Barriers to Medicaid Enrollment for Homeless People National Health Care for the Homeless Council Pat Post, MPA P.O. Box Nashville, TN /

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.

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:

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: FOR MORE INFO...

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

Who Is Eligible but NOT Enrolled? 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

WHY Eligible but Not Enrolled? 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

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

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

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

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

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

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. O’Connell, James. Determining Disability. Nat’l HCH Council, FOR MORE INFORMATION:

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.

For More Information Casualties of Complexity: Why Eligible Homeless People Are Not Enrolled in Medicaid by Patricia Post National HCH Council, Available online at: