Ensuring Inclusive Care: Medi-Cal Guidelines Now Support Street Medicine for All, Including Undocumented Immigrants
An onsite visit with Medi-Cal providers about street medicine and community health supports through the UCLA Homeless Healthcare Collaborative shed light on groundbreaking changes in healthcare delivery. This event, organized by Ethnic Media Services (EMS) in collaboration with the Department of Health Care Services (DHCS) and ethnic media partners, highlighted the transformative potential of the new Medi-Cal guidelines for street medicine.
Street Medicine is transforming healthcare delivery by bringing medical services directly to people experiencing homelessness. According to the 2024 Greater Los Angeles Homeless Count, over 75,000 individuals across LA County are without shelter or are unstably housed. For these individuals, reliable access to healthcare has often been as elusive as finding affordable housing. However, recent changes in Medi-Cal guidelines may signal a turning point, offering new hope and dignity to this vulnerable population.
Historic Changes in Medi-Cal Guidelines
A recent meeting with beneficiaries of this historic endeavor brought together ethnic media partners and healthcare providers to discuss the significance of these changes. The Department of Health Care Services (DHCS) has implemented a groundbreaking policy shift allowing street medicine providers to bill Medi-Cal directly for services rendered outside a hospital setting. This change represents a major departure from the past, where billing for medical services required them to be delivered within a licensed healthcare facility.
Brian Zunner-Keating, a key figure in UCLA’s Health and Homeless Care Collaborative, emphasized the importance of this shift, stating, “This is something that is unheard of historically.” Street medicine providers have traditionally relied on philanthropy, an unstable and unpredictable funding model. The new DHCS guidelines have disrupted that model, allowing groups like Zunner-Keating’s to not only continue their work but also expand their reach. “We are really grateful to have that sustainable way to continue our program,” he added.
Zunner-Keating also highlighted a new partnership with the Los Angeles Public Library system to disseminate information about street medicine services more effectively. This collaboration is particularly crucial given LA’s diverse population, where language barriers can be a significant obstacle. The street medicine team is equipped with a diverse group of licensed practitioners and doctors, ensuring that patients can receive care in their native languages. Students also rotate through the program, ensuring continuity for the next generation of healthcare providers.
The Expansion of Street Medicine
UCLA manages five street medicine teams across LA County, covering areas from the San Fernando Valley to the downtown metro area, South LA, and the city’s West Side. These teams visit locations like Casa Milagrosa weekly, offering a range of services that include primary care, mental health support, and housing navigation.
The program frequently treats patients with common illnesses like high blood pressure, infections, wounds, and substance abuse. The team consists of licensed practitioners and doctors—not students—though students do join on rotation to help ensure the continuity of care.
One of the most significant aspects of the program’s expansion is its accommodation of undocumented patients through Medi-Cal. This was historically impossible, but with the recent changes, undocumented individuals can now receive care and have it billed through Medi-Cal, ensuring the program’s sustainability. This expansion aligns with Governor Gavin Newsom’s vision that everyone should have access to healthcare, regardless of immigration status. “Getting sick is often more expensive for the state,” Zunner-Keating noted, underscoring the cost-effectiveness of preventative care for all residents.
Veronica Garcia, Program Manager at Casa Milagrosa, highlighted the benefits, stating, “It has definitely impacted our guests.” The ability to bill Medi-Cal provides a stable and flexible source of funding, enabling street medicine teams to deliver whole-person care to some of LA’s most vulnerable residents.
The Evolution of Street Medicine
Street medicine, established in the early 1990s, is the practice of delivering healthcare directly to people who are unsheltered, meeting them in their own environments. The approach is designed to reduce or eliminate barriers to care, building trust with this socially marginalized and highly vulnerable population. In California, there are around 25 street medicine programs, primarily clustered around the San Francisco Bay Area and Los Angeles, with others in communities like San Diego, Bakersfield, and Redding.
These programs have evolved from grassroots movements to established areas of medicine. Most of California’s street medicine programs use team-based approaches to provide a mix of primary care, urgent care, and care focused on unmet social needs. The new Medi-Cal guidelines now provide a stable funding source, allowing these programs to sustain and grow.
Sandy Close, founder of Ethnic Media Services, sees this program as a counter to the demonization of immigrants and the unheard. “California is at the forefront of trying to expand healthcare for all people,” she remarked, acknowledging the state’s leadership in providing healthcare access to everyone, regardless of their immigration status.
Implications of the New Guidelines
The new DHCS guidelines are a game changer for street medicine in several ways:
- Stable Funding: The ability to bill Medi-Cal provides a predictable and stable source of funding, making it easier for established programs to sustain and expand their services.
- Whole-Person Care: Enhanced Care Management allows street medicine teams to deliver comprehensive care, addressing not only physical health needs but also mental health, housing supports, and other social services.
- Access for Undocumented Individuals: The inclusion of undocumented patients through Medi-Cal is a significant breakthrough, aligning with Governor Newsom’s vision of healthcare for all.
- Diverse and Inclusive Care: The diverse team of licensed practitioners ensures that language barriers are minimized, providing culturally competent care to a wide range of patients.
- However, challenges remain as these new policies are implemented, including the administrative burden of setting up billing systems, the need for technical and financial assistance for new programs, and ensuring reimbursement rates cover the actual costs of delivering street medicine.
Conclusion
The new Medi-Cal guidelines represent a significant step forward in the delivery of healthcare to some of California’s most vulnerable residents. By enabling street medicine providers to bill directly for their services, the DHCS has laid the groundwork for a more sustainable and effective model of care. As these changes take effect, the hope is that more people experiencing homelessness will have regular and reliable access to the healthcare they desperately need, bringing dignity and hope to their lives.
Brian Zunner-Keating’s words encapsulate the transformative potential of these changes: “This is something that is unheard of historically.” With the support of these new guidelines, street medicine is poised to make a lasting impact on the health and well-being of LA County’s most vulnerable residents.
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