Homeless Special Needs Plans for People Experiencing Homelessness

Sachin H. Jain; John Baackes; James J. O’Connell

doi:10.1001/jama.2019.22376

Viewpoint

February 13, 2020

Homeless Special Needs Plans for People Experiencing Homelessness

Sachin H. Jain, MD, MBA^1,2; John Baackes^3,4; James J. O’Connell, MD^5,6

Author Affiliations Article Information

¹CareMore and Aspire Health, Cerritos, California
²Stanford University School of Medicine, Stanford, California
³LA Care, Los Angeles, California
⁴SNP Alliance, Washington, DC
⁵Boston Healthcare for the Homeless, Boston, Massachusetts
⁶Massachusetts General Hospital, Harvard Medical School, Boston

JAMA. 2020;323(10):927-928. doi:10.1001/jama.2019.22376

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The US Census Bureau estimated that in 2018, more than 550 000 individuals experienced homelessness on any given day.¹ Homelessness is both a recognized cause and a result of health problems. There has been a movement over the past several years to include housing as a health care intervention by several key cities and municipalities, notably, San Francisco, New York, and Los Angeles. Although these programs have had some success with small populations of patients, their reliance on city budgets raises questions about scalability. The creation of a homelessness-focused special needs plan, a type of Medicare Advantage insurance plan aimed at meeting the unique care needs of specific high-need populations, may be an approach through which to sustainably finance health care delivery for homeless individuals.

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February 24, 2020

Response to Viewpoint: Homeless Special Needs Plans for People Experiencing Homelessness, Feb. 13

Valerie Swenson, MA and BA, CPC; MN Rep. Mindy Greiling | Health Care for All Minnesota

In response to Sachin H. Jain's Feb. 13th Viewpoint, it is important to note that Jain is employed by a Medicare Advantage HMO. Medicare Advantage plans are highly profitable insurance plans. They are privatized versions of our traditional Medicare program. They gain a marketing “advantage” by including the word “Medicare” in their name. They profit off of what was originally meant to efficiently serve all of us - our publicly funded Medicare program. The U.S. General Accountability Office report 16-76 found that traditional Medicare had to send $14 billion in unwarranted payments in a single year to the Advantage plans because of their ability to game the system.

Jain apparently is proposing that Congress address the homelessness problem by funneling even more tax dollars through insurance companies that participate in Medicare Advantage. He appears to be capitalizing on the current wave of real interest in finally addressing our country’s dire lack of affordable housing. Jain is proposing that health care providers treat “homelessness” by using a diagnostic indicator that would support billing an ambiguous capitation cost, a cookie cutter price, for all providers, and then Medicare dollars would be sent to private Medicare “Advantage” companies for their financial gain. Paying health insurance companies to house the homeless is a bad idea.

Health care providers treat illnesses and injuries. Doctors and nurses struggle to find time to attend to their patients and also consistently comply with complex documentation guidelines that support accurate coding and billing processes. To suggest that providers also treat homelessness and bill for it, so that Medicare Advantage companies can profit, sounds like nothing short of outlandish greedy profiteering.

Let’s not pretend that doctors and nurses have the time to tackle homelessness. Paying Medicare Advantage plans to house the homeless is an extremely costly and inefficient way to provide shelter to the homeless.

Sincerely,

Mindy Greiling and Valerie Swenson

Former MN Rep. Mindy Greiling and Medical Coder, Valerie Swenson, CPC, both serve on the leadership team of the Roseville Area Advocates for Minnesota Health Plan(RAAMHP,) a chapter of Health Care for All Minnesota(HCAMN.)

CONFLICT OF INTEREST: None Reported

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