Homeless Does Not Have To Mean Health Plan-Less

Two of Los Angeles’ largest health insurers will invest $90 million over the next five years to improve health care and access to social services and housing for Los Angeles County’s homeless population.

The partnership between L.A. Care Health Plan, the largest publicly operated health plan in the U.S., and Health Net, a subsidiary of Centene Corp., a for-profit insurer with Medicare and Medicaid plans, launched two new street medicine programs in July 2024 aimed at coordinating care for their unhoused members.

Funding for the programs will come from California’s Housing and Homeless Incentive Program (HHIP), a voluntary program that was part of a five-year effort designed to improve health outcomes and the quality of life of people enrolled in Med-Cal, the state’s Medicaid program. HHIP has funds for Medi-Cal managed care plans that have projects that assistpeople who are unhoused. L.A. Care is earmarking 70% of its HHIP money for the programs, and Health Net, 30%.

Sameer Amin, M.D.

“As a public entity, our mission is much broader than you would assume,” says Sameer Amin, M.D., chief medical officer at L.A. Care Health Plan. “It is a responsibility to help these people in ways that are far outside … a normal insurance plan.”

Martha Santana-Chin, Medi-Cal president for Health Net of California, says that finding permanent housing for “the most vulnerable of the vulnerable” will allow members to focus on their health and cut down on emergency department visits
and hospitalizations.

California, with an estimated 180,000 people without housing, has the largest population of homeless people of any state in the U.S. Los Angeles County’s 85,000 homeless citizens are second only to those of New York City. Approximately 40,000 to 50,000 of the county’s homeless people are L.A. Care members, and between 20,000 and 25,000 are covered by Health Net.

Both insurers have worked with the doctors, nurses and social workers who provide street medicine to people living on the streets or in encampments. But care was hit or miss. The companies decided to collaborate and coordinate care and created the Field Medicine Program and the Skid Row Collaborative.

“The difference now is that we are also assigning individuals to primary care providers to take care of their longitudinal journeys and care coordination needs beyond the episode of addressing their immediate needs in the street,”
says Santana-Chin.

The $60 million allotted to the Field Medicine Program includes money for 10 new street teams, building a technological infrastructure and incentive pay for providers. The money is also intended for all the resources needed for primary, preventive, longitudinal, and urgent health care, chronic disease management, pharmacy and social services. “Part of the program is to get [patients] early [on] so they don’t have to run into the emergency department or be hospitalized for weeks on end,” Amin says. One-third of the $60 million was used to build the Los Angeles County Department of Health Services Crocker Street campus, which is expected to open nin early 2025.

The remaining $30 million underwrites the Skid Row Collaborative. Skid Row is home to the highest density of unhoused people in the county. To meet the long-term goal of permanent housing for their members, the companies are working with local agencies and organizations and have pledged an additional $114 million over the next several years to set aside 1,900 rental units. “We can’t have our services be a road to nowhere,” Amin says.

“We still have a lot to do,“ comments Santana-Chin. “By no means have we fixed all the problems. But I believe that we are paying attention to this like we have never [done] before. I’m very excited about that.”