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Medicaid now reimburses Pa. street medicine providers, who care for people experiencing homelessness

A woman walks down railroad tracks.
Allegheny Health Network
Street medicine practitioner Mary Sligh walks from an encampment in Pittsburgh's West End, carrying food and medical supplies.

People living without a roof over their head have one less barrier to medical treatment in Pennsylvania due to a change in the state’s Medicaid program. Pennsylvania providers are now able to be reimbursed for practicing street medicine — this is when health care is provided to unhoused people in non-clinical settings, such as encampments or alleyways.

Street medicine practitioners say while Medicaid reimbursement won’t revolutionize their work, it legitimizes this health care model and provides additional financial resources to support their work.

“Hopefully, this will result in people being connected to services that can then help them take those next steps to some better type of stability in a hopefully housed situation, getting treatment,” said Pa. Dept. of Human Services Secretary Dr. Val Arkoosh.

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Homelessness and poverty go hand-and-hand, so unhoused people often qualify for Medicaid, which is taxpayer-funded health insurance for low-income people. Yet many who are experiencing unsheltered homelessness struggle to access health care as they find medical facilities unwelcoming or even traumatic, said nurse practitioner Mary Sligh, the street medicine lead within the Center for Inclusion Health at Allegheny Health Network.

“Another factor is that the lives of the folks we serve can be quite chaotic. Homelessness is a full-time job,” said Sligh, who explained that people might delay seeking medical care because they don’t have a secure place to keep their belongings or pets.

More than 900 people were identified as homeless earlier this year by Allegheny County’s Department of Human Services. The state estimates that more than 15,000 Pennsylvanians are experiencing homelessness.

Using U.S. Census data, University of Chicago researchers estimate that the mortality rate for non-elderly people experiencing homelessness in the U.S. is 3.5 times higher than the general population: “A 40-year-old homeless person faces a similar mortality risk to a housed person nearly twenty years older.”

In addition to being exposed to harsh weather and physical violence, a 2022 analysis from the University of Delaware finds that more than half of unhoused people have depression, an anxiety disorder and a drug use disorder.

Common ailments that street medicine teams encounter include wounds caused by habitual drug use or violence, along with broken bones and issues related to chronic medical conditions such as diabetes – the condition can be life-threatening for people who don’t have housing since insulin must be refrigerated.

Pittsburgh Mercy’s street medicine program can even perform ultrasounds and lab tests, said the nonprofit’s medical director of homeless services Dr. Jim Winters. During an appearance on WESA’s The Confluence, Withers said when practicing street medicine, the most important thing is to respect a patient’s agency.

“It’s the beginning of a relationship, that then you have to follow people into other resources and build resources if they’re not that,” said Withers.

The only other state Medicaid programs that reimburse for street medicine are California and Hawai’i, according to Brett J. Feldman, director of the division of street medicine at USC’s Keck School of Medicine. This is slated to change in October when the Center for Medicare and Medicaid Services will recognize “non-permanent location on the street or found environment” as a place of service. Soon more Americans experiencing homelessness can get more of the medical care they need.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.