Advancing Primary Care

Grantee Name

Care for the Homeless

Funding Area

Advancing Primary Care

Publication Date

November 16, 2018

Grant Amount

$184,454

Grant Date:

November 2014 - October 2015

Every night, more than 50,000 people are homeless in New York City, including more than 22,000 children.

Chronic diseases disproportionately affect people who are homeless, leading to poor health outcomes and premature deaths. Adjusted mortality rates among homeless individuals are three or more times greater than that of the general population. People experiencing homelessness also face barriers to accessing appropriate health care services; high rates of mental illness, transience, and substance use; and difficulty navigating a complex medical system—all of which contribute to significant health disparities between the housed and homeless. However, research shows that creating health care services in places where homeless people congregate is a proven successful model for improving health outcomes and addressing disparities.

NYSHealth awarded Care for the Homeless a grant to support a mobile health clinic to serve as an alternative medical home for homeless patients.

Outcomes and Lessons Learned

  • Surveyed some of the intended patient population for information on homeless status, emergency room visitation, and health insurance needs.
  • Provided health education; insurance enrollment; preventive care, testing for HIV/AIDS, hepatitis C, and sexually transmitted diseases; and follow-up referrals for patients at three mobile sites.
  • Launched primary care services to supplement existing mental health services, substance use counseling, and health education services.
  • Reduced barriers to care for patients requiring additional specialty care by completing referrals.
  • Provided primary care, mental health, substance use, and health education services to 678 patients, including 249 new patients.

Although Care for the Homeless had some success, it was unable to meet a number of project goals. Care for the Homeless mobile health clinic sites only reached 62% of the total intended new patient population of 400. Of the three mobile clinic sites, one was discontinued because of low client usage and irregular follow-up appointment attendance by patients. Initially, the program aimed to enroll 50% of the new patient population in Medicaid. After the first year of the project, however, Care for the Homeless discovered that the majority of patients (71%) using the mobile clinics were already successfully enrolled in Medicaid.

The length of time required to receive New York State approval for the mobile health clinics to operate and provide primary care services delayed some of the project’s goals. Until this approval was obtained, the mobile health clinic could only provide screening and education outreach. The actual delivery of primary care services started late and the planned four-day-a-week provision of services was not fully operational on the planned schedule. Care for the Homeless also had difficulties in securing reimbursement for primary care services as a federally qualified health center through the Health Resources & Services Administration, which impacted its fiscal resources for year one and slowed progress. Structural limitations of the mobile health vans made it challenging to provide confidential care, behavioral counseling, and case management, which had an unanticipated negative impact on the project’s goals.

Co-Funding and Additional Funds Leveraged: Approximately half of the funding necessary for the mobile health clinic’s first year of operations was received through private support and Medicaid revenue. Additional grant funding was provided by Direct Relief ($75,000), Insurance Industry Charitable Foundation ($50,000), JRM Construction Management ($25,000), and Broadway Cares/Equity Fights AIDS ($5,000 renewed annually).