Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 3. Using Medicaid Waivers to Expand Coverage


Chapter 3 Highlights

Some states have used Medicaid waivers authorized under Section 1115 of the Social Security Act to expand health coverage for low-income people, which gives them the ability to reach many people experiencing homelessness or who were once homeless and now live in PSH.

Among case study sites, California and Illinois used 1115 waivers as a "bridge to reform," helping them establish low-income health plans in advance of 2014 that offered access to health care for many people who became eligible for Medicaid upon full implementation of the Affordable Care Act.

Under these waivers, jurisdictions receive federal Medicaid funds to match state and county spending on health care services delivered to qualifying low-income people.

As many people who enrolled in the health plans developed under the waivers had previously had no insurance and were being served at county facilities as uncompensated care patients, the availability of the federal match freed up some county funds for reassignment to other uses. These funds have helped many of the safety net hospitals and other health care providers to prepare for service, billing, and payment systems that needed to be in place for 2014.

Under California's 1115 waiver, each county could establish a low-income health plan, which in Los Angeles is called Healthy Way LA. Providers include the county's own extensive network of hospitals and clinics, plus Health Centers that operate as community partners under contract to the county. During its first year, 2012, Healthy Way LA enrolled almost 200,000 people, and enrolled almost 100,000 more by the end of 2013.

The Illinois waiver was approved more than a year after California's and applied only to Cook County. Enrollment began late in 2012, giving Cook County only a year to expand enrollment through the low-income health plan it developed, called CountyCare. In addition to the county's own health and hospital system facilities, CountyCare partners with Health Centers to serve as primary care providers for many CountyCare members, as required by the waiver.

Most of the people enrolled in the health programs developed under the California and Illinois waivers were automatically switched over to Medicaid enrollment on January 1, 2014.

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