Challenges in meeting the health care needs of homeless adults with physical disabilities who receive Medicaid

Background: Homeless adults with disabilities receiving Medicaid face challenges towards accessing quality health care. Expected budget cuts to Medicaid could adversely impact this vulnerable population.

Objective: Identify health service needs and determinants of health of homeless adults with physical disabilities receiving Medicaid in Washington, DC, against the backdrop of recent policy proposals concerning Medicaid.

Methods: Homeless adults with physical disabilities receiving DC Medicaid and residing in shelters were interviewed. Data collected included health status, functioning, needed health care services, and barriers to service receipt. Descriptive data is used to identify health service needs. Bivariate analysis used to identify correlates of high comorbidity. Policy changes effecting this population are considered in context of findings.

Results: Sample (n=59) consisted of mostly single, African-American males, with an average of five comorbid conditions (e.g. high blood pressure, arthritis, depression, diabetes) and low ADL functioning. Participants reported high health service needs, particularly prescriptions, case management, medical equipment, physical therapy, and mental health services. Barriers to services included lack of knowledge on existing services, Medicaid restrictions or lengthy approval processes, transportation barriers, and poor time-management. High rates of hospitalization and ER admissions reported. Comorbidity was inversely correlated with ADL performance, and positively associated with unmet ADL needs, a need for prescription refills, new medical equipment and mental health services.

Conclusion: This population reports high levels of need for health services, yet encounter barriers towards receipt . The Obama administration's 2011 budget would drastically reduce Medicaid funding. Health outcomes for this population may be further at risk.