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The implementation of the Affordable Care Act has been a mess in many ways. But for Colorado's homeless, it has still ushered in a new era of hope. The reason: Under the ACA, Colorado is expanding Medicaid, giving the poorest of the poor a chance to access a full range of health care.

"The Affordable Care Act is just tremendously beneficial to the homeless population," says Greg Morris, program director of the local Peak Vista Homeless Health Center. "... Once something comes up like Medicaid that can open the door to all these services, they jump at it."

Local homeless advocates have long cited limited access to health care, including mental health care, as one of the biggest barriers to recovery. Most local homeless people lack a primary care physician and consistent medical records. Emergency rooms and clinics provide some help, but can't always follow through with specialists, tests and prescriptions.

In mid-2012, Colorado began a pilot expansion of Medicaid, offering the insurance to at least 10,000 adults who made $90 a month or less. Locally, Peak Vista Community Health Centers, which oversees the Homeless Health Center, signed up more than 900 people through the program. (Its computer programs can look up birth certificates and Social Security numbers that may have been lost, easing the process.)

"It's been very gratifying to participate in a program that has so much impact on our homeless population," writes Deanna Bond, outreach supervisor for Peak Vista, in an email.

Though the pilot has a waiting list, Peak Vista staff are continuing to turn in applications, because Colorado is one of the states that accepted the federal government's offer to foot the bill for a massive, permanent Medicaid expansion. (The state will pay for a percentage of the program in future years.) Come January, adults who make less than $14,856 can sign up for Medicaid. And unlike the pilot, this program doesn't cap the number of participants; 160,000 Coloradans are expected to register.

Asked to describe how the expansion has affected his practice, Morris recalls a patient who enrolled early in the pilot. The man had been living with a group of friends who had slowly moved out over the years, leaving him alone. Gradually, mysterious symptoms began to eat away at the man's mobility. He wasn't able to hold down a job, and could barely get to the store for groceries. When Morris examined him, he could tell the problem was neurological, but couldn't pinpoint it.

Once the man was on Medicaid, he was able to see a neurologist who diagnosed him with multiple sclerosis, and said he had been deteriorating for about eight years. With the diagnosis, Morris was able to help the man get into a long-term care facility, where he's made significant strides.

It's a great story, but the kind of story that's often drowned out by tales of others abusing Medicaid. To fight such abuse, Kelley Vivian says the expansion in Colorado has been accompanied by the creation of seven regional-care collaborative organizations. She leads our local Region 7 collaborative, which she says organizes a network of doctors, specialists and patients. It's meant to ensure that all health care providers share information on patients, eliminating duplication; that all patients have and use a primary care physician; and that Medicaid runs as efficiently and effectively as possible.

stanley@csindy.com

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