benefits –Improved ability to work and regain housing –Less stress and worry over medical bills –Greater ability to access disability documentation Feeling empowered to manage health and participate in care decisions Those in non-expansion state continued to face gaps in care and experience poor health outcomes Impacts of Coverage Gains for Homeless Clients

Wider treatment options are available Increases in third-party payments help stability New revenue facilitates long-term strategic & operational improvements Better ability to increase and/or shift staff Other funding sources remain vital Impacts of Coverage Gains for Providers

Support services, trusting relationships, and care coordination are key Important to incorporate social determinants of health (e.g., housing, poverty, hunger, etc.) into health care models Most individuals are staying with providers who have experience serving this population Broader system changes need to address the poor health and significant needs of this population Homeless provider sites have good internal data-sharing, but face gaps sharing with external providers Access to and Delivery of Care for the Homeless Population

Auto-enrollment into plans and providers Narrow or changing provider networks Prior authorizations and changing drug formularies Credentialing of providers Lack of experience among managed care plans in serving this population Emerging Challenges Serving the Homeless Population through Managed Care

Program Manager, Benefits & Entitlements Specialist Team Central City Concern (CCC) Portland, Oregon Kascadare Causeya

New enrollment systems and new requirements create confusion for frontline workers Need for phone numbers and addresses are barriers to client engagement and communication Loss of Year 2 funding and added hours of training create shortages in enrollment workforce Potential for coverage losses at renewal Looking Ahead: Enrollment Worker Perspectives on Challenges

Clients willing to enroll, happy to have benefits, and more engaged in outreach Consumers are spreading the word, leading to additional people initiating enrollment Able to access services at the point of enrollment Seeing visible improvements in outward appearance, increased trust, looking better, have more hope Looking Ahead: Enrollment Worker Perspectives on Opportunities

Chief Medical Officer Health Care for the Homeless (HCH) Baltimore, Maryland Nilesh Kalyanaraman, M.D.

Lack of reimbursement for key services –Case management –Outreach –Dental Changing formularies and need for prior authorizations in managed care plans create delays in access Lack of housing is still the biggest clinical problem Providers still learning how to navigate the insurance landscape Looking Ahead: Clinical Perspectives on Challenges

Better access to comprehensive care –Preventive services –Specialty care Increased availability of medications –Medications for asthma, Hepatitis C, arthritis –Wider choices of medications available to prescribe Patients have greater control over their health Potential for improved health outcomes over the long- term Looking Ahead: Clinical Perspectives on Opportunities

Executive Director Heartland Health Outreach CEO Together Health Chicago, Illinois Karen Batia

Ongoing need for grant-based funding Managed care requires multiple provider contracts, significant investment in infrastructure, and increased compliance requirements Data is fragmented and remains in silos Increased demand for services stretches provider capacity and creates recruitment and retention issues Initial cost of care will likely be high as clients access needed care, but eventually costs will come down Looking Ahead: Administrator Perspectives on Challenges

Increased revenue allows growth in infrastructure and staff positions Better data availability will yield better understanding of population/individual health needs and costs of care Potential to establish risk-stratified reimbursement based on specific population & appropriate outcomes Opportunity to build a system of integrated services (network) needed to effectively impact health of homeless populations Looking Ahead: Administrator Perspectives on Opportunities

You can type your questions via chat at any time (bottom left hand corner of your screen). We will answer questions that were submitted via chat. Due to time constraints, we may not be able to answer all of them, but we will answer as many as we can. Q&A: We Will Now Answer Questions Submitted Via Chat

Early Impacts of the Medicaid Expansion for the Homeless Population kff.org/uninsured/issue-brief/early-impacts-of- the-medicaid-expansion-for-the-homeless- population/ Related Issue Brief from the Kaiser Family Foundation

The slides and the recording will be posted online by or before tomorrow morning. kff.org/medicaid/event/web-briefing-early- impacts-of-the-medicaid-expansion-for-the- homeless-population/ Today’s Web Briefing Will Be Recorded

Until next time, keep up with the Kaiser Family Foundation online: Facebook: /KaiserFamilyFoundation LinkedIn:/company/kaiser-family-foundation Alerts:kff.org/ Thank you!