10/21/2013 - Leveraging the Affordable Care Act to Solve Homelessness: A Message to CoCs and Ten-Year Plan Leaders

By Barbara Poppe, Executive Director of the US Interagency Council on Homelessness 

Just a few months before Opening Doors was adopted, President Obama signed the Affordable Care Act into law giving us a game changing tool to help us achieve our goal of ending homelessness in America.  The Affordable Care Act gives states the option of providing nearly all people experiencing homelessness with health insurance coverage through Medicaid and other insurance, thereby increasing their access to critical medical and behavioral health services.  And, by transforming our nation’s approach to health care to focus on quality and outcomes rather than on procedures, the Affordable Care Act paves the way for Medicaid to pay for services like case management, life skills, behavioral health, and other wrap-around services provided in and around permanent housing.  

October 1st is an important day as the first day of open enrollment in private insurance through the health insurance marketplaces and in Medicaid in the states that are expanding.  But it’s also important to remember that it’s only the beginning, not the end, of the road to health care transformation.  The Affordable Care Act won’t bring about changes to our nation’s approach to health care overnight, nor will it fix everything in our nation’s approach to health care. But it’s an important first step.  

These changes won’t happen by themselves either. The Affordable Care Act is a tool, but a tool is only as good as its user. It will take our collective efforts to help implement the law and fully leverage it to end homelessness.  

So how can we make the best use of the Affordable Care Act to solve homelessness? Here are five questions to consider: 

For CoC and TYP leaders in all states: 

1)      Are you aware of your state’s decisions around the implementation of the Affordable Care Act? Is your state participating in Medicaid expansion and will the Health Insurance Marketplace be state- or federally-operated? 

2)      Has your CoC/TYP organized trainings for providers on how the Affordable Care Act is being implemented in your state and how to apply for health insurance through the marketplaces? Does your CoC/TYP website contain information about how the Affordable Care Act will work for people at risk of and experiencing homelessness in your state? 

3)      Have you considered how leveraging Medicaid to pay for services in permanent supportive housing might free up HUD Continuum of Care funds to pay for additional housing units? 

4)      Have you educated your Medicaid officials, managed care organizations, and health policymakers about the role that permanent supportive housing can play in improving outcomes while lowering health care costs?  Have you engaged them in conversations about how Medicaid and managed care benefits can cover and pay for services in permanent supportive housing? 


For leaders in states participating in Medicaid expansion: 

5)      Are you doing everything you can do to help people experiencing homelessness get educated about and enroll in the expanded Medicaid program? Are you partnering with Health Care for the Homeless, community health centers, or other health care organizations to determine how they can help with Medicaid enrollment and deliver primary and behavioral health services to people experiencing homelessness?   


For states not participating in Medicaid expansion: 

5)      Are you using the SOAR model and coordinating with Social Security Administration field offices to maximize Medicaid coverage among people experiencing homelessness with disabilities through Supplement Security Income (SSI) and Social Security Disability Insurance (SSDI) enrollment?

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