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How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs

Executive Summary
  1. Health centers are funded through the Health Resources and Services Administration at the U.S. Department of Health and Human Services. HRSA-funded health centers provide preventive and primary health care to patients regardless of their ability to pay.

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Issue Brief
  1. Fazel, S., Geddes, JR, Kushel, M. (October 2104.) "The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations." The Lancet 384 (9953), 1529 - 1540. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61132-6/abstract

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  2. O’Connell, J.J. (Ed.) (2004.) “The health care of homeless persons: A manual of communicable diseases and common problems in shelters and on the streets.” The Boston Heath Care for the Homeless Program. Available at: http://www.bhchp.org/health-care-homeless-persons.

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  3. Morrison, D.S. (2009.) “Homelessness as an independent risk factor for mortality: Results from a retrospective cohort study.” International Journal of Epidemiology, 28(3), 877-883.

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  4. Kaiser Family Foundation (September 2012). Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion. Available at: http://kff.org/health-reform/report/medicaid-coverage-and-care-for-the-homeless/

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  5. Kaiser Family Foundation (November 2014). Early Impacts of the Medicaid Expansion for Homeless Population. Available at: http://kff.org/uninsured/issue-brief/early-impacts-of-the-medicaid-expansion-for-the-homeless-population/

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  6. HCH grantees are required to offer substance abuse services, unlike other health centers. Client need together with this requirement likely explains the difference.

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  7. Kaiser Family Foundation (January 2013).  Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2012–2013 Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/05/8401.pdf.

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  8. Revenue categories include the following: BPHC grants are Public Health Service Act, Section 330 grants from the Bureau of Primary Health Care (BPHC) at the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services; other federal grants include Ryan White program funds, Medicare and Medicaid electronic health record incentive grants, and other federal grants drawn from the U.S. Treasury; non-federal grants include state and local government grants and contracts, indigent care programs, and foundation or private grants and contracts; third party payments are patient-related payments that include Medicaid, Medicare, other public payments, which includes CHIP, family planning programs, and State insurance programs, and private payments, which are payments made by commercial insurers; self-pay is where the patient makes payment on their own. Other revenue includes revenue not related to charge-based services or grants, which may include fund-raising, rent from tenants, and medical record fees.

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  9. Medical care includes costs for medical care personnel; laboratory and X-ray; and other direct medical care costs (e.g., staff recruitment, equipment depreciation, medical supplies, professional dues and subscriptions, continuing medical education and travel associated with CME). Other clinical care includes staff and related costs for dental, mental health, substance abuse, pharmacy, vision, and services rendered by other professional personnel (e.g., chiropractors, naturopaths, occupational and physical therapists, speech and hearing therapists, and podiatrists). Enabling services includes staff and related costs for case management, outreach, transportation, translation and interpretation, education, eligibility assistance—including pharmacy assistance program eligibility, environmental risk reduction, and other services that support and assist in the delivery of primary care and facilitate patient access to care.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.