This is an archived article that was published on in 2016, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Health care services are a critical component of reducing homelessness. Since 1988, The Fourth Street Clinic, located across from Pioneer Park, has provided health care to homeless people in Salt Lake County. Due to limited funding and capacity, Fourth Street Clinic can serve only half of the 10,000 people who cycle in and out of homelessness in the county each year.

The services we do provide are made possible by a combination of federal and local government grants, and the generous private donations from individuals and corporations in our community. But every day we still see homeless patients who aren't receiving essential health care services that are beyond what we currently can provide.

Medicaid expansion is currently the best opportunity to fill these service gaps and provide health care to the rest of the county's homeless population. Every year that no expansion occurs in Utah, homeless patients and others without health insurance coverage suffer.

House Bill 437 appears to be the approach to expanding Medicaid that has the most likely chance of passing the Utah Legislature this year. But because the specifics of who will be eligible and for how long aren't clearly defined in HB437, it is difficult to tell how many of our patients might benefit.

Among the nearly 5,000 patients seen at the Fourth Street Clinic in 2015, 2,000 needed substance abuse treatment, and another 1,500 had non-substance abuse related mental health disorders. More than 1,000 of the patients at Fourth Street Clinic last year suffered from either diabetes, Hepatitis C or high blood pressure.

Homeless people experience exposure to the elements and violence and infections and stresses that cause existing diseases to get worse and increase the risks of acquiring new ones. After we make a diagnosis, some of our patients don't fully recover because they lack insurance coverage for needed prescriptions or X-rays or surgical procedures.

What would it take for HB 437 to allow Fourth Street Clinic to provide more effective health care services for all of Salt Lake County's homeless residents?

First, we need to expand our capacity to see many more patients. Ninety-five percent of our current patients are adults, and only a quarter of them meet the disability criteria to be eligible for Medicare or Medicaid. The rest are uninsured. Expanding Medicaid eligibility to all low-income adults who lack health insurance would allow Fourth Street Clinic to get the reimbursement needed to increase our staff, expand our clinic hours and offer more satellite services in other locations and with our mobile medical van.

Second, we need to significantly expand our ability to either provide mental health and substance abuse treatment directly, or have enough case managers to assure that our patients successfully access these services from our partner agencies who provide them. And it needs to be efficient for our patients to get the drugs or procedures they need in order to get well enough to work again. Medicaid expansion should cover these services as well as dental care, which at Fourth Street is currently funded exclusively with private donations and is limited only to fillings and extractions.

Third, the enrollment for an expanded Medicaid program that covers homeless people must be simple and efficient and they must be able to access providers who are equipped to provide the specialized type of care they need. Many of our patients lack reliable transportation and phone service and their schedules are organized around the hours of shelters and soup kitchens and multiple service agencies. Their health care and case management needs are often complex and cannot easily be met in a typical private physician's office.

Finally, to successfully emerge from homelessness, or prevent it in the first place, a person must stay healthy enough to work and to navigate the logistics and decisions of daily life. An unexpected deterioration of one's health or the lack of access to needed medicines for chronic conditions can result in losing a job or becoming overwhelmed by medical bills and begin the spiral into homelessness. Medicaid expansion for all low income working people in Utah is essential to stopping this cycle.

Depending on how HB437 is implemented, expanding Medicaid coverage for Utahns who are homeless may be the first step that could help some of our patients get some of the health services they need. The next steps are just as important, and those are to make sure all homeless people have ongoing coverage and to also assure access to health care for those who are not currently homeless but are either sliding into homelessness or have taken steps to climb out.

Laura Michalski is Fourth Street Clinic executive director. Scott Williams, M.D., is Fourth Street Clinic board chair.