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Medi-Cal's efforts seek to support homeless Californians by addressing the community's essential needs with medical services that go beyond medical consultations, such as housing transition, rental and bail assistance, post-hospital recovery housing, day care, and street medicine, among others.
The California Department of Health Care Services (DHCS) is committed to community-based housing and home-based services that provide social services to people at risk of homelessness. This multi-year initiative serves one in three, or nearly 15 million, Californians.
During a briefing held by Ethnic Media Services (EMS), DHCS leaders say they are using Medi-Cal to help Californians experiencing homelessness and housing instability lead healthier lives.
Glenn Tsang, homeless and housing policy advisor for the California Department of Health Care Services, talked about the importance of addressing issues around homelessness, as it is really troubling to have to make difficult decisions like buying food or paying rent.
“I want to start with our enhanced care management and community supports, that’s what we’re going to focus on, covering the issues that concern the community through street medicine; these services really constitute a strategy to support the frontline response that offers connection to emergency shelters and others,” said Gleen Tsang.
The administration of housing and outreach programs specifically is a new benefit that was launched in phases since January 1, 2022; this has been implemented in phases by target population, with homeless people being one of those populations of the new benefit.
Tsang explained that health plans are also encouraged and supported to collect data on racial and ethnic groups, with the goal of building a broader network of providers to serve these members and thus build a relationship of trust, connection and access points with the most vulnerable groups.
“Let’s say we have a member or an individual who is homeless and is diabetic, how can we reasonably expect them to store their insulin medications and take care of their medications? That’s an example I go back to again and again to really frame how these community supports are set up,” Tsang added.
For the homeless population, she said, one of the services available is housing transition, which guides people through the process of identifying stable housing and provides assistance with housing search requests to provide support during the process.
Another of these supports is for people who are discharged from the hospital and are experiencing homelessness; having another housing option is better for their recovery compared to an unstable living environment, so a request was submitted to federal partners at the Centers for Medicare and Medi-Cal Services to cover 6 months of rent for members who are making very critical and impactful transitions from emergency department settings, but which may serve as a pathway into homelessness.
Another important topic is medicine and street care services, which seek to provide medical services within everyone's reach, so that people will not have to travel long distances to receive care, providing more health opportunities to vulnerable communities.
Amber Middleton, director of the HOPE program at the Shasta Community Health Center in Redding, California, said they have a program that has a mobile medical component where they park at different sites and support those who are homeless.
“I'm a social worker by training and education, the whole approach is really to go to the population and not wait for things to get so bad that they have to seek services in an emergency, so I think this is a great example of breaking down barriers,” Amber Middleton said.
There are three community supports that are specific to housing: housing transition and navigation, housing deposits, and housing services, and then there is a person who is really focused on being a housing expert,
The Shasta Community Health Center Health Department has a Consumer Advisory Board and is comprised of individuals who are currently in shelter or have been in one in their lifetime, that group meets twice a month to inform the Hope department of any type of changes in practice as a way to continue to infuse the direct needs of the population being served.
Brian Zunner-Keating, director of the UCLA Homeless Healthcare Collaborative, explained the Homeless Healthcare Collaborative program, which began in January 2022 to promote health equity by bringing high-quality healthcare to the streets of Los Angeles County.
Since its inception, more than nine thousand clinical evaluations have been provided to almost five thousand people. It started with two teams and has now been expanded to five teams and other similar ones.
In this way, they are seeking to bring doctors and even prescription drugs directly to people suffering on the streets, in camps, shelters and other vulnerable places, making it a very useful tool for those who cannot attend a physical clinic.
“We can’t usually just walk up to someone we meet, it works much better to make a real human connection and say something simple like: Hi,” added Brian Zunner-Keating.
She said that they have a very diverse team that speaks multiple languages and comes from different ethnic backgrounds, in this way they can make health care more accessible, ensuring that team members are culturally and linguistically sensitive to the communities they visit.
Experts say that changes in medical services are improving, taking into account the most vulnerable population and those with fewer opportunities to be informed about health services, so continuing with projects aimed at homeless people will be a key piece to guarantee access to health care for all Californians.
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