By Dr. Nilesh Kalyanaraman, Vice President for Medical Affairs at HCH
Being homeless is deadly. People who are homeless are three to four times more likely to die than someone in the general population and have a life expectancy between 42 to 52 years. To put that in perspective, the average life expectancy is 78 years. That’s right, homelessness can decrease your life by more than 25 years.
This is why Health Care for the Homeless exists: to address the unique health issues facing those who are homeless. Our patients with diabetes get their meals at soup kitchens so they can’t control the amount of sugar and starch that they eat in a day which makes it harder to control their blood sugar. Our patients with asthma have trouble with their breathing because they may live in an encampment by the side of the road and breathe car exhaust all day. Our patients with back pain can never get relief while carrying their belongings all day in bags and then sleeping on thin mattresses in shelters.
We recognize these limitations and do everything we can to work around them and get our patients healthy. But, we can’t do everything. At some point most of our patients will need referrals to services such as X-rays, or lung function tests or visits to a specialist. The problem is that 70% of our patients are uninsured or underinsured and don’t have coverage for referrals. Our patients are able to get many specialty services donated by Mercy Hospital and a handful of other providers in the community but often times these appointments take a long time to materialize if they do at all.
Thankfully, this will change starting in 2014 when Medicaid is set to expand. Those making less than 138% of the federal poverty level, over 99% of our patients, will be eligible for Medicaid. Our homeless patients will have access to specialty care when and where they need it. They will be able to get their medications at any pharmacy. They won’t be second class citizens dependent on the kindness of others. They will have the same access to care as everyone else, as it always should have been. More importantly, it gives them security, as they work on finding permanent housing, to know that they’ll have comprehensive and dependable access to health care going forward.
To address the challenge of getting all the newly eligible folks onto the rolls of Medicaid we need to plan for coming deluge. We already have a strong foundation of benefits workers who do wonderful work in getting our patients enrolled in assistance programs. Building on that will require identifying barriers to enrollment and best practices from around the country so that we’ll be ready to hit the ground running in 2014.
