Getting healthcare coverage for homeless may be a challenge

The benefits of expanding Medicaid coverage to homeless and chronically ill adults under healthcare reform may seem obvious. But enrolling this population and providing them with healthcare services will not be easily achieved, a survey published in Health Affairs shows.

The survey, which included more than 700 homeless adults enrolled in a housing and healthcare effort between 2004 and 2009, found adults reported “serious physical and mental health conditions, suggesting that chronically homeless adults have a wide variety of health needs that require a broad range of health services.”

Extending healthcare services to homeless adults likely will require support including transportation and housing, wrote Jack Tsai and Dr. Robert Rosenheck of Yale University, Dennis Culhane of the University of Pennsylvania and Samantha Artiga of the Kaiser Family Foundation's Commission on Medicaid and the Uninsured.

A limited number of homeless adults already covered by Medicaid were the most likely to seek medical care and were among the least likely to report difficulty paying for their care, the survey found. Homeless adults who were uninsured were less likely to seek care than the insured and the uninsured were far more likely to report difficulty paying for healthcare services.

Regardless of insurance, those surveyed lived with multiple conditions and psychiatric and substance abuse disorders were common, but the uninsured reported fewer health problems.

That's not necessarily good news, the authors said. “These findings could reflect better health status among this group, but they may also reflect undiagnosed and untreated conditions, given the participants' limited use of healthcare services and reported difficulties in affording care.”

Efforts by hospitals to reduce preventable emergency room and hospital visits in some states, including Minnesota and New York, have sought to develop housing and find apartments for homeless patients.

Follow Melanie Evans on Twitter: @MHmevans