Utah lawmakers are considering the approval of a Medicaid waiver for a pilot program led by the Utah Department of Health that would provide medical respite care for individuals experiencing homelessness.
Medical respite care refers to “acute and sub-acute medical care for people experiencing homelessness who are too ill or frail to be on the streets (shelters, unsheltered, motels, encampments) but not ill enough to need hospital-level care,” according to a proposal presented to the legislative Health Reform Task Force on Wednesday.
“People experiencing homelessness have significant health care needs and use hospitals at higher rates and for longer periods of time than their housed counterparts,” wrote Kimberlin Correa, executive director of The INN Between, a Salt Lake City-based nonprofit that provides hospice and respite care to homeless Utahns. “Medical respite programs address this problem by offering a safe and appropriate venue for patients to rest, recuperate, and receive follow-up services after they no longer need acute care, in a setting that allows for ongoing clinical care, comprehensive case management, and care transition planning that encourages patients to use primary care over emergency care.”
“The goal of a Medical Respite 1115 Waiver is to give medical respite care providers, state and federal Medicaid leadership, and managed care organizations specific reimbursement options to incorporate into the care they offer to medically complex homeless patients, resulting in improved health outcomes and reduced cost and strain on the health care system,” Correa continued.
The proposal requests an ongoing legislative appropriation of $1 million for the pilot program, including $100,000 for the state health department’s “evaluation and oversight” and $900,000 annually for Medicaid reimbursements.
“Any amount of funding given to this project would support a significant pilot program given what we anticipate the level of demand would be,” Correa told lawmakers Wednesday. “So even a few hundred thousand dollars that could go toward the reimbursement would, I think, have a significant impact on the community, on the patients and be able to give us some very good data about the efficacy of the program.”
The INN Between is primarily funded through charitable donations, Correa said, adding that “the long-term sustainability of a program like ours does depend on additional, sustainable funding.”
If successful, the Salt Lake County pilot program could be expanded and rolled out in assisted living facilities statewide, “so that folks experiencing homelessness from St. George all the way down to Logan would have some type of mechanism” for receiving continued care, she said.
“It’s an important concept because it provides that continuity of care … (for) people experiencing homelessness, from the hospital down to other types of solutions, which might be housing but also might be a return to shelter, a return to couch surfing ... or it might even be a return to the streets,” the nonprofit director said. “But that transitional period helps to improve their health care outcomes while lowering costs associated with hospital re-admissions, ambulance use, their disease becoming exacerbated to where they now need new and higher levels of medical intervention. So that’s the goal of medical respite, really.”
“There’s definitely a gap there for this population of our community that struggles with housing,” Jeff McNally, hospice director at Intermountain Healthcare, told lawmakers in support of the proposal. “I think there’s an opportunity here with this type of waiver to make a very positive impact and have a bit of a ripple effect on the resources that could be used to better support this population.”
The Health Reform Task Force voted to open a committee bill for the respite care pilot program. Rep. Jim Dunnigan, R-Taylorsville, recommended that the Senate work on the funding aspect of the bill while the House work on the policy side.
“I know it needs funding, but I’d like to get going on the language and policy of it,” Dunnigan said.