We all know, juggling—and navigating—Medicaid and Medicare is hard. A recent visit from the Center for Medicare and Medicaid Services (CMS) to our downtown clinic gives us new hope that life will get easier for our "dually eligible" clients—and the staff members who support them.

The Affordable Care Act has done great things for vulnerable people. In addition to expanding Medicaid and increasing resources for Community Health Centers like Health Care for the Homeless, the law also established a new CMS office to improve access to care for individuals who are dually eligible for both Medicare and Medicaid.

On Tuesday, July 19, representatives of the CMS “Medicare-Medicaid Coordination Office” visited our downtown clinic for a tour and conversation about how to remove barriers to care for people experiencing homelessness. Barbara DiPietro organized the visit and enlisted the help of Pete Iacovelli, Dan Hendricks, Nilesh Kalyanaraman and Kevin Lindamood to show our visitors the scope of our work and the challenges of our “dually eligible” clients. Pete and Dan powerfully illustrated the frustrations our dually eligible clients face, along with the staff who serve them.

• For dually eligible clients, the conversion to Medicare after receiving Social Security Disability Insurance for 24 months can be bumpy, with those receiving a blend of Supplemental Security Income and Social Security Disability Insurance, for example, becoming confused when their primary coverage converts from Medicaid to Medicare.
• For dually eligible clients, the large volume of mail that comes to them once Medicare activates is overwhelming, and managing and understanding all that mail is a challenge.
• The multiple components related to Medicare Parts A, B, C and D are tough to understand and tend to confuse recipients converting from comprehensive Medicaid coverage.
• Multiple agencies are involved with our clients who are dually eligible, including Social Security, CMS, Department of Social Services, insurance drug plans and Medicare Advantage Plans. With so many different players, transmission of coverage does not always occur properly and resolving discrepancies becomes challenging for both clients and providers.

Also on hand for the visit was client Mary Beth, who receives Medicare and Medicaid and who is no longer experiencing homelessness thanks to our SOAR supportive housing project. She spoke directly to the challenges she faced in navigating the health insurance programs and to the importance of supportive housing and the range of services provided by Health Care for the Homeless. Near the end of the meeting, as the conversation turned to 13 pilot projects happening in communities across the country to improve coordination between Medicaid and Medicare, one of our visitors said, “One of the mistakes on our part was not first interacting with service providers such as Health Care for the Homeless to understand the challenges faced by vulnerable populations.” We look forward to an ongoing partnership with CMS and the Medicare-Medicaid Coordination Office. Another fine example of Health Care for the Homeless advocacy in action!