Initiative And New Law Could Boost Health Care For The Homeless

In January, medical teams in Southern California will step up treatment for older people struggling with homelessness, in the hope that the expansion of such street medicine will result in more medical care, at a lower cost, for those who do not have a home in the region.

Called Healthcare In Action, and backed by Long Beach-based health insurer SCAN Group, the initiative will work in much the same way as existing Medicare Advantage plans offered by private insurance companies; basically, like HMOs that replace traditional fee-for-service Medicare coverage.

TREATMENT EVERYWHERE

But Healthcare in Action doctors and nurses will treat people — Medicare-eligible adults — in all kinds of non-traditional settings: on sidewalks and parks, behind garbage cans or in alleys; wherever your needs can be met. The goal is to overcome obstacles that make it difficult for the homeless to get medical help until a crisis sends them to more expensive hospital emergency rooms.

And as SCAN Group accelerates its expansion into street medicine, California lawmakers are close to creating new rules that could boost healthcare for homeless seniors.

Assembly Bill 369, or the “Street Medicine Act: Bringing Care to the Street,” has passed both houses in Sacramento and is on the desk of Governor Gavin Newsom. The legislation is intended to facilitate health treatment and reimbursement from Medi-Cal, the state’s public health insurance program for the poor.

Many of California’s more than 150,000 homeless people qualify for Medi-Cal but are not enrolled. And among those who are enrolled, nearly three in four do not see a primary care physician regularly, according to background information in the bill.

Additionally, healthcare providers face a hurdle trying to bill Medi-Cal for the treatment of the homeless. Under current law, the agency requires a billing address for the place where care is provided, usually a hospital clinic or doctor’s office, before processing claims.

Although the Healthcare in Action project and state legislation are not related, they are taking separate paths on the same issue; find ways to get more health care for people who live outdoors.

Dr. Michael Hochman, a Los Angeles-based primary care physician who will serve as CEO of Healthcare in Action, said the main question for SCAN Group was how to improve the health and overall outcomes of homeless people who aging, a rapidly growing segment of the street population while reducing costs.

A recent count of homeless people in Los Angeles County found that from 2019 to 2020, the number of homeless people age 62 and older increased by 20%. Hochman, who for 10 years has been a primary care physician at Los Angeles County Medical Center-USC, estimated that about 1 in 4 people who receive treatment there are homeless.

“They are some of the most expensive patients,” he said.

“Could we take better care of them?”

LEGISLATIVE ACTION

While SCAN sponsors hope to improve the financial aspect of healthcare for the homeless, the bureaucratic side of the puzzle could be altered with the Street Medicine Act.

Among other things, AB 369 would require Medi-Cal to recognize the street as a legitimate place to provide health care. It would also make it easier for homeless people to enroll in Medi-Cal. And it could make it possible for someone receiving street treatment to eventually be referred to a specialist

The key to the legislation is something called “presumptive eligibility,” which would allow people living on the street to receive medical treatment even if they are applying for Medi-Cal insurance on the spot.

The street medicine legislation was introduced in February by now Sen. Sydney Kamlager, Democrat of Los Angeles. On Friday, September 10, the bill was sent to Newsom.

Even for the homeless who are already enrolled in Medi-Cal, actual medical care is almost non-existent. The state has enrolled most homeless people in the Medi-Cal program, yet about 73% of those enrolled “have never seen their health care provider,” according to the bill’s author.

If you are homeless, the barriers to getting health care can seem endless. If you don’t have any of the following (transportation, ID card, or postal address), it can be a barrier to getting treatment

Problems such as mental illness, addiction, and widespread lack of confidence also serve as reasons why health care for the homeless is patchy at best.

The results are devastating and deadly. Homeless people are much more likely than others to suffer from chronic diseases such as diabetes and hypertension. It’s also one of the reasons homeless people die younger than the general population, in their 30s.

Proponents of the legislation include USC’s Keck School of Medicine and its director of street medicine, Brett Feldman, a medical assistant who began working in street medicine in 2007.

Over the years, Feldman has seen the movement grow. When it started, Feldman said, the key provider in Los Angeles County was the Venice Family Clinic, which had a pioneering program. Today, there are 28 street shows across the state, including several in the Los Angeles area.

In Orange County, Wound Walk OC, powered by volunteers, provides basic first aid to the homeless.

“There is tremendous interest,” Feldman said. “That is why the legislation must be updated.”

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