April 22, 2018
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Medicaid expansion can help Maine’s homeless veterans access care

George Danby | BDN
George Danby | BDN
By James Gagne, Special to the BDN
Updated:

Refusal to expand Maine’s Medicaid program has left many homeless veterans to suffer in shelters and on the street. Maine has the fifth highest per capita population of veterans in the nation, and Medicaid is essential for veterans. Yet we have repeatedly turned our backs.

Veterans are more likely to experience homelessness than the overall population, and Medicaid is important for “veterans experiencing homelessness who have high rates of chronic health conditions, disabilities, mental health issues, and alcohol or substance use disorders,” according to a new Kaiser Family Foundation report.

Using data collected from Health Care for the Homeless projects in nine states, the report includes both states that expanded their Medicaid programs and those that didn’t, and the numbers are striking. In those states that expanded Medicaid, 55 percent of homeless veterans served were covered by Medicaid, compared with only 5 percent in nonexpansion states.

Five percent.

That means 95 percent of veterans experiencing homelessness who walk into a health clinic for treatment in states like Maine do not have access to Medicaid.

An assumption I often hear across the state is that Medicaid is unnecessary for veterans because they receive health care through the U.S. Department of Veterans Affairs. Unfortunately, this is not the case.

While the VA offers health benefits to some veterans, many do not qualify because of length of time served, era served or discharge status.

For veterans who utilize VA health services, Medicaid in expansion states plays an important role in supplementing care.

Medicaid covers critical services, such as mental health case management, transportation to medical appointments and inpatient addiction treatment, that are not always offered by the VA in Maine.

Many who qualify for benefits do not live close enough to a VA facility to use them. Maine’s rural geography, low population density and lack of public transportation compound this issue for nearly every homeless veteran we see in rural communities. Medicaid solves that problem by ensuring access to providers in local communities throughout Maine.

The need for comprehensive health care coverage could not be more important for veterans experiencing homelessness in Maine. Of nearly 350 veterans served by Preble Street Veterans Housing Services last year, how many reported a disabling condition?

Eighty-two percent.

Eighty-two percent of veterans sleeping in shelters and on the streets struggle with post-traumatic stress disorder, alcohol or substance use disorders, anxiety, depression or chronic health conditions — all things that are better addressed with access to health care. But in a country where health care is only accessible with health insurance, how many veterans do we see who don’t have basic, necessary health care?

Forty-four percent.

That means about half of veterans sleeping in Maine’s shelters and on the streets do not have any health benefits. Not Medicaid, not Medicare, not the VA, not private insurance.

Nothing.

No health care coverage for anything — not for mental health treatment, curing a common cold or treating a broken ankle.

Nothing.

Often the best resource we have to offer these veterans when blood sugar spikes, anxiety triggers a panic attack or they need medication is the emergency room. Their symptoms are treated, but the underlying problem persists, and more often than not, unnecessarily. Veteran homelessness is a complex issue with a myriad of factors, but health issues are a primary contributing factor. A threat that is exacerbated because Maine has refused to accept Medicaid expansion funding.

Over the last year, we’ve seen nearly a 15 percent decrease in emergency shelter stays among veterans. As a community, we have made great strides toward ending veteran homelessness. But there is much work to be done. Many of the veterans who continue to suffer in our shelters and on our streets are the most vulnerable and have the highest needs, with chronic health conditions, mental health needs, physical health needs and more.

To continue our progress toward ending veteran homelessness, we must begin to address their underlying health care needs.

Expanding Medicaid in Maine can do that.

All who serve in our military, no matter what branch, abide by a set of core values. At the polls on Nov. 7, let us respect Maine veterans by repaying their loyalty and commitment. Let us have their courage and honor them by providing the health care they need and deserve.

Vote yes on Question 2, a salute to Maine Veterans.

James Gagne is the director of Preble Street Veterans Housing Services, which assists veterans and their families to find housing or avoid homelessness throughout Maine, working out of Portland, Lewiston, Bangor and Machias.

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