In the ongoing national conversation about healthcare funding, the debate around Medicaid spending hits especially close to home.
In Washington, DC, more than 257,000 people – 38 percent of the city’s population – depend on Medicaid to get the healthcare they need. That includes 83 percent of all nursing home residents, 51 percent of working-age adults with disabilities – and the overwhelming majority of some of our most vulnerable neighbors – people experiencing homelessness.
Beyond Basic Healthcare: How Medicaid Transforms Lives
For those experiencing homelessness, Medicaid provides far more than just basic healthcare coverage. It creates pathways to stability, dignity, and permanent housing solutions.
Recognizing the relationship between health and affordable housing, in 2022 the city created the Housing Supportive Services (HSS) Medicaid program to leverage Medicaid funds to help people experiencing homelessness receive the case management services they need to obtain and maintain stable housing – including Permanent Supportive Housing (PSH).
Since then, The Partnership to End Homelessness has provided funding to support training for dozens of PSH providers across DC to help them adapt to new billing procedures to fund their housing case management services. These trained PSH providers are also now better equipped to help their clients navigate the complex Medicaid system to access benefits.
“Medicaid isn't customer-friendly,” Shauna Figueroa Vice President of Housing Services at Friendship Place shared. “It's multi-layered and convoluted, with steps that must be done in a specific order and a lot of paperwork required. Without our case managers, hundreds of people who qualify for Medicaid simply wouldn’t have access.”
“We recognize that the population we serve really needs access to these resources – but they also don’t have access to a computer or a mailing address,” added Christy Respress, President & CEO of Pathways to Housing DC. “Our staff play a big part of getting people on Medicaid and keeping them enrolled.”
““People will die if Medicaid is cut - for any population. For most people, the fear of losing a job isn’t just about losing income. It’s also about losing access to healthcare.””
The impact of this work is immediate and life-saving.
"Two weeks ago, a gentleman we'll call Mr. J came to our U Street location in really bad physical and mental shape,” Figueroa shared. “He was living on the street and was HIV-positive with bipolar disorder and active addiction issues. He told us he couldn't sleep on the street anymore – you could see the look of despair on his face.”
“Because he was in the Medicaid system, we were able to quickly provide him with food, secure his medication that he hadn't taken for 60 days, and get him into bridge housing within just two hours."
Arianne Clyburn, Acting Director of Housing at Miriam's Kitchen, notes that Medicaid has "opened up the door for clients to be transferred to higher levels of care" and provides access to medications and preventative care for those who need them most. “Our clients can get yearly medical exams or access eye care and dental work that they haven't had in many years."
In addition to PSH and basic healthcare treatment, Medicaid coverage provides access to:
Essential medications: For those experiencing chronic homelessness, accessing critical medications is a challenge. "Medication is so expensive," Respress explains. “If you had to choose between taking your meds and having a roof over your head or food to eat, which would you choose?”
“Medicaid allows people to get the treatment they need for things like diabetes and hypertension so that conditions don't reach a point where they need to be hospitalized. It also covers medications for depression and anxiety, which are essential for behavioral health."Holistic support services: Medicaid-funded programs provide critical wrap-around services that dramatically improve accessibility and quality of life for those at risk of experiencing homelessness. These services can include transportation to medical appointments, nutritional support, and even gym memberships for high-risk individuals.
Respite & rehabilitation services: For those experiencing critical illness or struggling with substance abuse or mental health challenges, having access to a place of refuge is critical to their rest, recovery, and long-term stability.
Durable medical equipment: Items like walkers, canes, wheelchairs, and other assistive devices provide increased mobility and improved quality of life – especially for seniors and individuals that are recovering from traumatic events or living with a disability.
Home health aides: For many in Permanent Supportive Housing (PSH), access to a home health aide is crucial. As Respress notes, "Many DC residents are aging in place and just need help with basic activities of daily living. They don't need to be in a nursing home (which many can’t afford); they just need a helping hand so they can stay in their home and maintain their independence."
A senior with Open Arms DC, a permanent supportive housing provider in Congress Heights.
Beyond the Individual: How We All Benefit
When Medicaid helps our neighbors experiencing homelessness, the positive effects ripple throughout our entire community. These aren't just abstract "system benefits" – they're tangible improvements that touch all our lives:
Less crowded emergency rooms: When was the last time you or a loved one waited hours in an emergency room? Those wait times grow longer when people without healthcare access are forced to use the ER as their primary care provider. Christy Respress explains, "With regular access to medications and preventative care through Medicaid, people don't reach the crisis point that sends them to the emergency room. This means shorter wait times and critical resources for everyone who needs emergency services."
Safer, healthier communities: We all want to live in neighborhoods where people aren't suffering on the streets. Medicaid coverage means fewer untreated mental health crises in public spaces, less suffering, and communities where everyone can access the care they need. "When people get proper treatment for mental health issues or substance use disorders, we see dramatic improvements not just in their lives, but in neighborhood stability and safety," notes Respress.
Your tax dollars working smarter: Like it or not, we all pay for healthcare one way or another. Figueroa points out: "Treating someone's chronic condition through regular doctor visits and medication is dramatically less expensive than paying for an ambulance ride and emergency room visit every time they have a crisis. When we invest in preventative care through Medicaid, we're actually saving significant public funds for emergency services." Those savings can translate to lower healthcare costs and taxes for everyone.
Reduced strain on public services: From police responding to non-violent mental health crises to sanitation workers addressing public health concerns, many public services are stretched thin dealing with the consequences of untreated health conditions. As Clyburn from Miriam's Kitchen observes, "When our clients have access to appropriate healthcare through Medicaid, they're less likely to need emergency interventions from other public services. This frees those resources for other community needs."
A young family served by Friendship Place’s Permanent Supportive Housing Program
The Threat of Medicaid Cuts: "Unfathomable" Consequences
When asked about the potential impact of Medicaid cuts, our partners didn't mince words.
Christy Respress of Pathways stated: "It's unfathomable. It is literally unfathomable.”
“People will die if Medicaid is cut - for any population. For most people, the fear of losing a job isn't just about losing income. It’s also about losing access to healthcare."
The consequences would cascade throughout our communities:
Hospitals would suffer: Proposed cuts to DC’s Medicaid would slash more than $2 Billion from local hospitals – forcing hospitals to lay-off doctors, cut services, and even close facilities to make ends meet.
Emergency services would be overwhelmed: Without access to Medicaid, those without insurance will be forced to go to hospitals and urgent care centers to get the care they need, putting additional strain on already stretched emergency services.
Housing stability would collapse: Figueroa from Friendship Place warns, "Without Medicaid, our clients wouldn't just lose their healthcare – they'd likely lose their housing too. This would cause a level of instability that would bring about relapse for many, cause children to be displaced from their families, and increase demand for shelter placements that we simply don't have capacity for."
Seniors would struggle: Across DC and our region, many seniors rely on Medicaid to cover rising medical costs – such as home health aides - that Medicare and private insurance won’t cover. In DC alone, 34 percent of Medicare beneficiaries are also covered by Medicaid.
Community safety concerns: Without access to proper medical care or housing support, some fear that many experiencing homelessness would be criminalized and forced into the criminal justice system – resulting in increases in crime (including violent crime), as desperate needs continue to go unmet.
When asked about potential Medicaid cuts, Clyburn from Miriam's Kitchen expressed immediate concern about "whether we would be able to continue providing essential services and whether our clients would be able to get the support they need to survive and move forward with their lives."
Conclusion: Medicaid as Essential Infrastructure
For people experiencing homelessness, Medicaid isn't just healthcare coverage – it's essential infrastructure that enables stability, dignity, and the possibility of recovery. As Figueroa from Friendship Place summarizes: "Across the board, Medicaid provides individuals the ability to get wraparound holistic services – housing, medical, behavioral, and mental health support. Medicaid is truly invaluable in creating pathways out of homelessness."
"There's something profoundly important about living in a society where we don't allow our neighbors to suffer without medical care," Respress reflects. "The knowledge that we're not abandoning our most vulnerable citizens benefits us all on a fundamental human level."
As our nation debates the future of healthcare funding, we must remember that Medicaid is not merely a line item in a budget. For our most vulnerable neighbors, it is quite literally a lifeline – and cutting it would have profound, far-reaching consequences for individuals and communities alike.
