The Biden administration is making it easier for doctors and nurses to treat homeless people wherever they find them, from creekside encampments to highway underpasses, marking a sea change in how — and where — health care is delivered.
Since October 1, the Centers for Medicare & Medicaid Services has allowed public and private insurers to pay “street medicine” providers for medical services they provide wherever homeless people are present.
Previously, these providers were not paid by most Medicaid programs that serve low-income people because the services were not provided in traditional medical settings such as hospitals and clinics.
The change comes in response to the rising number of homeless people across the country and the exploding number of people needing intensive addiction and mental health treatment in addition to medical care for wounds, pregnancy and chronic illnesses such as diabetes.
“It’s a game changer. In the past, this was really all done on a volunteer basis,” said Valerie Arkoosh, secretary of the Pennsylvania Department of Human Services, which led an initiative similar federal billing change in July. “We are so excited. Instead of a doctor’s office, routine medical treatments and preventative care can now be provided wherever unhoused people are.”
California led the nation when the state Medicaid director approved a new statewide billing mechanism in late 2021 for on-site treatment of homeless people, whether outdoors or indoors in a shelter or hotel. “Street medicine providers are our trusted local partners, so their services should be paid for,” Jacey Cooper told KFF Health News.
Hawaii and Pennsylvania followed. And while street medicine teams already operate in cities like Boston and Fort Worth, Texas, the government’s new reimbursement policy will allow more health care providers and states to offer these services.
“It’s a bombshell,” said Dave Lettrich, executive director of the Pittsburgh-based nonprofit Bridge to the Mountains, which provides outreach services to street medicine teams in Pennsylvania. “It used to be that you could provide comprehensive primary care and even some specialty care under a bridge, but you couldn’t charge for it.”
Under the new ruleDoctors, nurses and other providers can receive reimbursement for providing care to patients in a “non-permanent location on the street or in a public setting.” This is the first time that the federal government has recognized the street as a legitimate place to provide health care. This particularly affects low-income, disabled and elderly people who receive Medicaid and Medicare.
“The Biden-Harris administration has been focused on expanding access to health care across the country,” CMS spokeswoman Sara Lonardo said, explaining that federal officials were issuing a new one at the request of street medicine providers who were not consistently receiving reimbursement had drawn up a reimbursement code.
The White House presented an ambitious strategy This year, we want to reduce homelessness in America by 25% by 2025, including by putting health dollars into better care for people living on the streets.
Legislation pending in Congress would further expand reimbursement for street medicine, targeting the mental health and addiction crises on the streets. The bipartisan bill, introduced earlier this year, has not yet had a committee hearing.
It is estimated that nearly 600,000 people are homeless in America Federal estimates from 2022, and on average they die earlier than those who have stable housing. The Life expectancy for homeless people is 48, compared to that Overall life expectancy 76 years in the USA
According to street medicine experts, there are more than 150 street medicine programs nationwide. At least 50 of those are in California, up from 25 in 2022, said Brett Feldman, director of street medicine at the University of Southern California’s Keck School of Medicine.
Feldman also led state and national efforts to help street medicine providers pay the Street Medicine Institute. They submitted formal request in January 2022 to the Biden administration to request a new billing regime for street medicine.
In the letter, they argued that street medicine saves lives – and money.
“This is done through backpack walking tours, usually from a pickup truck or car, but also on horseback, kayak, or other means to reach hard-to-reach people,” they wrote. “The balance of power shifts to the patient, with them taking the lead of their medical team.”
Street medicine experts argue that by dramatically expanding primary and specialty care on the streets, they can break the cycle of homelessness and reduce costly ambulance trips, hospital stays and repeated trips to the emergency room. Street medicine could help California save 300,000 emergency room visits annually, Feldman predicted based on Medicaid data. Some street medicine teams are even placing people in permanent housing.
Arkoosh said there is already interest in expanding street medicine across Pennsylvania because of the federal change. In Hawaii, teams plan to go into remote camps, some in the rainforest, to expand primary and behavioral health care.
“We see a lot of substance abuse and mental health issues, as well as a lot of chronic illnesses like HIV,” said Heather Lusk, executive director of the Hawai’i Health & Harm Reduction Center, which provides street medicine services. “We hope this can help people transition from the streets into permanent housing.”
But the federal change, quietly made by the Biden administration, will require a major public information campaign to get other states on board and get more providers to participate, said Jim Withers, a longtime street medicine provider in Pittsburgh, who said founded the Street Medicine Institute.
“This is just the beginning and a wake-up call because so many people are excluded from health care,” he said.
This article was created by KFF Health Newsthat published California Health Linean editorially independent service California Health Foundation. KFF Health Newsformerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – the independent source for health policy research, surveys and journalism.
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