Help Protect Medicaid Expansion – Sign Our Letter of Support

Date:
January 22, 2025

To:
The Honorable Majority Leader Thune, U.S. Senate
The Honorable Speaker Johnson, U.S. House of Representatives
The Honorable Minority Leader Schumer, U.S. Senate
The Honorable Minority Leader Jeffries, U.S. House of Representatives

Dear Majority Leader Thune, Speaker Johnson, Minority Leader Schumer, and Minority Leader Jeffries:

The expansion of Medicaid to single adults, made possible through the Affordable Care Act, is a vital benefit for people experiencing homelessness.  As safety net health care providers who deliver direct care to approximately 1 million unhoused people across the United States—and other organizations and individuals concerned about the health of unhoused people— we are very concerned about the budget cuts and policy changes being proposed to this essential health insurance program.

Almost 40 years ago, the Institute of Medicine found that poor health was a primary cause of homelessness, that the traumatic experience of homelessness created new health care conditions and exacerbated existing ones, and that homelessness prevented vulnerable people from accessing needed care. Many studies have confirmed those findings. People experiencing homelessness have higher rates of chronic, acute, and behavioral health conditions, which are compounded by stress, weather conditions, and social isolation. Poor health is the primary reason this group also has high rates of emergency department visits and readmissions to the hospital. Hence, Medicaid—as a core health insurance program—is a critical component to addressing the health care needs of those who are homeless.

We write to urge you to protect the Medicaid expansion provision and oppose changes that compromise eligibility or undermine financing for the Medicaid program (such as work requirements, lower federal reimbursements, or other barriers to enrollment and eligibility). Not only do very vulnerable people depend on Medicaid, but so does the larger health care system, which has used Medicaid to implement successful hospital diversion programs as well as cost-effective solutions to homelessness.

• People experiencing homelessness depend on Medicaid—especially the expansion benefit.

In 2013, prior to the ACA’s expansion provision, 57% of the patients served by HRSA-funded Health Care for the Homeless (HCH) programs nationally were uninsured and 34% were enrolled in Medicaid. Ten years later in 2023, HCH programs in states that expanded Medicaid saw their uninsured rate drop to 21% and enrollment in Medicaid increase to 62%. For people experiencing homelessness, the expansion of Medicaid provides access to comprehensive, system-wide care that better enables them to work, go to school, and seek housing and other basic needs. This includes coverage for prescription drugs, hospital and specialty services as well as the broad range of care that people need to manage chronic and acute illnesses and access preventive care. As the number one payor of behavioral health care, Medicaid is also an especially important component to addressing substance use disorders (to include opioid use disorder) and mental health conditions.

• Safety net health care providers depend on an expanded Medicaid program.

Medicaid expansion increased financial resources for health care providers who serve those experiencing homelessness. Instead of being limited to a patchwork of short-term and uncoordinated grants, many more services are now reimbursed by third-party insurers, thereby increasing providers’ financial stability and making them more likely to have adopted a patient-centered medical home where care coordination and addiction treatment are available. This directly led to reduced uncompensated care for hospitals and other providers. The additional revenue improved capacity at health centers to hire more staff and improve a number of chronic and preventive outcome measures (for example, asthma treatment, cancer screenings, hypertension control, and so forth). Expansion specifically improved access to behavioral health and preventive care in rural areas, where homelessness is increasingly an issue. Hospitals, health centers, and specialty care providers depend on the reimbursements Medicaid provides, while the larger health care system benefits from the improved system integration that enrollment in insurance facilitates. When both patients and providers have the resources they need, everyone benefits. 

• Medicaid drives innovative, cost-effective health system improvements and solutions to homelessness.

Medicaid expansion has allowed many states to tailor their health care systems to cover services designed to reduce overall costs and improve health outcomes among unhoused people. Specifically, states have added tenancy supports in supportive housing that show cost savings and system improvements from integrating services with housing. Likewise, states have also developed medical respite care programs, which help hospitals divert emergency room and hospital re-admissions and improve health outcomes for unhoused people. For state budgets, Medicaid is the largest source of federal funds. If federal funding is reduced, the cost burden would be shifted to states who then will be forced to shift the financial burden to hospitals and taxpayers, . When Medicaid-funded services are combined with other funding sources for housing (such as HUD-funded rental assistance programs), low-income people can build a healthier, more secure future and health care systems can operate more efficiently.

Conclusion

Like everyone, unhoused people deserve comprehensive, high-quality health care—and access to health insurance to pay for it. The Medicaid program—and specifically the expansion of Medicaid to single adults—is a vital lifeline for people experiencing homelessness and financially strengthens health care systems. The program provides comprehensive care, improves health outcomes and health care system operations, reduces the inefficiencies of being uninsured, and drives cost-effective solutions to homelessness. Policymakers must protect Medicaid, not undermine it. Together with those organizations and individuals below, we write to urge you to protect the Medicaid expansion provision and oppose changes that compromise eligibility or undermine financing for the Medicaid program.

Respectfully,

Bobby Watts, CEO

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Thank You For Your Support

The following individuals and organizations have signed our Letter of Support.