Mandatory Enrollment of New York City Homeless

On April 1, 2012, the New York State Department of Health (NYSDOH) implemented the mandatory enrollment of the New York City homeless population into managed care.

Implementation in New York City is happening in three phases over a six-month period, each targeting a specific homeless population. Each stage will begin with New York Medicaid Choice mailing mandatory enrollment notices to homeless individuals advising them they must chose a health plan within 30 days or they will be auto-assigned to a health plan. To establish valid mailing addresses for the mailing, NYSDOH is using information received from the New York City Department of Homeless Services (DHS) for people residing in DHS shelters, as well as people checking into soup kitchens, drop-in centers and Human Resources Administration job centers. Individuals without an address or way to be reached will not be enrolled until a valid address can be obtained. Implementation will occur as follows:


Phase 1 Implementation

FAMILIES

  • April: Bronx, Manhattan
  • May: Brooklyn, Queens and Staten Island

Note: Many individuals in this group have entered shelters due to economic distress. As such, they may appear similar to the non-homeless Medicaid population.


Phase 2 Implementation

SINGLE ADULTS/ADULT FAMILIES

  • June: Bronx, Manhattan
  • July: Brooklyn, Queens and Staten Island

Note: The homeless single adult population is highly transient and typically resides in multiple locations over any period of time.


Phase 3 Implementation

STREET HOMELESS (undomiciled)

  • August and September: All Boroughs

Note: Many chronically street homeless live with serous mental illness and substance abuse disorders. Additionally, some of these individuals are:

  • Heavy users of emergency room and inpatient care.
  • So disabled that they are unable to remain engaged in health care or maintain health insurance.

Identifying Homeless Members Enrolled With EmblemHealth

Medicaid enrollment files currently received from New York Medicaid Choice on a daily basis will be modified to include a homeless indicator and an address for homeless enrollees. The homeless indicator will be captured and stored in a new field in our claims system. Addresses will be placed in the primary address field of our claims system and will not be overwritten by addresses received on monthly enrollment rosters.

We will help you and your staff to identify homeless members enrolled in our HIP Medicaid programs. Primary care physician (PCP) panel reports will include the symbol '^' next to the names of members who are homeless. In addition, we will add an indicator field for homeless members to the eligibility extracts. The homeless indicator will be an 'H' if the member is homeless and blank if the member is not homeless.


Let's Work Together

Homeless members represent a diverse population with a range of special health care needs. We encourage you to be flexible when working with them.

Due to the transient nature of this population, communication is challenging. When a homeless member visits you, please ask them to provide their most up-to-date mailing address. If the address differs from what is in their file, please let us know. If possible, let them use your office phone to call the toll-free customer service number on the back of their member ID card. A customer service representative will update the system immediately.

We also urge you to take care of as many medically necessary screenings, exams and procedures as possible during each visit with a homeless member, and to consider scheduling extra time with these members to do so.

When prescribing medications, keep in mind that some homeless members may have limited — or no — access to refrigeration, storage, bathroom facilities, food or water. In this situation, try to simplify the member's medication plan by prescribing medications that don't require refrigeration and that can be taken without food or water. Should the member need medication that requires frequent monitoring, consider prescribing medicine that can be monitored less frequently. Sometimes the best care plan for homeless members will be achieving a balance between medical needs and the limitations of their living condition.


Medicaid Health Home Program

Some of our homeless members will be eligible for and enrolled in our Provider-Led Health Home program. This program is offered to Medicaid members who have been diagnosed with severe mental illness or substance abuse, HIV+/AIDS or with two or more chronic medical conditions, and who are designated by NYSDOH.

The Health Home is responsible for enrolling our members and contacting their PCP/practitioners as part of the development of a comprehensive care plan. The contact with you is important because the comprehensive plan seeks to integrate treatment plans from the member's health care professionals.

If you have a homeless patient who is eligible and has been assigned to a Provider-Led Health Home, you will receive a letter notifying you of the name of the Health Home to which your patient has been assigned and its contact number. We ask that you encourage your patient to participate and take advantage of these enhanced services.


EmblemHealth Case Management Services

Homeless members not eligible for the Health Home program may still meet our criteria for case management services. As with all of our members, if you believe a homeless member would benefit from case management, call 1-800-447-0768, Monday through Friday, from 9 am to 5 pm.


Resources for Homeless Medicaid Members

Below we have listed some valuable resources for our homeless members and for any other homeless person who comes to you for help. We recommend reaching out to these services on behalf of any homeless person or family.


Domestic Violence


Nutritional Resources


Clothing and Footwear


Cell Phone Services


Questions?

If you have any questions or concerns about this change, contact us by signing in to our Message Center or by calling us at
1-866-447-9717, option 5, Monday through Friday, from 9 am to 5 pm.





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