The President’s fiscal year (FY) 2017 budget for health care should benefit many homeless people as it provides funding for the expansion of Medicaid, proposes additional funding for federally qualified health centers, and increases funding for mental health and substance abuse treatment.
The proposed budget for the U.S. Department of Health and Human Services (HHS) requests $377.6 billion for Medicaid, an increase of $20.8 billion compared to the FY2016 enacted level, comprised of $262 billion for FY2017 and $115.6 billion in an advance appropriation from FY2016. As of January 2016, 30 states and the District of Columbia have expanded Medicaid to low-income adults, and the expansion in Louisiana, which goes into effect July 1 will bring the total to 31 states and the District of Columbia.
This funding for Medicaid benefits hundreds of thousands of homeless people. Overall, the Centers for Medicare and Medicaid Services estimates that 71.6 million adults and children will be enrolled in Medicaid for the equivalent of a full year in FY2017. In 2014, 311,765 adult patients and 74,244 child patients at Health Care for the Homeless Program Health Centers were enrolled in Medicaid.
The HHS budget proposes an incentive for the other 19 states to expand Medicaid. The Affordable Care Act provided for 100% federal funding for coverage of newly eligible individuals for three years starting in calendar year 2014 for states that expanded Medicaid and phases down to 90% federal funding by 2020. The HHS budget proposes to give any state that chooses to expand Medicaid eligibility three years of full federal support, no matter when the state expands at an estimated cost of $430 million in FY2017 and $2.6 billion over 10 years.
The proposal to encourage states to expand Medicaid could benefit hundreds of thousands of additional homeless individuals. At Health Care for the Homeless Program Health Centers, 43% of the 853,382 patients were uninsured. When evaluating only the ten Health Centers whose patients were all homeless in non-Medicaid expansion states, 82% of the 41,034 patients were uninsured.
The HHS budget also proposes several modifications to lower Medicaid drug prices. HHS proposes to strengthen Medicaid drug coverage and reduce Medicaid expenses by creating a federal-state Medicaid negotiating pool for high-cost drugs that would save $5.83 billion over 10 years and with actions clarifying brand-name drugs and generic drugs that would save an additional $5.616 billion over 10 years. Not only could these initiatives
provide homeless individuals with better access to needed medications, but the savings from these changes could be used to offset the proposal to provide three years of full federal support for newly expanding states.
The HHS budget also proposes extending health care funding for children, potentially benefitting thousands of homeless children. The HHS budget estimates $15.015 billion in outlays for CHIP for FY2017, an increase of $536 million compared to the FY2016 enacted level, and proposes an additional two years of funding for the Children’s Health Insurance Program (CHIP) for FY2018 and FY2019 at an estimated net cost of $3.07 billion. In general, CHIP provides coverage to children whose families have incomes too high to qualify for Medicaid, but too low to afford private health insurance. In 2014, at Health Care for the Homeless Program Health Centers, of the 103,000 patients under the age of 18, 74,244 children were enrolled in Medicaid, 506 children were enrolled in CHIP, and 23,382 children reported they were uninsured. An additional 337 patients aged 18 and older reported they were enrolled in CHIP. Without the additional funding for FY2018 and FY2019, children in Medicaid-expansion CHIP programs would continue to be covered by Medicaid, but other children could become uninsured. This funding would ensure comprehensive and affordable coverage for beneficiaries.
The proposed HHS budget for FY2017 also proposes to extend mandatory funding for Health Centers. The proposed HHS budget provides $5.1 billion for health centers, including $3.75 billion in mandatory funding and $1.242 in discretionary funding, to serve more than 27 million patients. For FY2017, $3.6 billion of the mandatory funding has already been authorized. The HHS budget proposes $150 million in additional mandatory funding for FY2017 and $3.6 billion in new mandatory resources for FY2018 and FY2019, to extend the current mandatory funding for two additional years.
As our recently released report illustrates, this proposed continuation of funding for Health Centers is crucial to maintaining adequate health care for homeless individuals. In 2014, 1.15 million homeless adults and children were seen at 1,278 Health Centers and 813,331 homeless adults and children were seen at 268 Health Care for the Homeless Program Health Centers. Health Centers served a critical role in preventing, providing early detection of, and treating several chronic and other life-threatening conditions, including HIV/AIDS, cancer, chronic liver disease, cardiovascular disease, diabetes, asthma, chronic lower respiratory disease, tuberculosis, sexually transmitted diseases, heat-related and cold-related illness, dental problems, and eye diseases.
The proposed HHS budget for FY2017 includes $1.274 billion for mental health programs, an additional $115 million compared to FY2016. This total includes level funding of $533 million for the Community Mental Health Services Block Grant and level funding of $65 million for Projects for Assistance in Transition from Homelessness. Funding for mental health programs can help thousands of homeless people. In 2014, 161,000 permanent supportive housing residents had a mental health condition or a dual diagnosis that includes mental health and substance abuse and 20,000 individuals and adults in families who stayed in an emergency shelter or in transitional housing in 2014 came from a mental health facility.
The proposed HHS budget for FY2017 includes $2.661 billion for substance abuse treatment, an increase of $469 million compared to FY2016. This total includes level funding of $1.858 billion for the Substance Abuse Prevention and Treatment Block Grant, $10 million in additional funding for programs of regional and national significance, and $460 million in new mandatory funding for cooperative agreements with states to support evidence-based programs that help people access treatment and recovery support to address the prescription drug abuse and opioid use epidemic.
The funding for substance abuse treatment can provide life-saving assistance to thousands of homeless people. In 2014, 91,000 permanent supportive housing residents reported having substance abuse issues or had a dual diagnosis that includes mental health and substance abuse and 38,000 individuals and adults in families who stayed in an emergency shelter or in transitional housing came from a substance abuse treatment center. Homeless individuals have died of drug overdoses to heroin, opioid analgesics, and cocaine and to multiple substances including alcohol. The medical professionals reporting these findings concluded that these deaths can be prevented by ensuing safe, effective, and appropriate opioid prescribing for chronic pain, public health initiatives aimed to prevent and reverse opioid overdoses through education and the distribution of intranasal naloxone, and office-based buprenorphine treatment.
In developing appropriations bills for HHS, the House and Senate should include these provisions to maintain funding for Medicaid, CHIP, Health Centers, mental health programs, and substance abuse treatment programs, encourage states to expand Medicaid, extend funding for CHIP and Health Centers an additional two years, and provide additional funding for substance abuse treatment to address the prescription drug abuse and opioid use epidemic. In addition, Congress should provide supplemental funding for Health Centers, particularly for Health Care for the Homeless Program Health Centers, to reduce the disparities in diagnosis and treatment of certain chronic health conditions and other life-threatening conditions for some homeless individuals compared to recommended levels and/or Health Center patients in general.