January 17, 2014; Kaiser Health News

Wonder how homeless people get healthcare coverage under the Affordable Care Act? Kaiser Health News and USA Today shed light on the process of reaching out to homeless people living on Skid Row in Los Angeles. The article describes the efforts of Christopher Mack, the lead outreach worker for the John Wesley Health Clinic, in talking to homeless men and women asking them if they have health insurance or see doctors, because the ACA-authorized expansion of Medicaid allows participating states to offer coverage people without children and without disabilities.

To reach the homeless, nonprofit groups like JWLC know that the work of buttonholing homeless persons in shelters, soup kitchens, homeless encampments, and alleys and doorways like many of the sleeping spots on Skid Row, will have to be done by workers like Mack, a formerly homeless person himself. For example, in Chicago, the Chicago Coalition for the Homeless sends outreach workers into homeless drop-in centers to contact homeless young people. In Baltimore, a nonprofit tries to reach the homeless through a street paper.

The challenge for homeless people is often one of survival. Many homeless persons have unmet health needs such as diabetes, high blood pressure, and asthma, not to mention problems of mental illness and drug abuse. However, thinking about seeing doctors, much less obtaining health insurance, is often a lower priority for the homeless than finding a meal or a place to sleep. A case in point, a 64-year-old homeless woman named Martha Castro told Mack that she had been homeless for four years, but had seen a doctor only once during that time.

Some number of homeless people might lack any form of identification or not be able to remember their Social Security number, making their access to Medicaid or even free services as health clinics difficult to obtain. How many homeless people live on the streets or in temporary shelters without access to doctors or much other kind of healthcare? How many live in states where even if they could qualify for expanded Medicaid coverage, the states haven’t taken advantage of the ACA opportunity to extend coverage to individuals?

Organizations such as the John Wesley Health Center and outreach workers like Christopher Mack may be doing yeoman work, but the structure of healthcare coverage in the United States is destined to leave many uninsured and underinsured Americans on the sidelines of affordable and accessible medical treatment. –Rick Cohen