Expanding Medicaid is a Life Saving Measure | Project HOME

Expanding Medicaid is a Life Saving Measure


Today's blog entry was written by Dan Muklewicz, a law student from the College of Law at Loyola University New Orleans, who is interning with Project HOME this summer.

The current debate on Medicaid expansion in Pennsylvania is sometimes reduced to numbers and statistics.  But it can be a matter of life and death. (For an update and call to action on the current effort, visit here.) The City of Philadelphia’s Homeless Death Review (HDR) is an annual evaluation of the circumstances of persons who die while homeless in Philadelphia. The 2009-2010 HDR identified 90 individuals who were homeless at the time of their death. The study’s conclusions included the assessment that “gaps in [health] coverage and/or care may contribute to inadequate access to appropriate care.” 

According to the Review, 55 percent of the deceased persons had no health benefits at the time of death, even though they had a serious condition Many of those persons who struggle with long-term homelessness often do not have healthcare coverage and must often rely on emergency room visits, which is more costly than preventive care.  And that lack of health care can contribute to an early and tragic death on the streets. That’s why Project HOME cares about Medicaid.  And that’s why we have been active in calling for Governor Tom Corbett and the Pennsylvania legislature to opt-in to the Medicaid expansion that is part of the Affordable Care Act of 2010. 

Medicaid expansion will help provide access to care for many who are not covered under the current system – and will have a positive impact on people who are experiencing poverty and homelessness. Some background:  Medicaid is a system of health care, jointly funded by the state and federal government, for individuals and families with low incomes.  The federal government sets minimum benefits that each state must provide.  The Medicaid program gives states a degree of autonomy in that they are permitted to offer additional benefits from the federal minimum.  Under the current structure, there are qualifications placed on Medicaid benefits. 

Medicaid is based on income and is also categorical. Only those who meet the age requirements, qualify for disability, or another program are able to receive coverage. For persons experiencing homelessness, Medicaid eligibility is typically dependent on qualifying for disability. Many homeless people who have mental health issues qualify for disability and therefore receive Medicaid coverage. However, common mental health issues such as depression and anxiety usually do not qualify as a disability. People with physical disabilities and serious health conditions, such as cancer and HIV/AIDS, are also eligible for disability. 

Homeless people who have struggles with substance use often do not qualify for disability. Though Medicaid is often the only option for individuals experiencing homelessness, the system is inadequate.  There are many who do not qualify for coverage.  For example, homeless people who struggle with substance use problems are unable to get coverage. As the HDR highlighted, many people who may be eligible for Medicaid coverage are not receiving the care that they need. The Patient Protection and Affordable Care Act, more commonly known as the Affordable Care Act or the ACA, is a comprehensive overhaul of the U.S. healthcare system.  It will take effect in 2014. One of the reforms that the ACA adopted was the expansion of Medicaid. 

The expansion of Medicaid allows states to enlarge their Medicaid programs to cover individuals earning up to 138 percent of the federal poverty line. Through the Affordable Care Act the federal government will reimburse states 100 percent of the cost of coverage from 2014-2017.  After 2017, federal reimbursement would gradually come down to 90 percent by 2020. 

As the law was drafted, states had to accept the federal increase of the Medicaid program or face a penalty.  However, in the Supreme Court case of National Federation of Independent Businesses v. Sebelius, the court found the penalty unconstitutional. This decision gave states the option to reject Medicaid expansion and keep their current program. Through the Affordable Care Act, most Americans below 133 percent of the federal poverty line will be eligible for Medicaid without any category requirements, including most people who live in poverty. 

Chronically homeless individuals will be able to receive appropriate coverage regardless of whether or not they qualify for a disability.  Instead of relying on emergency room visits, chronically homeless people can receive potentially life-saving preventive care.  Preventive care is the most effective method of treatment for the individual and the most cost effective for providers. Medicaid expansion will help prevent poverty and homelessness. 

For people who are uninsured, health care costs can be devastating.  Medical debt is the number one cause of bankruptcy in the United States.  Through the ACA, Medicaid will be available to a broader base of Americans.  People who would otherwise not have insurance will have access to coverage.

By reducing the number of people who are uninsured, many will be able to avoid the financial hardship of medical debt. The Medicaid reforms established by the Affordable Care Act will benefit many people experiencing homelessness.  It will help those who would otherwise be buried in medical debt, by providing a safety net.  More people who are chronically homeless will be eligible for Medicaid coverage.  The focus on supportive housing and comprehensive support services will help shift the primary method of care away from emergency room visits toward preventive care for those who are experiencing homelessness. And it might just save some lives.

Join us in taking action. Send an email to your state elected officials today.