Many adults who are disabled and homeless have a serious mental illness (SMI). Some homeless adults have other disabling health conditions, including physical disabilities, serious medical conditions, brain injuries, or cognitive impairments. They may also have co-occurring substance use disorders.
As adults not living with children and therefore not part of the Covered Families and Children population, many people experiencing chronic homelessness have had a difficult time establishing categorical eligibility for Medicaid. Those who have been able to establish eligibility have done so through SSI based on disability. This will still be the primary route to Medicaid eligibility available to this population after January 2014 in states not expanding their Medicaid programs based on the income criterion available through the Affordable Care Act.
In some states, people who are homeless but whose health conditions do not meet the level of functional impairment required by SSI, or those whose disabilities are attributable to substance use disorders and therefore not eligible for SSI, have been eligible to enroll in Medicaid under the terms of a Medicaid 1115 waiver that predates the Affordable Care Act.14 Likewise, since passage of the Act and before 2014, people living in the six states that opted for early expansion of Medicaid eligibility have been able to enroll if they met the criteria for their state's expansion.