Medicaid for the Homeless

[ProSense]

Via Senator Sanders: site.

Medicaid for the Homeless Today, most state Medicaid programs cover only disabled adults or those with dependents, so millions of deeply impoverished Americans are left without access to the program. But starting Jan. 1, President Obama’s health care law will expand Medicaid coverage to adults with incomes under 138 percent of the federal poverty line, and enrollment is expected to increase by about nine million next year, The New York Times reported.

http://www.sanders.senate.gov/

Medicaid Expansion Faces Major Logistical Challenges Among the Homeless

By ANNIE LOWREY

<...>

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.

“We really feel like this is the last piece of the puzzle that we need to end chronic homelessness,” said Steve Berg, the vice president for programs and policy at the National Alliance to End Homelessness...signing up homeless people for Medicaid is a huge logistical challenge, as housing advocates acknowledge. Homeless individuals often do not have an email address, phone number or permanent address. Many are unaware of the health care law or are skeptical of public programs.

Housing advocates and social workers across the country are now on a major push to inform impoverished and homeless people that they are eligible for Medicaid in the 25 states that are expanding the program and in the District of Columbia, and to enroll them.

For homeless people, experts said, the Medicaid expansion will mean more consistent treatment for medical conditions, including alcoholism, drug addiction, chronic pain and depression. For states and cities, they said, it will mean a more effective safety net, and perhaps even a cheaper one.

- more -

http://www.nytimes.com/2013/11/25/us/medicaid-expansion-faces-major-logistical-challenges-among-the-homeless.html

Medicaid Applications Up 35 Percent Since Obamacare Exchange Opened
http://www.democraticunderground.com/10024090501

In the heart of rural Kentucky
http://www.democraticunderground.com/10024090488

Single Payer movement in the era of Obamacare
http://www.democraticunderground.com/10024090281

[grasswire]

1. are there enough medical services to care for all the new enrollees?

How is that part going to work?

[NYC_SKP]

2. I think of it this way, like defered or preventative maintenance.

I'll use motor vehicles as an analogy.

Suppose everyone got free tuneups and lubes, all maintenance, for free, forever.

Once might think, well where are all those mechanics going to come from?

They would be right to think that, especially during the rollout.

But, over time, wouldn't the preventative maintenance mean LESS work for mechanics taking care of problems that arise from a lack of maintenance?

The people who now get no care eventually need care and when they do it's more care than would have been needed, delivered in more expensive ways, such as at ERs.

I think this will all work out-- there may be some shortages or waits but I think the system will be resilient and respond and might actually work more smoothly after a year or two.

[grasswire]

4. anecdote pre ACA

My neighbor is a patient at a neighborhood clinic that's part of the big teaching hospital/university here. She's not a medicaid recipient, but one step up -- something that pays co-pays on top of Medicare. She needed an eye appointment. Scheduling told her three weeks. But when they discovered that she has this co-pay that's akin to medicaid, the appt could only be made for six months down the road. Apparently there are quotas and those who have better insurance or personal pay are put at the front of the line.

[NYC_SKP]

5. This sort of thing sounds like a class action lawsuit waiting to happen.

Or a serious flaw in the system that begs to be addressed.

It doesn't sound legal as it is, and in some states it might not be.

[grasswire]

7. maybe so

It's a sliding scale clinic. I don't know how they apportion the care and services that the larger hospital and ancillary clinics provide. I know there is a lot of high-dollar care available to some through the network. And I'm sure that medicaid isn't going to cover much of that stuff.

But a medical school gets federal money in terms of grants, too. Seems all very complicated.

[ProSense]

3. Community Health Centers Expand

This should help.

Community Health Centers Expand

Sen. Bernie Sanders announced on Thursday that the federal government designated three new community health centers in Vermont. The announcement will increase from eight to 11 the number of health centers that will provide primary care for some 163,000 patients throughout the state. Nationwide, the latest round of grants awarded today totaled $150 million for 236 new community health centers around the country to serve more than 1.25 million additional patients.

A Sanders provision in the Affordable Care Act authorized $11 billion to build, expand, and operate community health centers throughout the United States.

“This is a huge step forward for health care in Vermont in providing high-quality, affordable primary care, dental care, low-cost prescription drugs and mental health counseling to people throughout Vermont,” said Sanders, chairman of a Senate subcommittee that oversees primary health care.

Altogether, the eight current Federally-Qualified Health Centers operating now in Vermont served more than 130,000 patients last year, one of the highest participation rates in the country. The $2.4 million in new funding released by the Health and Human Services Department today for three additional Vermont centers will serve about 33,000 additional patients, bringing the total number of Vermonters served to about 163,000. In addition, about 25,000 Vermonters received dental care at community health centers, a number which will also rise.

In Vermont, $775,000 was awarded for the Battenkill Valley Health Center to operate a new Federally Qualified Health Center in Arlington, Vt., the first such facility in Bennington County to win full recognition as a Federally Qualified Health Center.

The Five Town Health Alliance in Bristol, Vt., was awarded $812,500 to operate the first center in Addison County.

Another $812,500 went to the Gifford Medical Center in Randolph, Vt., in Orange County.

And an Essex County site in Canaan, Vt., will open as part of a $456,793 grant to the Indian Stream Health Center headquartered in nearby Colebrook, N.H.

“As chairman of the Subcommittee on Primary Health and Aging, I am proud that we have seen in recent years a tremendous increase in the number of community health centers in Vermont to address the primary health care crisis in our state and throughout the United States,” Sanders said.

Northern Counties Health Care in 1976 became the first Federally Qualified Health Center in Vermont. A center in Burlington, Vt., won federal designation in 1993.

The federally-funded but locally-run centers are open to everyone and care for patients covered by Medicaid, Medicare and private insurance, as well as those who have no insurance. Payments are on a sliding scale, so people with low or moderate incomes can afford the care they need.

http://www.sanders.senate.gov/newsroom/recent-business/community-health-centers-expand-11-07-2013

[jwirr]

6. If you are homeless you are no doubt pretty poor. I would think that alone should have qualified

them for Medicaid even before ACA. What am I missing here?

[xmas74]

8. It depends on the state.

In Missouri it's almost impossible for an adult to get Medicaid, unless they are pregnant or disabled. Even if you qualify (an income of $292 a month for a family of three) you have to jump through hoops just to get it.

[ProSense]

10. Low-income adults weren't covered. Only a

handful of states provided very limited coverage. I learned that California has a law providing short-term coverage from the homeless.

http://www.democraticunderground.com/10023827703#post2

Stunning map of states refusing Medicaid expansion. 5 million hurt. TPM
http://www.democraticunderground.com/10024019515

The Cruelty of Republican States in One Chart
http://www.democraticunderground.com/10023790604

[ProSense]

9. Kick! n/t

[ProSense]

11. When Republicans start calling Obamacare 'free health care,' that means it's working

When Republicans start calling Obamacare 'free health care,' that means it's working

by Jed Lewison

Brian Beutler, noting a new Familes USA study showing that 71 percent of people under age 65 in the individual market are qualified for Medicaid or for insurance subsidies, observes:

For the past couple of months, the Healthcare.gov failure allowed Republicans to ignore the moral imperative they face to direct these constituents toward new options. The cash registers aren’t working, they could tell themselves, so what good would we be doing by directing people to the market anyhow. This was always dodgy logic, but it enjoyed a real sheen of plausibility. And that’s why Republicans have spent most of November soliciting Obamacare horror stories, rather than trying to help the narrators.

But as he points out, Jeffrey Zients, the Obama administration's healthcare.gov fixer, says that by the end of next week, the site will be able to handle nearly one million users a day, a development that will go a long way towards addressing the logistical problems that have challenged Obamacare's early days. If Zients delivers, this is a real problem for the Republican position, which comes down to variations of the claim that Obamacare isn't working.

There's no question that Obamacare delivers a quality product that people want—reliable health insurance—and for the vast majority of people, it does so more affordably than ever before. The problem really has been about logistics, and once more people can get health insurance through Obamacare, the GOP's technocratic critique falls apart. If they remain staunchly opposed to Obamacare—which they surely will—then their position becomes one of denying health care insurance to people in need. And it's not hard to see why that will quickly become a political liability.

Take a state like Kentucky, for example, where they don't call it Obamacare, but it's already working well. (For a great read on how well it's working, check out this weekend's Washington Post.)

Senate Minority Leader Mitch McConnell derides Kentucky's success as an example of government handouts run amok—"If you want to give out free health care you're going to have a lot of interest," McConnell says. The logical conclusion of that attack is that McConnell believes you should only get health care coverage if you've got deep pockets, a fundamentally immoral position that will appeal only to the the hardest core elements of the GOP base. Just look at the enduring popularity of Medicare if you doubt that fact.

If Republicans could spend the next 12 months arguing that Obamacare is an operational disaster, they'd be thrilled, because in making that argument, they would be able to avoid the reality that their position is to go back the era in which you were lucky to get health insurance—and luckier still if your health insurance actually gave you health security. But as Obamacare implementation improves, they won't be able to do that—and their arguments will increasingly echo McConnell's.

Twelve months of that from Republicans, and in their next port mortem, they'll look back at Mitt Romney spouting nonsense about the 47 percent as the good old days.

http://www.dailykos.com/story/2013/11/25/1258244/-When-Republicans-start-calling-Obamacare-free-health-care-that-means-it-s-working

[Scurrilous]

12. K & R

[sheshe2]

13. K&R

[Tumbulu]

14. but income tax returns are required, aren't they?

how many homeless people file tax returns?

I have a friend who is super low income, but never files taxes. He cannot apply without a history of returns and is scared to file them for reasons that make little sense to me. But make sense to him.