Homeless Services and Medicaid Enrollment

March 26, 2013  |  Publications

Health care reform is rolling out to consumers. New insurance coverage for millions took effect on January 1, 2014. Enrollment, however, begins three months sooner.

Beginning October 1, 2013, all consumers had access to information and the ability to enroll in health insurance through the new online Health Insurance Marketplace. In 24 states, the Marketplace also serves as a portal to Medicaid for a new group of enrollees who are eligible under the Affordable Care Act of 2010 (ACA). (For a map showing where your state stands on Medicaid, click here).

In the 24 states expanding Medicaid in 2014, adults with incomes under $15,000 (approximately) will were able to enroll in basic Medicaid benefits. This and other ACA provisions could affect how vulnerable homeless people receive medical services, behavioral health treatment and long-term supports; and how these services are funded in communities. Expansion of Medicaid has the potential to help thousands of homeless people, and possibly to end their homelessness. But it will not help those who are not enrolled.

Medicaid Expansion

Communities must plan and prepare to enroll people experiencing homelessness and assure they can benefit as much as possible from Medicaid programs. Frontline service agencies, and their staff who understand vulnerable populations, will fill critical roles, especially in states that choose to cover the new adult group.

  • Eligibility decisions are important first steps to guarantee that new applicants are enrolled in programs that best meet their needs. For instance, an applicant who is deemed “medically frail” can have coverage that may be more generous than an applicant who does not meet such criteria.
  • Distinct from the new adult coverage group, the ACA also extends Medicaid coverage to young adults who have been in foster care. This provision will take effect in every state in 2014, and eligibility does not have income limits.

Streamlined Enrollment

In all 50 states, rules and methods of enrolling people in Medicaid will change (or begin to change), under ACA provisions.

  • States will be relying more on existing data systems to verify eligibility, and will relax some of their more onerous rules, such as requiring applicants to specify a home address, or produce original birth certificates and proof of residency. The primary entry point for information and action in the new insurance marketplace is healthcare.gov.
  • People will also be able to enroll in a streamlined process available by phone, by mail and in person. To see or download a printed version of Marketplace consumer application, which many states will use or adapt to sign up new enrollees, click here.

Helping People Enroll

A great many people who are eligible in the new Medicaid group are unfamiliar with their options and will want in-person assistance to help them enroll. In every state, in-person help will be available for people who to decisions about their health care coverage, including their eligibility for Medicaid or other programs to help them get affordable coverage.

  • The different ways to help consumers are explained in this short brief, “Assistance Roles to Help Consumers Apply & Enroll in Health Care Coverage Through the Marketplace.”
  • A good place to start, if you want to help, is to reach out to community partners that have been awarded grants to educate consumers and help them enroll. You may be able to partner with a community-based group that has trained staff who understand the options in your state. Grants from the U.S. Department of Health and Human Services (HHS) are supporting enrollment programs through community health centers, mental health organizations, tribal agencies and other groups.  The names of participating health centers in your state can be found here.  In a number of states, other community groups are receiving federal support for their enrollment efforts.
  • For complete information about how to be a leader in outreach and enrollment, visit the website that HHS has created for exactly this purpose: marketplace.cms.gov.