So many people still don’t know that the Affordable Care Act is law. Among those are the homeless or very poor who instead are focused on survival, such as food or shelter. I had the opportunity one recent morning to walk Los Angeles’ Skid Row neighborhood with Chris Mack, an outreach worker with JWCH Institute, which operates several clinics. He showed me how challenging it was to enroll those who are homeless into free health insurance, one of the provisions under Obamacare. Above, Mack speaks with Denise Scott. Below, a homeless man clutches his heart when he hears that he qualifies for free health insurance. I’d like to thank Daily News Staff photographer Hans Gutknecht, for the amazing images. From my story (Daily News, May 31, 2013):
Denise Scott shouts angrily over the way America has forgotten her.
“We don’t need no more illegals comin’ over here!” she screams from a Skid Row sidewalk littered with chicken bones, paper plates and discarded clothes.
“Fix the problems in this country! I need a place to live!”
Christopher Mack, a lead community outreach worker for a health clinic in the heart of Los Angeles’ Skid Row, squats next to her. He softly tells her to calm down, to breathe, to remember to see her case worker in the morning about housing.
He also wants to know if she has health insurance.
But Scott, who will turn 61 soon and has lived on Skid Row for 18 months, is in no mood to hear sweet talk. She’s bone thin. Her sweater is ripped and riddled with holes. Her clothes and important papers are squashed into various size bags all around her. Tears of frustration drip down her face.
“I’m not a racist,” she tells Mack apologetically, “But I can’t go to Mexico to get a house and you can’t find me a place to live here.”
Today is not Scott’s day, Mack determines. She is too angry. Despite the fact that she and many others will qualify for health insurance by the end of the year under requirements of the Affordable Care Act, finding a place to live, not health care, is Scott’s priority. So Mack will try again another time.
The encounter demonstrates how difficult it can be to provide health coverage to some of the most destitute, even those who qualify for free or subsidized plans. Some of them say that simply trying to survive or find a roof over their heads takes precedence even over caring for their own health.
“Out here, it’s about repeated education,” said Mack, who has worked the streets of Skid Row 10 years for the JWCH Institute, which runs the Center for Community Health on downtown’s 5th Street. “It’s about what we in social work call multiple encounters. Where there’s a willingness, there are no barriers.”
Mack’s work is part of what has been an aggressive, three-year outreach campaign by the Los Angeles Department of Health Services to enroll as many of the estimated 390,000 potentially eligible uninsured residents into Healthy Way LA, a no-cost county health insurance that will convert to Medi-Cal in January. Outreach workers from clinics countywide have gone to churches, schools, soup kitchens, homeless shelters and the streets of Skid Row in an effort to find those who qualify.
“The goal is an ambitious one, but we think it is doable given the multitude of incredible partners, internal and external, that we are working with to make it happen,” said Amy Luftig Viste, director of community partner programs for the Los Angeles County Department of Health Services.
But the work and the program has had its challenges, she said.
“We have had some difficulties along the way: adequate staff capacity to enroll patients, technological challenges, outreach challenges,” Luftig Viste said, but much of that has been remedied by funding that has provided more staff.
“Yes there have been challenges, but we’re at 257,000 enrolled — approximately two-thirds of the state’s total — so despite the challenges we are proud of our success,” she said.
One challenge for DHS is the annual renewal of Healthy Way LA. Many of those who have the insurance didn’t know they had to renew it, Luftig Viste said.
“Most recently we have created a redetermination mail-in unit, and are now even calling our patients to confirm that they received their renewal paperwork and if necessary to help them fill it out,” she said. “This has improved our redetermination rate significantly, but there is still much work to do to ensure that covered members stay covered.”
On Skid Row, for example, a complex knot of homelessness, mental illness and drug or alcohol use, along with a deep distrust of government, makes it difficult for Mack and other outreach workers to help people understand how starting in January, Medi-Cal will have expanded to cover all low-income individuals, ages 19 to 64, who are U.S. citizens or national or legal permanent residents for at least 5 years, and are not pregnant. Those who are pregnant qualify for another insurance.
“Most people come to the clinic already in crisis,” Mack said.