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- Title
Technically Accessible, Practically Ineligible: The Effects of Medicaid Expansion Implementation on Chronic Homelessness.
- Authors
Willison, Charley E.; Lillvis, Denise; Mauri, Amanda; Singer, Phillip M.
- Abstract
Context: Homeless policy advocates viewed Medicaid expansion as an opportunity to enhance health care access for this vulnerable population. We studied Medicaid expansion implementation to assess the extent to which broadening insurance eligibility affected the functioning of municipal homelessness programs targeting chronic homelessness in the context of two separate governance systems. Methods: We employed a comparative case study of San Francisco, California, and Shreveport, Louisiana. which were selected as exemplar cases from a national sample of cities across the United States. We conducted elite interviews with a range of local-level stakeholders and combined this data with primary-source documentation. Findings: Medicaid expansion did not substantially enhance the functioning of homelessness programs and policies because of Medicaid access challenges and governance conflicts. Administrative burden and funding limitations contributed to limited provider networks, inadequate service coverage, and lack of linkages between Medicaid enrollment and homelessness programming. Governance conflicts reinforced these functional challenges, with homelessness under the administration of local municipalities and nongovernmental organizations while states administer Medicaid. Conclusions: Improving access to health care services for persons experiencing homelessness cannot occur without intentional coordination between sectors and levels of government and thus necessitates the development of targeted policies and programs to overcome these challenges.
- Subjects
CALIFORNIA; LOUISIANA; MEDICAID law; HEALTH policy; HEALTH services accessibility; HEALTH facility administration; PRACTICAL politics; ATTITUDE (Psychology); INTERVIEWING; MEDICAL personnel; COMPARATIVE studies; PUBLIC housing; HEALTH insurance reimbursement; HUMAN services programs; CASE studies; INTERPROFESSIONAL relations; RESEARCH funding; HOMELESSNESS; MEDICAID; THEMATIC analysis; INSURANCE; MENTAL health services
- Publication
Journal of Health Politics, Policy & Law, 2021, Vol 46, Issue 6, p1019
- ISSN
0361-6878
- Publication type
Article
- DOI
10.1215/03616878-9349142