Homeless Are Hesitant to Use Medi-Cal

By Lisa Renner via California Health Report

The expansion of Medi-Cal under the Affordable Care Act means that the homeless have more health care options this year than ever before.

Yet the handful of free homeless medical clinics in Modesto continue to see lines of patients eager to use their services. Some homeless people have trouble understanding the Medi-Cal enrollment process or providing the needed paperwork. Others would just rather be around other homeless people. Because of their hard life on the streets, they don’t always feel comfortable in more traditional settings.

As long as they earn no more than 138 percent of the poverty level ($15,860 for single adults, $32,500 for family of four), they qualify for Medi-Cal and can see any doctor who accepts the health coverage.

Richard Freitas, a homeless man who showed up for the free clinic at the Modesto Gospel Mission one evening for help with a wounded head, couldn’t give a good reason why he chose to go there rather than a doctor’s office. “I don’t know, I just don’t know,” he said, shaking his head.  He is enrolled with Medi-Cal and had a car that could take him to a doctor’s office.

Medi-Cal used to be open only to those under 21 or over 65 or people with disabilities or who were pregnant or met other requirements. An additional 2 million people are now eligible for Medi-Cal, according to the California Department of Health Care Services.

Despite the change, the Modesto Gospel Mission doesn’t expect to close its clinic soon. The homeless people it serves. depend on it.  “This is where they are,” said Dr. Jim Boozer, who volunteers at the mission’s clinic once a month. “They’re going to come anyway. While they’re here, they can get the care.”

The Modesto Gospel Mission, Modesto’s oldest homeless shelter founded in 1948, provides a place to sleep for up to 150 people a night. Two nights a week, volunteer doctors and nurses come on site to offer basic medical services.  They typically serve 20 patients in each three-hour session. Common ailments include infections, skin irritations and sinus problems. They can offer antibiotics, inhalers, ibuprofen and other basic remedies.

“It’s front-line Band-Aid medicine,” Boozer said. “We’re not trying to be anybody’s routine doctor.”

They encourage patients to sign up for Medi-Cal or the county’ Medically Indigent Adults program so that they can get follow-up treatment if needed from another physician.

Kevin Lopez, who came to the mission clinic for help with skin bumps, said he hopes to get on Medi-Cal soon. He has been homeless for a year since he lost his job in landscaping. “I have some mental problems,” he said. “It’s been hard to hold a job.”

But many homeless are not yet aware that they qualify for Medi-Cal.  Sandra Williams, health reform project lead for Stanislaus County, said the county has tried to get the word out by sending mailers to homeless with a mailing address.  County staff has also put up flyers and brochures at clinics and offices where homeless people go.

The Modesto Gospel Mission clinic tells patients about Medi-Cal but doesn’t help them sign up for the service on site. It’s a different story two miles away at the Golden Valley Health Center’s Corner of Hope Clinic, where there’s a big sign in the lobby, written in English and Spanish, saying “Uninsured? Ask about Medi-Cal and Covered California Enrollment Today.”  Another flyer alerts patients to an informational talk on the Affordable Care Act at a nearby church.

The clinic is run by paid staff and offers a range of medical services including behavioral health and dental.  Many patients are repeat visitors.

Juan Villa, Golden Valley’s homeless health care coordinator, said many of the homeless need extra help getting enrolled because they have cognitive disabilities. Others don’t have driver’s licenses, birth certificates or Social Security cards. The clinic will help reorder missing papers for patients that don’t have them. “We try to do as much work as we can for them,” Villa said. “My goal is every patient who comes through the door has an application pending.”

People find out about the clinic from other homeless, social service agencies and hospitals.  Homeless patient Gerald Saunders, who came to the clinic with a painful pelvis, said he learned about the clinic from his fiancé.

Though he and other homeless patients could visit other physician offices, they prefer Corner of Hope because of its concentration on homeless care. “They like to have a place of their own,” said Lisa Baladad, Golden Valley marketing coordinator.

The Salvation Army opened a medical clinic at its winter shelter in Modesto just last August and has only served a few dozen patients to date. The clinic only offers optometry and dental services now but has plans to offer women’s health services sometime this year.  Demand for all services is high. The clinic has a wait list with more than 100 names on it, said Carrie Ann Pimentel, the Salvation Army’s medical coordinator.

Pimentel said she often hears from shelter residents that they don’t have ID or paperwork necessary to sign up for Medi-Cal. “Either they’ve never had it or they had it and it was stolen, “she said.

If the Salvation Army didn’t have the clinic, some of its homeless clients might never get needed treatment.  Some won’t seek care unless a medical clinic is easily accessible.

Lauro Ramirez, a 65-year-old resident of the shelter, said he is grateful the Salvation Army provides the clinic. He recently visited the dentist to take care of an infected tooth. He couldn’t remember the last time he visited a dentist.  “Now I can eat better,” he said. “I feel much better.”