Utah lawmakers are currently engaged in an in-depth cost/benefit analysis regarding the optional Medicaid expansion made possible by the Affordable Care Act. [1] While some studies may show that the expansion will cost the State money, others show that the savings may outweigh the costs. [2] The economic cost of the expansion is being debated, but the potential benefit of Medicaid expansion to certain populations, such as the homeless population, is undeniable. Medicaid expansion has even been called the “secret weapon in the fight against homelessness.” [3]
Utah’s homeless population presents unique difficulties with regards to the provision of health care. Homeless individuals often suffer from chronic and acute mental and physical problems, as well as substance abuse. They are often transient and distrustful of government and other organizations. And they may not seek health care when other basic needs, such as shelter and food, are not being met. Because of these and other factors, the National Coalition for the Homeless estimates that the average life expectancy in the homeless population is between 42 and 52 years, compared with 78 years in the general population. [4]
The Affordable Care Act and the Medicaid Expansion provide a floor of coverage and care for populations such as the homeless, and meaningful and innovative implementation of these measures could result in major health benefits and saved lives for Utah’s homeless. For example, Utah should expand Medicaid and then coordinate with trusted community groups and public service organizations (such as shelters, churches, and food banks) to facilitate Medicaid enrollment by in-person outreach and communication. Additionally, emergency rooms, drug treatment centers, food stamp offices, domestic violence shelters, and community health centers may be used as additional ways to target potential enrollees. Notably, the Affordable Care Act has already provided for measures that will aid in the enrollment and care of the homeless population, such as a coordinated, streamlined enrollment process and people serving as “Navigators,” meant to raise awareness of the program and facilitate enrollment.
While the noblest reason for embracing Medicaid expansion may be to improve the lives of all Utahns, there may also be some financial benefits to early and meaningful expansion. For example, it is in the state’s financial interest to find and enroll homeless and other chronically ill individuals in the first three years while the federal government covers the full cost. This way, Utah does not pay out of pocket to take care of any expensive, up-front procedures that may be required for new enrollees, and early enrollment serves as preventative measure against future high-cost enrollees. Additionally, by enrolling homeless individuals in Medicaid early and channeling them to a primary care physician for routine checkups, the state (and Medicaid) will save money by limiting current inefficient uses of Medicaid by homeless individuals, such as frequent emergency room visits.
The State of Utah may continue to debate the financial sensibility of expanding Medicaid, but the potential benefits of Medicaid expansion to the homeless population are indisputable. Should the state chose to expand Medicaid, it should focus on active enrollment and care of the homeless population in order improve their quality of life and take one major step toward ending homelessness.
Ryan Beckstrom graduated with the class of 2013, and was Student Fellow with the Center for Law and Biomedical Sciences
[1] State of Utah Medicaid Expansion Assessment.
[2] Jennifer Dobner, Analysis: Medicaid Expansion Would Save Utah Millions, Cover 123k Uninsured, May 23, 2013.
[3] Ho, Jennifer M., Using Health Reform to Prevent and End Homelessness, United States Interagency Council on Homelessness.
[4] National Coalition for the Homeless, Health Care and Homelessness Fact Sheet, July 2009.