Health services are direct outpatient treatment of medical conditions when provided by licensed medical professionals. This may include providing an analysis or assessment of an individual’s health problems and the development of a treatment plan; assisting individuals to understand their health needs; providing directly or assisting individuals to obtain and utilize appropriate medical treatment; preventative medical care and health maintenance services, including in-home health services and emergency medical services; provision of appropriate medication; providing follow-up services; and preventative and non-cosmetic dental care.
Which HHS programs might be used to provide these services?
Medicaid pays for a broad range of health care services provided by qualified providers to people who are enrolled in Medicaid coverage. Each State must develop a State Medicaid Plan that describes the benefits its program will provide (including what optional services will be covered), and must have this plan approved by the U.S. Department of Health and Human Services’ (HHS’s) Centers for Medicare and Medicaid Services (CMS).
Federal law and CMS regulations prescribe a core set of benefits that each state must provide. Mandatory benefits include inpatient and outpatient hospital services; nursing facility, rural health clinic, Federally Qualified Health Center (FQHC) services, prenatal and freestanding birth center services; physician, nurse-midwife, and certified pediatric and family nurse practitioner services; home health, family planning, tobacco cessation, laboratory, X-ray services; and early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21.
States may decide to cover additional optional services. Optional benefits include clinic services; prescription drugs; rehabilitative services; case management; home and community based services (HCBS) as an alternative to institutionalization; physical, occupational, speech, hearing, and language therapy; diagnostic, screening, and a variety of other services that may be approved by CMS. States and may limit eligibility for certain additional services to specific groups of people. States may modify their Plan’s coverage of services beyond the federally-mandated core, including changes in provider qualifications, definitions of covered services, target populations, and payment mechanisms for optional benefits.
For both Mandatory and Optional benefits, an individual still must meet “medical necessity” criteria to be eligible for particular covered services. These criteria take into consideration a person’s diagnosis and other factors such as functional impairments.
Who is eligible?
Medicaid is an “entitlement” program, meaning that eligible individuals are entitled to receive covered health, behavioral health, and long-term care services, as defined within the State’s approved Medicaid Plan. The Affordable Care Act gives States the choice to expand Medicaid eligibility to persons with incomes under 133% of the Federal Poverty Level (FPL), and allows States to determine eligibility under their Medicaid plans.
How is it financed?
The Medicaid program operates under broad State discretion, and is funded by a combination of State and Federal matching funds. Each State must develop a State Medicaid Plan that describes the benefits its program will provide. Many Medicaid benefits, including those most likely to cover behavioral health services delivered in settings such as shelters, drop-in centers, or supportive housing programs, are “optional” benefits, meaning that States can decide if and how to cover these services. Federal spending on Medicaid is considered a “mandatory” program, meaning that the Federal government matches State spending for all covered services provided to eligible individuals. This makes Medicaid distinct from other HHS health and supportive services programs, which operate as “discretionary” programs with funding levels that can change from year to year based on actions taken by Congress and the President.
Where do I go to assist persons experiencing homelessness to enroll in healthcare?
Where can I find which States have expanded Medicaid?
Where do I learn more about the healthcare services available for persons experiencing homelessness?
- Medicaid and CHIP Program Information
- A Primer on How to Use Medicaid Who are Homeless to Access Medical, Behavioral Health, and Support Services
- USICH’s Affordable Care Act webpage
Health Care for the Homeless Programs and Community Health Centers
Health Care for the Homeless Programs and Community Health Centers provide primary, behavioral health, and in some cases, dental care to people experiencing homelessness. Health Care for the Homeless programs are targeted to persons who are homeless and local programs are encouraged to participate in the local CoC planning process. The first step for any Continuum should be to reach out to any HCH program in its jurisdiction and connect to current services
Who is eligible?
Individuals and families who are literally homeless as well as those living in hotels or motels, transitional housing, or permanent supportive housing
How is it financed?
These programs receive grant funding from the Health Resources and Services Administration (HRSA) as well as a grant under Section 330 of the Public Health Service Act, qualifying them as Federally Qualified Health Centers (FQHCs). FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. In addition, they receive Medicaid reimbursement for some of the services they provide to people who are enrolled in Medicaid.
Where can I find a local HCH provider?
Where can I find a local Community Health Center?
PATH (Projects for Assistance in Transition from Homelessness)
PATH programs provide services to people with mental illness who are experiencing homelessness or at risk of homelessness. PATH eligible services include habilitation and rehabilitation, case management, referrals, and housing support, as well as outreach and a range of other behavioral health services. Case management and other services funded by PATH is typically provided to people who are currently or at-risk of homelessness as opposed to people who are formerly homeless and living in permanent housing. PATH programs are administered by the State. State mental health authorities select providers, usually through a competitive process. PATH providers are encouraged to participate in the local CoC process and all PATH providers are in the process of transitioning data and reporting practices to participate in HMIS.”
Who is eligible?
Individuals determined to be experiencing serious mental illness or co-occurring serious mental illness and substance abuse disorder; and (2) experiencing homelessness or at imminent risk of homelessness.
How is it financed?
PATH is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). PATH is a formula grant provided to all 50 States, the District of Columbia, and US Territories, and allocated to more than 480 local organizations.
Where can I find a local PATH provider with which to partner?