As the Department of Health Care Services (DHCS) transforms Medi-Cal, California is embarking on the nation’s most ambitious effort to address social needs through healthcare. This multi-year initiative, which insures one in three Californians, now includes comprehensive social services aimed at improving the health of those at risk of homelessness. These new programs go beyond traditional medical care, offering services such as homelessness prevention, housing transition and tenancy navigation, rent and deposit aid, post-hospitalization recuperative housing, sobering centers, day habilitation, and street medicine.
At a recent briefing organized by Ethnic Media Services (EMS), DHCS leaders, community providers, and healthcare workers shared how they are leveraging Medi-Cal to help Californians experiencing homelessness and housing instability lead healthier lives. This briefing, the second in a series exploring the transformative changes in Medi-Cal, featured speakers such as Glenn Tsang, Policy Advisor for Homelessness and Housing at DHCS; Amber Middleton, Director of the HOPE Program at Shasta Community Health Center; and Brian Zunner-Keating, MS, RN, Director of the UCLA Homeless Healthcare Collaborative.
Glenn Tsang, Policy Advisor for Homelessness and Housing at DHCS, opened the briefing by providing a comprehensive overview of the transformations within Medi-Cal. He discussed the integration of health and social services, emphasizing how this holistic approach is crucial for addressing the complex needs of the unhoused population. Tsang highlighted the various innovative services now covered under Medi-Cal, such as:
- Homelessness Prevention: Efforts to identify and support individuals at risk of losing their homes before they become homeless.
- Housing Transition and Tenancy Navigation: Assistance in finding and securing housing, including navigating the complexities of housing markets and rental agreements.
- Rent and Deposit Aid: Financial support for initial housing costs, such as first and last month’s rent and security deposits.
- Post-Hospitalization Recuperative Housing: Temporary housing solutions for individuals who need a safe place to recover after a hospital stay.
- Sobering Centers and Day Habilitation: Facilities providing a safe space for individuals under the influence of substances and programs to develop daily living skills.
- Street Medicine: Bringing medical care directly to people living on the streets, in shelters, or in encampments.
Tsang underscored the importance of these services in not only improving health outcomes but also in promoting stability and self-sufficiency among the unhoused population. He noted that these efforts are part of a broader strategy to create a more equitable healthcare system that addresses the social determinants of health.
Amber Middleton, Director of the HOPE Program at Shasta Community Health Center, followed Tsang’s presentation by sharing her experience in implementing these Medi-Cal transformations at a community level. The HOPE Program (Homeless Outreach and Patient Engagement) focuses on providing comprehensive care to the homeless population in Shasta County, a predominantly rural area with unique challenges.
Middleton highlighted several key aspects of the HOPE Program’s work:
- Outreach and Engagement: The program actively seeks out homeless individuals, engaging with them in encampments, shelters, and other locations to offer medical care and support services.
- Comprehensive Care: The HOPE Program provides a range of services, including primary care, mental health support, substance abuse treatment, and social services. This integrated approach ensures that patients receive holistic care tailored to their needs.
- Partnerships: Collaborating with local organizations and agencies is crucial for the program’s success. These partnerships enable the HOPE Program to extend its reach and offer more comprehensive support to the homeless population.
- Patient Stories: Middleton shared compelling stories of individuals whose lives have been transformed by the HOPE Program. For instance, she spoke about a man who, through consistent engagement and care, was able to address his health issues and secure stable housing. These stories illustrated the profound impact that targeted, compassionate care can have on individuals’ lives.
Middleton emphasized that while the challenges are significant, the positive outcomes and improvements in patients’ lives provide motivation and validation for the work they do. She also highlighted the importance of continued support and investment in these programs to sustain and expand their impact.
Brian Zunner-Keating, the Director of UCLA Homeless Healthcare Collaborative, transitioned the discussion from rural northern California to the urban landscape of southern California. He shared his journey in homeless healthcare, starting from his time in nursing school and early career with the Boston Healthcare for the Homeless Program, one of the pioneers in this field.
Zunner-Keating began by expressing his gratitude for being part of the discussion and highlighted his passion for homeless healthcare, which was ignited during his nursing education and early career. He worked at the Boston Healthcare for the Homeless Program, which set the foundation for his current role.
In January 2022, the UCLA Homeless Healthcare Collaborative was established with a mission to promote health equity by providing high-quality medical care directly to the streets of Los Angeles County. Since its inception, the program has conducted over 9,000 clinical evaluations for nearly 5,000 unique individuals. Initially operating with two teams, the program has now expanded to five teams and plans further growth, facilitated by the recent Medi-Cal transformations.
Zunner-Keating emphasized the collaborative nature of their work, which involves partnering with various organizations. The “Collaborative” in their name signifies their reliance on partnerships with local organizations to extend their reach and impact. They employ community health workers who act as bridges to the community, helping to locate individuals in need and build trust.
These community health workers, often with lived experiences of homelessness, substance abuse, or mental health issues, play a crucial role in engaging with the homeless population. They help the teams find people on the streets and encampments, offering immediate assistance such as water, snacks, and hygiene kits. These initial interactions are vital for building relationships and encouraging individuals to accept more comprehensive medical care.
Zunner-Keating highlighted that the program brings a multidisciplinary team, including doctors, nurses, social workers, and psychiatrists, directly to the people who need it most. They provide medical supplies, case management, and even prescription medications on the streets, in shelters, and in other locations. This approach is particularly beneficial for those unable to visit traditional healthcare facilities due to various barriers.
He shared several impactful stories to illustrate the program’s success. One elderly gentleman they served had been living in an alley, barely able to walk and see, and with severe dental issues that prevented him from chewing food. The team provided medical care, helped him secure insurance, linked him to a dentist, and facilitated his transition to a shelter. He now has a full set of dentures, a new hip replacement, and glasses, and is on the path to permanent housing
Another story involved a woman who felt constantly tired and overwhelmed. The team conducted simple blood tests and provided medications, significantly improving her health and mood. After a few weeks of not seeing her, the team learned she had moved into housing and expressed deep gratitude for the care and kindness she received, which she credited with saving her life.
Zunner-Keating emphasized that making a human connection is crucial in their work. They often start conversations with simple, friendly questions or comments to build rapport. For instance, asking if someone is a Dodgers fan can be an effective icebreaker in Los Angeles. These interactions help make individuals feel seen and heard, fostering trust and openness to receiving care.
He noted that their team is diverse, reflecting the community they serve. This diversity, in terms of language, cultural background, and lived experiences, is essential for providing accessible and sensitive care. The program’s goal is not just to bring medical care to the streets but to ensure that the care is culturally and linguistically appropriate.
Street medicine, Zunner-Keating explained, has a long history of dedicated volunteers and small groups making a difference. However, with over 180,000 people experiencing homelessness in California, the need for more extensive, sustainable efforts is clear. The recent Medi-Cal transformations have enabled programs like the UCLA Homeless Healthcare Collaborative to scale up and provide long-term, impactful care without relying solely on donations and philanthropy.
In conclusion, Zunner-Keating expressed the honor and privilege felt by the team in serving their homeless neighbors. The collaborative efforts and transformative policies of Medi-Cal are paving the way for a more inclusive and supportive healthcare system for all Californians. The work is challenging, but each success story underscores the profound impact that compassionate, comprehensive care can have on the lives of those experiencing homelessness.
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