Health care reform at the federal level and expansion of the Oregon Health Plan (OHP) provide an opportunity to increase access to health care and improve health outcomes for thousands of Oregonians, especially those experiencing homelessness.
More than half of those counted as homeless in Multnomah County suffer from one or more serious physical, mental or substance abuse-related conditions. Prior to reform, the vast majority of individuals on the street or in shelters had no health insurance. Only disabled individuals and parents with dependent children qualified for Medicaid. Individuals without insurance had to rely on emergency rooms and social service clinics for their health care or they simply received no care at all.
A potentially game-changing expansion of health care is now underway in Oregon. As of January 2014, the Affordable Care Act expands health coverage to low income Oregonians, including those defined as homeless.
The new criteria extend Medicaid to all adults under 65 with incomes under 138 percent of the federal poverty line — regardless of health status or gender. For Multnomah County, estimates predict a minimum increase of 55,000 Oregon Health Plan enrollees over the next two years. This is an opportunity for thousands of individuals to access health care for the first time.
This spring, City Club of Portland will launch a research committee to study how the homeless population in Multnomah County can optimize the benefit from health care reform and expansion of the OHP. City Club of Portland is a nonprofit, nonpartisan, member-based organization that brings civic-minded people together through forums, research and advocacy, to make Portland and Oregon better places to live, work and play for everyone. During the yearlong study, the committee will review literature and data, and interview people who are experiencing homelessness, health care professionals, consumers of health care services and other experts in order to reach conclusions and recommend improvements.
In Oregon, the health coverage and delivery of care for Medicaid-eligible individuals is now the responsibility of a network of 16 Coordinated Care Organizations (CCOs) throughout the state. These CCOs are expected to eliminate health disparities, improve health outcomes and reduce costs. Working with a fixed dollar allotment per client, CCOs assume accountability for health outcomes of the populations they serve. This more holistic and integrated approach to care delivery will focus on preventative care and effective management of chronic conditions.
As part of this new approach, a combination of CCOs and patient-centered primary care homes will use community health workers and flexible services to meet the needs of patients. Early intervention, treatment of mental health and substance abuse disorders, and dental care will now be considered essential health benefits. For an often-underserved homeless population, where mental health, substance abuse and other chronic conditions are prevalent, this change represents a significant opportunity.
The question City Club of Portland will consider is how to ensure better and more equitable access to care by homeless individuals. City Club will investigate, among other topics:
(1) The dynamics of the Medicaid expansion in Oregon, and its implementation through the Oregon Health Plan and CCOs;
(2)The impact on our homeless population’s access to and use of providers, and the resulting health outcomes;
(3) The changes in access, delivery and use throughout the transformation;
(4) The unique medical and social challenges of serving and encouraging use of services among this population; and
(5) Racial, ethnic, or gender disparities.
In coordination with the launch of this new research study, City Club of Portland, Citizens Crime Commission, Oregon Opportunity Network, and Street Roots, will welcome Nan Roman, President & CEO of the National Alliance to End Homelessness, to the Friday Forum stage on April 4. This event will be held at the Sentinel Hotel, 614 SW 11th Avenue in Downtown Portland, from 12:15-1:15pm. To learn more and purchase tickets, go to this website: pdxcityclub.org/homelessness.
Kathy Black is Research Board Chair for the City Club of Portland. She is also an in-house attorney for the Bonneville Power Administration (BPA). Prior to BPA, Ms. Black was employed by NCR Corporation for 25 years, in various roles including Vice President of Database Engineering and Vice President of Customer Services.
