The Portland City Club has issued a report on healthcare and homelessness, making several recommendations to strengthen the local safety net, particularly in light of the Medicaid expansion a year ago, which provided healthcare for most people who fall under 138 percent of the poverty level.
The recommendations include requiring hospital discharge plans to include housing or shelter upon patients’ relase; ensuring that all CCO members are educated on how to access care; and calling on local governments, including Multnomah County and the cities of Portland and Gresham to build more low-income housing with social supports.
Their ideas will be presented and debated on Friday at the weekly City Club meeting at the Sentinel Hotel in downtown Portland.
Many homeless Portlanders wrestle with addictions and severe mental illness -- psychological troubles that are notoriously difficult to treat and recover from.
But the promise of Obamacare and healthcare reform has led to more federal money to pay for this population that didn’t exist before, along with a coordinated care framework intended to integrate mental health services with physical healthcare.
For example, the Native American Rehabilitation Association reported to City Club researchers that before Obamacare, 23% of the individuals it serves had Medicaid; afterward, 59% did. Mental health coverage has grown from 40% to 74%, and addictions treatment has risen from netting just 37% to 91% after the law took effect.
John Duke, the clinic director of Outside In, told The Lund Report that 65% of its clients are homeless and the clinic has worked to get as many as 70% signed up for Medicaid. Nearly all of its patients are poor enough to qualify for assistance, but the remaining uninsured are often immigrants, both documented and undocumented.
At a City Club event in the Pearl District on Tuesday night, Health Share CEO Janet Meyer told The Lund Report that 2015 should be a year of great improvement for CCOs, as the organizations enter their fourth year and second since the expansion took effect.
Tackling the issues of mental health, addiction and homelessness will be a big test for the CCOs. The locally run Medicaid programs have had marked success in bringing down the cost of care and improving quality by routing people away from expensive emergency departments and successfully managing chronic conditions such as congestive heart failure and chronic obstructive pulmonary disease.
But providing appropriate mental healthcare and addictions treatment, while greatly beneficial to the lives of the affected people, is not typically an area in which CCOs will have a great immediate financial benefit.
“We have the capacity,” Meyer said. “We need to support the providers.”
Multnomah County has a homeless population that numbers around 4,400 and more than half of them report suffering from a chronic medical condition. Racial and ethnic minorities are disproportionately impacted. Portland is the whitest major city in the United States at 72% of its population, but minorities make up almost half of the metro area’s homeless population; LGBT folks are also over-represented, making up 40% of the homeless youth.
Chris can be reached at [email protected].
