When USICH released Opening Doors in June 2010, the Affordable Care Act had passed in March, just three months earlier. The second anniversary of Opening Doors occurred the same time that the Supreme Court delivered its ruling on the Affordable Care Act (ACA). Since the law was largely upheld, many of the provisions that will help us prevent and end homelessness are still in place. The provision giving states greater choice around Medicaid expansion, however, means that some of the original promise of the ACA in the fight against homelessness will be, in some parts of the country, up in the air, at least for a while.
Remaining provisions of the law that will prove helpful for populations experiencing homelessness are the expansion of affordable insurance coverage through state health insurance exchanges and the expansion of community health centers. Better access to affordable insurance that covers people with pre-existing conditions and does not limit coverage when you get sick can act as homelessness prevention for many. If Americans have health insurance, then they are financially protected from an unexpected, expensive health event that may push a family or individual into unemployment, foreclosure, and homelessness. Expansion of affordable, accessible health insurance is a key element in preventing a devastating health crisis that may lead to homelessness.
Already the Department of Health and Human Services has invested in expansion of community health centers, including new Health Care for the Homeless sites. Affordable insurance translates into affordable care when there are locations, doctors, and other health practitioners available to provide that care. And increasingly, Health Care for the Homeless providers have become instrumental in providing help to find and keep a home.
The Supreme Court gave states an option related to the expansion of Medicaid to all households at or below 133% of poverty ($14,400/year for an individual or $29,300/year for a family of four). Instead of all people with extremely low incomes, including people experiencing homelessness, being eligible for Medicaid come 2014, each state will determine its best course. Many states will still continue on this path, making Medicaid easier to access for people with the greatest health challenges. And with better access to care, people will have options beyond using the local emergency room for care. Hopefully this will also lead to more preventive care and better chronic condition management, including treatment of mental illness and substance abuse disorders.
States that expand Medicaid will still be making critical decisions about which benefits to cover. There is an enormous opportunity to provide better care while also managing high health care costs by offering solid home- and community-based services and comprehensive behavioral health supports. These are the kinds of benefits that will allow communities to help sick and vulnerable people get off the streets and out of shelters into homes. homes that become a foundation for better health and recovery.
The Federal Government has offered states economic incentives to do the smart thing. States now need to choose to offer access to Medicaid and the types of benefits that will help communities not only manage down the exploding cost of health care, but provide care that dramatically improves people’s lives.