Health spending on homeless people in Orange County will grow by $100 million
The rising number of homeless deaths in Orange County, coupled with the intervention of a federal court judge, will spur an extra $100 million in health care spending for homeless people over the next three years.
A package of initiatives approved Thursday, April 4, by CalOptima, the county’s healthcare program for the poor, includes spending federal Medicaid dollars, known as Medi-Cal in California, on a variety of homeless services that include:
— Contracts with four clinical teams with medically-equipped vehicles to bring services to people in the streets and at shelters.
— Dedicated phone line staffed by CalOptima to daily dispatch services in less than 90 minutes.
— Personal care coordinators and clinical case managers to be part of a CalOptima homeless response team.
— Coordination with local hospitals under state mandate to provide discharge plans for homeless patients, who in the past more often than not were cut loose on their own or dropped off outside shelters, a practice referred to as “dumping.”
— Recuperative care and referrals for behavioral and substance abuse treatment and other social services.
With their vote, the CalOptima board added $75 million in spending to $25 million that had been authorized earlier this year.
The $100 million is set aside specifically for health services to help homeless people — many of whom would qualify for Medi-Cal coverage but typically are not signed up for that program. The money includes $60 million for undefined “new initiatives.”
The board declined to discuss increasing the reserve fund to $140 million as requested by U.S. District Court Judge David O. Carter during a homeless lawsuit conference on Tuesday that was attended by CalOptima representatives. No board member seconded the motion by Orange County Supervisor Andrew Do, who also sits on the CalOptima board, to consider the judge’s request.
But several CalOptima board members said the reserve fund should be looked at as a commitment to delivering services that can change and grow as the need dictates.
“This is a big commitment,” said Dr Alexander Nguyen, a psychiatrist who joined the CalOptima board in 2016. “Maybe it should have been done a long time ago. But it’s being done now.”
The mobile health services, to begin phasing in Wednesday, will enhance street outreach already provided by county healthcare staff, the so-called “blue shirts” identified by the distinctive polo shirts they wear in the field. The field teams will be able to provide urgent care services, wound care, vaccinations and screenings, along with writing prescriptions that can be filled at the nearest pharmacy in walking distance.
The mobile outreach is expected to ramp up over a couple of weeks, CalOptima Chief Executive Officer Michael Schrader told the board: “We hope to build quickly.”
Go where they are
CalOptima will partner with four federally qualified healthcare providers — Central City Community Health Center, Hurtt Family Health Clinic, Korean Community Services and Serve the People — to send clinicians to “hot spots” and other places where homeless people congregate.
CalOptima’s action in approving the homeless reserve fund comes two days after the chairman of the board, Dr. Paul Yost, and the agency’s chief executive officer, Michael Schrader, told Judge Carter that the agency was prepared to rapidly expand health services for homeless people to help prevent needless deaths.
Records from the Orange County coroner show 210 homeless people died in Orange County in 2018, nearly four times as many as in 2005. But homeless advocates put the number closer to 250 people and say the cold and rain of the past few months have only led to more deaths that could have been prevented.
Back in February, Carter called the mounting death toll a “public health crisis” and met privately with CalOptima representatives who, days later at a Feb. 22 emergency meeting, initiated the effort to dedicate more dollars and services to homeless people.
Yost told the judge at Tuesday’s court hearing that CalOptima had never before dedicated such a large amount of funds directly to healthcare for homeless people and said a system will be set up to track the treatment provided.
As happened with the county’s Health Care Agency, CalOptima has been criticized by homeless advocates for what they see as a wrongheaded lack of outreach to homeless people — waiting for those in desperate need to take the initiative to sign up for Medi-Cal and seek out healthcare services. Instead, homeless people have overburdened hospital emergency rooms.
Criticism and support
There were harsh words and tears on Thursday during the public comments portion of the meeting.
“I see a bunch of suits behind desks who looked at some stuff and put this together,” said Mike Robbins, a longtime homeless advocate who told the board that they needed to seek input from the advocates who know the needs of homeless people and have earned their trust.
“If they don’t have input into this, it’s just doing exactly what’s out there now and you’re going to fail.”
The most emotional moment came when Assemblywoman Sharon Quirk-Silva, D-Fullerton, addressed the board and spoke of her brother, William Raymond “Billy” Jaso, who struggled with alcoholism and homelessness most of his life and died last year at age 52 when he rode his bicycle into traffic. Quirk-Silva sobbed as she spoke in support of working together to expand services to homeless people.
“We can’t continue to see people die on our streets.”