Medically underserved population?

[Nomemal]

This is gonna be a dumb question but would you classify homeless individuals as medically underserved. A lot of my work and EC involve free clinics but I feel like homeless individuals should be able to qualify for free healthcare (don’t know if every state has this as a law). I’ve felt that a lot of Docs say that people with low income have better insurance than themselves which is why I was wondering.

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[getdown]

yes they are

 

[deleted887473]

homeless individuals should be able to qualify for free healthcare

Yeah if only that's true

 

[ak-aka-dak]

Hospitals can’t turn them away, but they won’t get ongoing specialist care for chronic conditions which might not have been chronic if they had a primary care doctor. I’ve talked to many homeless people who have untreated conditions. Their access and barriers to healthcare are huge.

 

[Nomemal]

Hospitals can’t turn them away, but they won’t get ongoing specialist care for chronic conditions which might not have been chronic if they had a primary care doctor. I’ve talked to many homeless people who have untreated conditions. Their access and barriers to healthcare are huge.

Could you give a few examples or a way to find these out (not anecdotal but maybe like a list of well known obstacles/barriers)?

 

[ak-aka-dak]

Could you give a few examples or a way to find these out (not anecdotal but maybe like a list of well known obstacles/barriers)?

Factors Associated With the Health Care Utilization of Homeless Persons

 

[precisiongraphic]

Could you give a few examples or a way to find these out (not anecdotal but maybe like a list of well known obstacles/barriers)?

Let me introduce you to google:

First results of "medical barriers to healthcare for homeless"
Health care for homeless Link
Understanding Health Concerns and Barriers to Accessing Care Among Underserved Populations link
Barriers to healthcare access in non-elderly urban poor Link
Working to eliminate barriers to care for homeless people link
Healthcare for the Homeless link

Using google or the alternate site "google scholar" is a good first step in research. Look for cited articles, pubmed articles, NIH articles.

 

[PeleHonuaMea]

A lot of my work and EC involve free clinics but I feel like homeless individuals should be able to qualify for free healthcare (don’t know if every state has this as a law). I’ve felt that a lot of Docs say that people with low income have better insurance than themselves which is why I was wondering.

Our state does NOT have such a law for our homeless population, thank goodness! I'll be paying taxes out of my okole for the rest of my life! Hawaii has the ideal climate to be homeless, so we have ALOT of young and able bodied folks who are homeless by choice. To be fair, if I didnt have children, I'd probably be sleeping in my car at Ala Moana Beach too just to save money for medical school! But I digress...

I'm assuming the "low income have better insurance" folks the docs are referring to are those with Medicaid. Some of our homeless population here in Hawaii work or they make too much money through other forms of income such as SS, SSDI, annuity, pension..etc.. so they are overqualified for Medicaid. Although they are supposed to purchase their own insurance through the exchange, most do not by choice. So they just cruise through the ER for all their medical needs and hele on their way whenever they're ready, if it's 78deg and sunny, or if they're threatened to be placed in a care home or shelter.

And here in the Aloha state, the homeless who are mentally ill and those with qualifying chronic conditions are fully covered under Medicaid and/or Medicare per CMS guidelines.

 

[LizzyM]

Medicaid pays for health care for the poor. The catch is that the reimbursement to providers is so low that many providers will not take Medicaid patients (emergency medicine docs and ERs don't have the option of refusing to care for Medicaid patients and have to, at the very least, stabilize them. Hence, many of these patients make the emergency department their defacto primary care setting.)

Given that it is difficult for some people on Medicaid, including the homeless, to find a primary care provider who will take Medicaid, they may have a long wait to get care and/or have to travel long distances to find a willing provider. That seems to fit the definition of underserved.

 

[ThetisAntithesis]

Yes, the homeless are underserved.
I work with the homeless population and I do find that a lot qualify for medicaid but they don't know it.
The 1st step is helping them apply and getting it (they may need ID or birth certificate which is actually not that easy to get).
As it has been mentioned above, then its the issue of getting them to a primary care - transportation, forgetting appts, unstable housing/contact info...
Honestly if I were homeless, the last thing on my mind would be getting to the doctor unless if something starts to go wrong.

Then there's the issue of bias (from healthcare workers) - I had 1 patient at the shelter that I recommended to be seen in the ER for further care. I went to call the ambulance but she said "No, I'll have my friend take me... If they find out I'm from so and so shelter, they'll treat me like s***".

In the ER, they'll get seen in a few hrs and even though its a long wait, they might get warm (esp on a cold day) and have a meal. Its obviously not a good thing but its what works for them.

 

[PeleHonuaMea]

Medicaid pays for health care for the poor. The catch is that the reimbursement to providers is so low that many providers will not take Medicaid patients (emergency medicine docs and ERs don't have the option of refusing to care for Medicaid patients and have to, at the very least, stabilize them. Hence, many of these patients make the emergency department their defacto primary care setting.

Given that it is difficult for some people on Medicaid, including the homeless, to find a primary care provider who will take Medicaid, they may have a long wait to get care and/or have to travel long distances to find a willing provider. That seems to fit the definition of underserved.

In our state, it's easier to find a primary care provider for a Medicaid pt than a Medicare fee for service pt. The case workers assisting with the mentally ill and those with qualifying chronic conditions are pretty akamai to set their patients up with the more integrated Medicaid/Medicare providers such as Kaiser Permanente and HMSA (Blue Cross Blue Shield). Finding a PCP for such patients will be no different from finding a PCP if you had straight forward HMO coverage.

More recently, the homeless population case workers in the community or hospitals are following suit: when a client is auto assigned by the state to a random Medicaid provider (usually a small company with no healthcare system behind their name such as Aloha Care or Ohana) they assist and encourage the pts to have their coverage transferred to providers such as Kaiser or HMSA.

In addition, most of these ginormous insurances have built teams and programs to minimize the accessibility issue, hospitalization, re-admission...etc. Obviously for reimbursement issues but mostly because it ultimately decreases healthcare costs in the long run: preventative health is key. So they bombard the "at risk" population with community outreach, SWs and RNs go to the field, they provide notices, appt reminders, and even offer free transportation to all medical appointments.

I apologize, I am not trying to be offensive and I am not saying homeless people are not underserved, I am CERTAIN some are... I am just replying to the "homeless people should qualify for free healthcare" idea. I strongly believe that would be better assessed case by case, at least here in our state.

 

[LizzyM]

In our state, it's easier to find a primary care provider for a Medicaid pt than a Medicare fee for service pt. The case workers assisting with the mentally ill and those with qualifying chronic conditions are pretty akamai to set their patients up with the more integrated Medicaid/Medicare providers such as Kaiser Permanente and HMSA (Blue Cross Blue Shield). Finding a PCP for such patients will be no different from finding a PCP if you had straight forward HMO coverage.

More recently, the homeless population case workers in the community or hospitals are following suit: when a client is auto assigned by the state to a random Medicaid provider (usually a small company with no healthcare system behind their name such as Aloha Care or Ohana) they assist and encourage the pts to have their coverage transferred to providers such as Kaiser or HMSA.

In addition, most of these ginormous insurances have built teams and programs to minimize the accessibility issue, hospitalization, re-admission...etc. Obviously for reimbursement issues but mostly because it ultimately decreases healthcare costs in the long run: preventative health is key. So they bombard the "at risk" population with community outreach, SWs and RNs go to the field, they provide notices, appt reminders, and even offer free transportation to all medical appointments.

I apologize, I am not trying to be offensive and I am not saying homeless people are not underserved, I am CERTAIN some are... I am just replying to the "homeless people should qualify for free healthcare" idea. I strongly believe that would be better assessed case by case, at least here in our state.

Who said that homeless people should qualify for free healthcare??
Also, what is akamai?

Finally, what one of the most liberal states in the Union, and the one that is most remote, has a much different approach that some of the more conservative states on the mainland. Just sayin'.

 

[PeleHonuaMea]

Who said that homeless people should qualify for free healthcare??
Also, what is akamai?

Finally, what one of the most liberal states in the Union, and the one that is most remote, has a much different approach that some of the more conservative states on the mainland. Just sayin'.

"Akamai" just means clever. I was referring to OPs suggestion for free healthcare and why I believe it wont work in Hawaii.
And yes, we are definitely more liberal than most states (can sometimes be a good thing, sometimes not so much).

 

[LizzyM]

This is gonna be a dumb question but would you classify homeless individuals as medically underserved. A lot of my work and EC involve free clinics but I feel like homeless individuals should be able to qualify for free healthcare (don’t know if every state has this as a law). I’ve felt that a lot of Docs say that people with low income have better insurance than themselves which is why I was wondering.

I gues the question would be, "for what purpose would you be classifying homeless individuals as medically underserved?" Is it for a secondary application or pre-med committee interview that asks you to identify your experience with such populations or for some other reason?

You mention working in free clinics and feel that homeless individuals "shoudl be able to qualify for free healthcare". Do they not qualify for services at the free clinics where you work? Why do you say "they should be able to"? Do you mean that they do not qualify and you think that the rules should be changed or is there something I'm not understanding?

 

[Nomemal]

I gues the question would be, "for what purpose would you be classifying homeless individuals as medically underserved?" Is it for a secondary application or pre-med committee interview that asks you to identify your experience with such populations or for some other reason?

You mention working in free clinics and feel that homeless individuals "shoudl be able to qualify for free healthcare". Do they not qualify for services at the free clinics where you work? Why do you say "they should be able to"? Do you mean that they do not qualify and you think that the rules should be changed or is there something I'm not understanding?

It’s just I felt they should be qualified for Medicaid, and I realize that may be harder with a lack of ID or other resources such as transportation. But I feel like there is something else that’s a big factor that I’m missing as to why they would be classified as underserved if they technically should be covered and get the care they need based on my pretty liberal state laws but In practicality that may not be true.

Or maybe I just need to research the actual healthcare laws because I have a sugar coated view of Medicaid.

 

[LizzyM]

To qualify for Medicaid, you must be a citizen or legal alien or permanent resident. That's a barrier for some people.

You have to be poor. That seems pretty obvious for someone who is homeless but they might have income high enough to put them over the threshold (< $17K/yr in one state that I looked up).

In some states, if you are between 18 and 64, you aren't eligible unless you are disabled or pregnant. It is a struggle for some people to be declared disabled, particularly if the disability is due to mental illness.

Again, I would say that in some locations, it is difficult for patients who are on Medicaid to find a provider because the providers don't want Medicaid patients because the reimbursement is too low.