Homeless Children: Update on Research, Policy, Programs, and Opportunities. IV-A. Access to health and mental health care

05/15/2010

Access to health insurance is an important step in securing health care for homeless children. Medicaid is the primary source of health insurance for homeless children (National Center on Family Homelessness, 2009 p.43). Medicaid is health insurance for children and adults who meet the financial and general eligibility requirements. Eligibility depends on income and asset limitations, family size, and living situation. Persons under age 65 who don’t meet standard eligibility criteria may be eligible for Medicaid if they meet government disability standards. The Children's Health Insurance Program (CHIP) program extends health insurance coverage to more than 5 million children who are not eligible to receive Medicaid, usually because their household income is above what Medicaid will allow but below what is required to purchase private health insurance. Both Medicaid and CHIP are jointly financed by the federal and state governments, and the programs are administered at the state level. For children in some states, Medicaid and CHIP are combined in one program.

Many homeless children without health insurance are likely eligible for Medicaid or CHIP. Fourteen states have presumptive eligibility for Medicaid and 11 states have presumptive eligibility for CHIP for poor children (Kaiser Family Foundation, 2009). Presumptive eligibility allows qualified health care providers to immediately enroll children who appear to meet the state’s income eligibility requirements into Medicaid or CHIP. Thus, immediate care can be given to children without documentation of eligibility, although documentation must be provided by the end of the following month (HHS, 2001). In some states homeless shelters are considered qualified entities for presumptive enrollment of children into Medicaid and CHIP. Because Medicaid and CHIP do not collect information about children’s housing status when they receive services, the amount of Medicaid or CHIP funding that is spent on children who are homeless is unknown.

The recently enacted Patient Protection and Affordable Care Act (health reform) will help individuals and families keep quality, affordable health insurance whether they lose their jobs, switch jobs, move, or get sick. The Act also will increase Medicaid eligibility for many more homeless families and individuals by creating a uniform minimum eligibility threshold and allowing adults without dependent children to enroll.

Another widely used source of health care for homeless children is the Health Care for the Homeless Program administered by the Health Resources and Services Administration within the Department of Health and Human Services. This program was first established with the McKinney Homeless Assistance Act of 1987 and reauthorized in 2002 in the Health Care Safety Net Amendments Act and then again in 2008 in the Health Care Next Act. In FY 2010, the Health Care for the Homeless Program received $185.5 million (National Health Care for the Homeless Coalition, 2009). About 17 percent of those served by this program are children (HHS, 2007).

Table 3.
Selected Federal Programs That Assist Homeless Children and Their Families

Program Agency/ Department Who is eligible Eligibility Service(s)
McKinney-Vento Education for Homeless Children and Youth Program Office of Elementary and Secondary Education, Department of Education Homeless children in schools. Must report they are homeless at a school Transportation to school of origin
Medicaid & Children’s Health Insurance Program (CHIP) Centers for Medicare & Medicaid Services, Department of Health and Human Services Low income children US Citizen or lawfully admitted immigrant, must meet specific income levels by state and age Health/mental health insurance
National School Lunch and Breakfast Programs Food and Nutrition Service, Department of Agriculture Homeless children in school Must report they are homeless at a school. Then they are categorically eligible Free lunch and breakfast where available at schools
Supplemental Nutrition Assistance Program (SNAP) Food and Nutrition Service, Department of Agriculture Children in households with a citizen or legal immigrant Income and resource limitations SNAP benefits (formerly, food stamps)
Earned Income Tax Credit (EITC) Internal Revenue Service Low to moderate income workers   Refundable tax credit
Child Tax Credit (CTC) Internal Revenue Service Working individual with care of a child Must have a child under age 17, some citizenship requirements Federal tax reduction
Section 8: Housing Choice Voucher Program Public and Indian Housing, Department of Housing and Urban Development Low income families, seniors and the disabled US Citizens and some with eligible immigration status. Income requirements vary by location. Rent assistance
Temporary Assistance for Needy Families (TANF) Administration for Children and Families,  Department of Health and Human Services Low income families Eligibility varies by state as do work, school and other requirements Cash assistance
Low Income Home Energy Assistance Program (LIHEAP) Administration for Children and Families,  Department of Health and Human Services Low income households Varies by state. In some states households who receive TANF, Social Security Income (SSI) or Food Stamps are categorically eligible Assistance for paying energy bills
Federal-State Unemployment Insurance Program Employment and Training Administration, Department of Labor Workers who became unemployed through no fault of their own Varies by state Temporary financial assistance
Home Affordable Refinance Program (HARP) Departments of the Treasury and Housing and Urban Development Homeowners Homeowners with good credit and payment histories Home loan refinancing
Home Affordable Mortgage Program (HAMP) Departments of the Treasury and Housing and Urban Development Homeowners Homeowners with good credit and payment histories Home mortgage modifications to lower payments and terms
Child Care Assistance through the Child Care and Development Fund Administration for Children and Families, Department of Health and Human Services Low income families, families receiving TANF and those transitioning Assistance is for families that need child care to work or attend training or education for children under age 13 unless disabled or under court supervision Subsidies and payments for child care

The National Health Care for the Homeless Council Pediatric Working Group has recognized the special health needs of homeless children and has developed a detailed set of pediatric protocols for the Health Care for the Homeless network of providers. These protocols include specific care guidelines for general and supportive care, emergencies, trauma, HEENT (head, eyes, ears, nose and throat), hematology, respiratory, gastrointestinal, genito-urinary, and dermatology. Also included are addenda for specific diseases such as tuberculosis and other health-related concerns. Each section includes specific recommendations for assessment, intervention, and referral within the context of a homeless child’s life and experience.

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