Using Medicaid Waivers to Improve Access to Care for People Experiencing Homelessness During COVID-19

Following President Donald Trump’s declaration of a national emergency, Florida became the first state to get approved for an 1135 Medicaid waiver in response to coronavirus (COVID-19) 

1135 waivers allow the U.S. Department of Health and Human Services (HHS) to set aside administrative requirements to increase access to medical services when a national emergency is called. Florida will now be allowed to waive prior authorization requirements, make it easier for out-of-state providers to provide care, allow care in alternative settings from a hospital or doctor’s office, waive pre-admission screening for certain assessments for 30 days, and temporarily delay Medicaid hearings and decisions. 

These steps will certainly help reduce barriers to care for COVID-19 and help other states assess their needs to address the crisis. As states continue to plan for the pandemic, one of the most important things to consider as a response is access to care for vulnerable and uninsured populations, such as people experiencing homelessness 

Section 1135 waivers and 1115 Medicaid demonstrations can certainly play a key role in bridging the gap to care. As many of us in the field know, many people experiencing homelessness are older adults, often with compounding disabilities, who reside in large congregate facilities or in unsheltered locations with poor access to sanitation. Their age, poor health, disability, and living conditions make them highly susceptible to illness.  

Without access to health services the effects of coronavirus transmission could be devastating among this vulnerable group. Waivers can give states more flexibility to address the complex health needs of people experiencing homelessness 

What Can We Do to Ensure Access to Care? 

States should assess waiver options to address COVID-19 among vulnerable populations. For instance, the 1135 waiver could expand telemedicine so people most at risk do not have to travel to multiple locations for care. The 111Medicaid demonstration could, for example, grant states the authority to cover uninsured individuals during the COVID-19 crisis, and potentially beyond. These waivers have been used in past emergencies to expand coverage.  

Continuum of Care (CoC) leads and advocates in the field should make sure the needs of people experiencing homelessness are prioritized – vulnerable and low-income people should not face barriers to care during the COVID-19 crisis   

Encourage your states to prioritize the needs of the most vulnerable and take advantage of Medicaid waivers. Reach out to your state’s Medicaid agency to help them assess the needs of those most at risk.