The Impact of Medicaid – A Bridge House Perspective

Medicaid-ExpansionYou don’t have to look far to hear about the flaws and hassles of newly implemented Obamacare. From difficulties with online exchanges, to dropped coverage, to more expensive premiums, it is safe to say that many individuals and businesses have not had a smooth experience.

However, I am pleased to share with you some overwhelmingly positive news about the impact of Medicaid expansion – a pillar of the new system – on homeless men and women in our community. With Medicaid expansion, now 100% of the clients we see at Bridge House and, anyone in Colorado with an annual income of 133% of the Federal Poverty line or $15,288 for an individual or $31,352 for a family of 4, qualify.

With a simple sign up, eligible applicants can receive coverage within 30 days for preventative care, mental and physical health treatments, and even some dental work. Since expansion we have seen impacts in three areas in particular.

First, efforts across the county and state have demonstrated great coordination between providers and government agencies to outreach and sign up eligible clients. Bridge House has been at the forefront in signing up the homeless population. Every client who participates with Bridge House case management – over 700 in 2013 – fills out an intake and gets assessed for Benefit eligibility. If the client is not yet on Medicaid, we work with them to enroll immediately. Since August of 2013 when pre-enrollment went live (the benefit took effect in January 2014) Bridge House case management has assisted 126 clients enroll, helping these individuals get the care they need.

Second, we are already seeing savings from Medicaid enrollment. Bridge House has always paid directly for client medications spending upwards of $7,000 a year. Frequently critical medications such as those to prevent psychotic episodes or antibiotics to prevent infections after surgery were prescribed yet clients had no means to pay. We would do our best to triage and pay for necessary medications on a client’s behalf but consistently fell short, meeting only a fraction of the need. The result – clients wouldn’t get or take their prescribed medications leading to worsening conditions and, often, hospitalizations. Now clients with Medicaid are able to pay for their medications with co-pays of $1-$3. Instantly, medications are accessible as never before allowing clients to get the care they need and preventing small problems from snow balling into big ones.

Finally, as a result of Medicaid expansion, we are seeing an improvement in the quality of care our homeless clients receive. Doctors are able to order diagnostic tests previously reserved for those with private insurance. This kind of proper diagnosis and preventative treatment is helping people from becoming critically ill as was the previous norm before Medicaid expansion and a homeless person could seek care.

So, have we reached a tipping point? Could this change in coverage actually stem the tide of people in poverty, those experiencing homelessness and all of the medical challenges associated with a life on the streets, from using emergency care as their only medical resource? As with so many “systems” we often lose sight of the people involved.

The stories of those impacted Medicaid expansion are mind boggling. One client whose medications to keep him from extreme anxiety and paranoia which used to cost an impossible $200 a month are now $2 a month. The result – now he can take the medication, he can function, he can be productive, and he won’t end up in the hospital before the vicious cycle would start again.

On the ground level Medicaid expansion is changing lives. Will these small wins compound into an economic story that will move our country to see the value of comprehensive medical care no matter what perspective you come from? If we can improve lives and save resources at the same time – who can’t agree on that? We, at Bridge House, are seeing real world examples of how the shift in eligibility is changing the status quo and will continue to sign people up one person at a time.

Written by Isabel McDevitt

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