13/08/2024 | News release | Distributed by Public on 13/08/2024 22:31
In 2023, more than 650,000 people in the U.S. were homeless - the highest number since the U.S. Department of Housing and Urban Development started tracking these data. While 60 percent of people who are homeless live in shelters or transitional housing, the remaining 40 percent are unsheltered, meaning they live in places that aren't considered suitable for human habitation, such as streets, abandoned buildings, or parks. People who are unsheltered tend to have significant health challenges; the health care system has historically failed to meet their needs.
Poor health is a driver and a result of homelessness. The links between poverty and poor health are well established, and the living conditions that people who are homeless face can pose serious health risks or exacerbate existing health problems. Compared to people living in poverty who are housed, people experiencing any type of homelessness are 60 percent more likely to die in a given year. People who are unsheltered have unique health challenges, with disproportionately high rates of communicable diseases and chronic conditions such as behavioral health conditions, tuberculosis, hepatitis, and heart disease.
Accessing health care services is challenging for people who are unsheltered. Barriers include a lack of transportation or insurance, inability to pay for care, and limited access to technology or other resources to make or track appointments. Some people may avoid seeking care because of previous medical trauma or mistreatment or because their living situation requires them to prioritize immediate needs (e.g., finding their next meal) over health maintenance.
For decades, clinicians and other service providers have tried to meet the needs of people who are homeless by creating street medicine programs, which bring care directly to people in their current environments. This model allows providers to offer many services traditionally administered in clinics instead in a street setting. These can include prescribing and administering medication and vaccinations; labs, diagnostics, or point-of-care testing; and health education. Street medicine is also a promising approach for expanding access to mental health and substance use disorder treatment.
Relationship-building is central to success. That means delivering care where and when people feel comfortable, letting patients define their goals for care, and listening to their priorities. Street medicine uses a team-based model, which typically includes at least one medical provider paired with an outreach worker like a community health worker. Outreach workers establish relationships with people and connect them with resources to meet nonmedical needs, such as referrals to transitional housing or nutrition assistance programs.
Street medicine started as a grassroots movement but has become increasingly organized, with more than 150 programs nationwide. However, many programs rely on grants or volunteers and have been limited by a lack of funding.
Until recently, street medicine providers in most states (except California and Hawaii) could not bill public insurance programs because there was no federal billing code for care provided in street settings. In October 2023, the Centers for Medicare and Medicaid Services added a place of service (POS) code to allow Medicare and Medicaid providers to bill for these services. The addition of the POS code could significantly expand street medicine's reach, particularly because of its potential to unlock funding through Medicaid. Many people who are homeless - particularly those living in states that have expanded eligibility under the Affordable Care Act - are eligible for Medicaid because of their low income.
The new POS code for street medicine is a first step, but more work is needed to support the expansion of street medicine in Medicaid. State policymakers should consider the following actions:
As states grapple with increases in homelessness, many are leveraging their Medicaid program and managed care contracts to connect people to housing. Financing street medicine through Medicaid is one piece of the puzzle to address health needs and connect people to the resources they need to become stably housed.