Affordable Care Act: Impact of the Medicaid Expansion on Chronic & Veteran Homeless

Affordable Care Act: Impact of the Medicaid Expansion on Chronic & Veteran Homeless

Healthcare Blog PhotoCurrently, 1.4 Million Californian living below the poverty line are uninsured. With the implementation of the Affordable Care Act (ACA), there is the potential for many of these low-income individuals, including those experiencing homelessness, to access needed medical services. ACA offers a tool for providers and increased services for clients, supporting Home For Good's goal of ending chronic and veteran homelessness in Los Angeles by 2016.

With the implementation of ACA, many people experiencing homelessness should become eligible for health insurance through the expansion of the Medicaid program, however not all states have opted-in to this ACA provision. Even though, “the federal government will pay for 100% of the expansion for the first three years,” there is a concern that federal subsidies plan to “gradually reduce… to 90% by 2020.” Additionally, with the Supreme Court rulings on ACA, some states are unfortunately finding ways to opt out of insuring our nation’s most vulnerable populations.


Though it is true that many states are avoiding opting in to ACA, California has already taken steps to adopt the ACA. As California Senator, Mark Leno of San Francisco, puts it, California hopes that with the implementation of the Medicaid expansion we will prove that “health care is not considered a privilege of the fortunate few but… [is] a basic human right.” Beyond the ethical arguments for ACA though are strong studies showing favorable outcomes for both state budgets and low- to moderate-income residents. As a recent study published by the US Interagency Council on Homelessness (USICH) highlights, residents may have previously been bypassed for mental health care due to their uninsured status, forcing them to rely on public health care services funded through state and local resources. With this expansion fiscal pressure on the states is reduced as individuals enroll in Medicaid programs, “fully covered by the Federal government.” As a result, healthcare providers and hospitals will see fewer “uncompensated visits and less crowded emergency rooms,” meaning an overall cost savings to state and local agencies which could be diverted to other community programs and projects.

Chronic and Veteran Homeless Populations

For chronic and veteran individuals experiencing homelessness, the Medicaid expansion will provide highly needed supportive services, like mental health care, in a stable and affordable way, currently unavailable to many. Though this will open a door to access services, clients will still need to be educated and connected to the system. Unfortunately, there is no magic wand that when waved will create an easy inflow of Medicaid enrollees from the chronically and veteran homeless population. Limited knowledge of the programs and reduced access to technology will act as barriers to enrollment. For these reasons, USICH study urges service providers to focus on community outreach and engagement to increase enrollment in Medicaid, especially for states that have already opted in, like California.

Ultimately, the Medicaid expansion helps to increase health services for chronic and veteran homeless.  As this is an important resources for the partners and clients involved in Home for Good, we plan to strategize on how to support partners in accessing these benefits, and continue to inform partners about resources, such as the ones listed below, they can use when outreaching to clients and enrolling them in the expansion programs under ACA. And, of course, Home For Good continues to work to end chronic and veteran homelessness in LA County, beliving that, as one of our partners notes in our featured picture, that "Housing is healthcare." Together, with housing and health care reform we work to create a healthier LA.

Tools and Resources on ACA:

  • For information on health reform, an enrollment tool kit, and taped webinars trainings visit the National Health Care for the Homeless Council website.

  • Read this informative blog, "Housing is Health Care," written by Bill Pitkin at the Hilton Foundation on the important impact of housing and homeless services on the health of clients and the potential cost savings to the health care system from housing our most vulnerable.

  • To discover how “stable housing can significantly improve health outcomes for chronically homeless individuals,” visit the US Department of Housing and Urban Development website.

  • Learn about the U.S. Department of Veterans Affairs implementation of ACA for veterans at


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