Improving the Health of People Experiencing Homelessness: Issues and Recommendations

December 5, 2014

California’s decision to expand its Medicaid program provides federal funding opportunities to improve the health of its most vulnerable residents. Individuals experiencing homelessness have much to gain from Medi-Cal coverage, particularly considering that the homeless are in poorer health than their housed counterparts. Studies show that there is great potential for public cost reductions by improving the health and well-being of the state’s homeless residents.

Homeless adults, particularly the chronically homeless, frequently suffer from a complex blend of physical and behavioral health issues that necessitate a more comprehensive coordination of care than currently exists system-wide. To truly improve the health of those who are homeless, it will be important to coordinate funding, communication, and policy priorities across different providers, as well as across departments and agencies at the city, county and state levels. We provide the following policy recommendations to help achieve this goal:

  • Acknowledge that housing is a critical component to health care, and invest in permanent supportive housing for the chronically homeless to not only improve their well being, but for documented public cost savings.
  • Improve the Medi-Cal enrollment processes to require as few client visits/follow-ups/contacts as possible. Improve CalHEERS’ intersystem functionality to properly communicate with existing county eligibility systems, and allow for managed care plan selections online.
  • Case management should be a recognized and reimbursed service in assisting individuals experiencing homelessness.
  • In the absence of developing a universal data system for housing, health, behavioral health, and substance use providers, agencies and departments must develop a means to efficiently and securely share data about homeless patients for improved coordination of care.
  • Incorporate socio-demographic factors and social determinants of health in risk adjustment and quality outcome measures. Monitor access and utilization of health care in managed care plans, particularly behavioral health services and specialty care.
  • Prevent housing instability by updating hospital and criminal justice discharge policies, and coordinating necessary housing and supportive services to young adults who were formerly in the foster care system.

The full report is available for download:

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