Healthcare and the unhoused
Those of us who, even for the sake of adventure, have slept curled up in a car, know just how exhausting that can be. And doing so every day is bound to take a heavy toll on both the body and the mind.
California has more than 170,000 people, who do not live in homes and are forced to live in tents in encampments, parks, freeway underpasses, and even a jalopy. They often lack the means to locate a doctor who will provide them with health care, let alone to go to one.
In what is a pioneering program in the country, California’s Department of Health is expanding Medi-Cal—which is what Medicaid is known as in California—that has the potential to improve the health outcomes of people who are either on the verge of experiencing homelessness or have been rendered homeless.
A new Medi-Cal initiative
Medi-Cal, which provides health insurance to 15 million Californians—one in three—is now embarking on a bold initiative, which will not only add a new mode to how health care is offered, but it will also address social needs through it.
The program known as CalAIM (or California Advancing and Innovating Medi-Cal), was launched in January 2022. It’s a multi-year reform, with a slew of programs that go far beyond the doctor’s office.
Speaking at a May 2 Ethnic Media Services briefing on bringing healthcare to the unhoused, Glenn Tsang, Policy Advisor for Homelessness and Housing, California Department of Health Care, said, “Medi-Cal is going through an interesting transformation lately and it’s playing a pivotal role in meeting the unique needs of our members who’re on the brink of homelessness.”
On-site healthcare
And that is “meeting them outside the four walls of a home,” he said. “We meet them where they are. That could be in a shelter or in an unsheltered living environment.”
By “members,” he means those who are enrolled in a managed health care plan.
The primary plank of this plan is that instead of expecting members to locate health care, health care locates them and brings with it social resources to them.
Its other objective is to determine the “social drivers of health,” meaning the myriads of social factors that lead them to adverse health. Housing, for instance, is a “pretty incredible determinant of one’s health,” he said.
Preventative measures
Tsang compares that task to something like “swimming upstream.” Instead of having an unhoused member constantly rush to the emergency department to get urgent care, we are starting to look at the things that are propelling them to have to get their care in an emergency department. “What’s taking them there?” he asked.
He explained with an example. Let us say that we have a member who’s living on the streets and has high blood sugar. How can we reasonably expect that member to store their insulin if they don’t have an apartment or a refrigerator? What is the likely health outcome for this member going to be then? It could lead to an amputation of a leg. The approach that the expanded Medi-Cal takes is that it provides a member with a favorable arrangement where they don’t have to forgo their treatment.
CalAIM support programs
CalAIM has a set of 14 new programs, known as Community Supports, which were not covered under Medi-Cal. Six of those cater to the homeless. They include, but are not limited to:
- Helping people on the edge of homelessness with navigating a deposit on a rent and a rent.
- Providing recuperative housing for people who’ve just been released from the hospital.
- Connecting those who are intoxicated by alcohol and/or drugs to “sobering centers” to enable them to recover from the effects of those substances without having to go to an emergency department.
The HOPE Program
Much before the state of California embarked on this journey, the Shasta Community Health Center, a federally qualified health center in northern California, had begun on the road to providing health care to the homeless through its HOPE program, which stands for Health Outreach for People Everywhere.
Amber Middleton, Director of HOPE, said, “We’ve been doing it for the past 20 years and our program’s goal is to establish a continuum of care.”
One of the ways in which it takes health care to the unsheltered is through its 40-foot mobile van, which is, in essence, a small “clinic” that has an intake area, a lab, and two examination rooms. Providers on that van see patients three days a week in places in the Shasta area.
The UCLA Healthcare Collaborative
Down in southern California, the UCLA Health Homeless Healthcare Collaborative offers both primary care and urgent care to those experiencing homelessness in Los Angeles. Like CalAIM, this program too, started in January of 2022.
Brian Zunner-Keating, the program’s director, said, “Since our inception, we’ve provided over 9,000 clinical evaluations to nearly 5,000 individuals. We started with two teams and now, we’ve expanded to five teams.”
Our program and others like it bring doctors, nurses, and social workers directly to homeless people in our community, who need medical care. Workers are bridged to the community.
Poor health doesn’t lead to homelessness. However, homelessness invariably leads to poor health.
CalAIM hopes to change that.
