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Rola Hariri
Dr. Harrison
PS 1010 Section 519
March 28, 2016
Homelessness is an issue many cities are facing today. It is an issue that has been
occurring for years. Many people end up homeless due to tragic life occurrences such as
the loss of loved ones, domestic violence, and divorce (Top Causes of Homelessness).
Today, the rapid, unexpected loss of jobs and tax and mortgage foreclosures has
dramatically added to the number of people without a roof over their heads (Top Causes
of Homelessness). Other factors, including depression, untreated mental illnesses, posttraumatic stress disorder, and physical disabilities are responsible for a large portion of
the homeless (Top Causes of Homelessness). Out of the 100,000 homeless citizens in
Michigan, about 20,000 of them are currently wandering the streets of Detroit, with a
third of them being mentally ill and untreated (Gerritt). Due to their illnesses, many
homeless citizens are unable to stabilize themselves and find a home or job. The
remaining two thirds put their very minute earnings towards health insurance. Health
insurance in Michigan for a single individual ranges from $180-$760 a month
("Michigan Releases Cost). For the homeless, that amount is very difficult to come up
with. Without access to health care, the homeless are winding up in a worse condition
than they have started off. Since they are unable to receive any sort of treatment, the

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number of homeless people is gradually increasing throughout time. Overtime, the

streets of cities throughout the nation will be flooded with homeless wandering about.
With the right resources and efforts, such as the creation of Medicaid, the homeless
population could decrease and potentially diminish the issue to where it becomes a
minor one.
Since homelessness is an issue that has been around for quite some time, there
have been numerous efforts made to help resolve the issue. These efforts are made
through different levels of government (federal, state, local and neighborhood) by each
of the four different spheres of life: government, civic, market, and private (Biggs and
Helms). One example would be the United Community Housing Coalition (UCHC).
This nonprofit organization located in Detroit offers the homeless services that include
landlord tenant legal counseling, tenant organizing, and tax and mortgage foreclosure
prevention (About Us UCHC). These services are helpful to those individuals who are
being forced out of their homes by county officials, and whose homes are being
auctioned off as part of an annual tax foreclosure process. (Kellogg). However, this
organization is focusing on those who are newly homeless or on the verge of becoming
homeless. It doesnt benefit the ones who have been wandering the streets for quite some
time now. This is where other organizations come into play, such as the Neighborhood
Service Organization (NSO). The NSO is another Detroit-based nonprofit organization
that offers the homeless clinical and outpatient services for adults with mental illness,
developmental disability services, youth leadership and advocacy training on gun
violence and substance abuse prevention, and many more (Clay). The NSOs offerings

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are helpful to those homeless citizens who have little to nothing to live off of. Although
this organization does offer their services to the homeless that approach them for help,
many of their programs are focused towards the NSO Bell Buildings residents. The
newly renovated Bell Building is located in Downtown Detroit and is currently home to
155 residents who were once homeless (NSO Bell Building NSO). The homeless who
arent residents do not get the luxury of receiving quality healthcare. Efforts have been
made to offer healthcare to the homeless who are unable to afford health insurance and
are not receiving it through civic spheres, such as the NSO. One significant effort that
was made was the passing of Medicaid.
Created in 1965, Medicaid is a mean-tested entitlement program that finances
the delivery of primary and acute medical services as well as long-term care to more
than 57 million people at an estimated cost to the federal and state governments of
roughly $300 billion (Herz). Medicaid was created to help those individuals who are
unable to afford health insurance. However, it was not very successful in doing so at
first. When Medicaid was created, it had very specific criteria developed at the federal
level to determine who is eligible for Medicaid and who isnt. Each state can choose
whether to take part in this program, and if so, can set additional criteria for eligibility
(Adams). This process is based off a concept referred to as cooperative federalism,
which means that the federal and state government share power in areas of public policy
(Lenz and Holman). Some of the federal population groups that were considered eligible
were poor families that meet the financial requirements, poor individuals with
disabilities or over the age of 64 that qualify for cash assistance under the SSI program,

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pregnant women and children under the age of six with a family income below 133% of
the Federal Poverty Line, or children of ages six through 18 with family income below
100% of the Federal Poverty Line (Herz). There are many people who dont fall under
the federal criteria of this program and are unable to afford health insurance. In 2005, 34
out of the 50 states had 12% or less of their residents enrolled in the Medicaid program
(Adams). The enrollment rate was substantially low and was program itself was not
effective. There have been many reforms made to this program from the year it was
created, however, none of them showed a great change in enrollment. It wasnt until the
Affordable Care Act enacted in March 2010 that the nation saw success in Medicaid
(Monthly Medicaid Enrollment).
The Affordable Care Act, also referred to as Obamacare, was created to help
improve healthcare in the nation. One of its more significant reforms was to expand
Medicaid. In the Affordable Care Act, Title II Subtitle A Section 2001 states that starting
in January 2014, individuals under the age of 65, who are not pregnant, and not enrolled
or entitled to other benefits and have an income that does not exceed 133 percent of the
federal poverty line will now we eligible to receive Medicaid (S. 3590, 2010). For a
state to officially be considered as an expansion state using this reform, the state must
offer health benefits coverage to parents and nonpregnant, childless adults whose
income is at least 100 percent of the poverty line, [and] that is not dependent on access
to employer coverage, employer contribution, or employment (S. 3590, 2010). Since the
reform was optional for states to take on, the law required states to simplify and
modernize their Medicaid enrollment processes and eligibility (Paradise). This helped

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ensure that regular low income adults are able to have access to healthcare, regardless if
states take on the reform. When the ACA finally came into play at the beginning of 2014,
the nation saw success in the insurance program. Enrollment in Medicaid increased in 49
states total by more than 10.7 million individuals (Paradise). For the first time, the
majority of single individuals are now eligible to receive health care. The majority of the
homeless population suffer from sort of illness, whether physical or mental, and this
prevents them from stabilizing themselves and finding a home or job. They are not in the
right state of mind to do so. The new and improved Medicaid will now help these
individuals get back up on their feet. Not only will this better their health, but it could
potentially get them to live a more stable life.
Policies are made to help solve certain situations at either the federal level or the
state level. However, not all policies end up being successful. Sometimes the structure
within the policy prevents the policy itself from being effective. In this case, Medicaid
was created with the goal to provide health insurance to those citizens with low income.
Due to the restrictions the federal government set for Medicaid eligibility, it became hard
for majority of the people to have access to it (Adams). Medicaids failure to be effective
showed the government that it needed to be revised. The expansions of Medicaid
through the Affordable Care Act brought the program to its peak. With the reforms in
eligibility requirements, Medicaid enrollment skyrocketed (Paradise). Success doesnt
always happen after one attempt. In some cases, policies become successful with the
help of other policies, as Medicaid became successful with the expansion through the
ACA. As more and more homeless people have access to health insurance, the problem

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of homelessness could potentially decrease in the future as they are able to get treatment
and live a healthy life. Once a healthy life is established, it is only a matter of time
before the homeless are able to find jobs and a place to stay.

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Works Cited
"About Us." United Community Housing Coalition. Web. 13 Feb. 2016.
Adams, Rebecca. "Medicaid Reform." CQ Researcher 16 July 2004: 589-612. Web. 24
Mar. 2016.
Biggs, Selden, and Helms, Lelia B. 2006. Practice of American Public Policymaking.
Armonk, NY, USA: M.E. Sharpe, Inc.
Clay, Sheilah. Personal phone interview. 2 February 2016.
Herz, Elicia J. Medicaid: A Primer. ProQuest Congressional 19 Dec. 2005: 33202.
Web. 24 Mar. 2016.
Kellogg, Alex. "In Detroit, Massive Foreclosures Strip Neighborhoods of People and
Homes." Aljazeera America. 6 Oct. 2015. Web. 15 Feb. 2016.
Lenz, Timothy O., and Mirya Holman. "Federalism." American Government. 4th ed.: U
of Florida, 132. Print.
"Michigan Releases Cost Of Health Insurance Plans." CBS Detroit. The Associated
Press, 01 Oct. 2013. Web. 21 Mar. 2016.
"Monthly Medicaid Enrollment (in thousands)." Kaiser Family Foundation. Web. 24
Mar. 2016.
Norman, Jane. "Health Care Law Target: Medicaid Expansion." CQ Weekly 29 Nov.
2010: 2762. Web. 24 Mar. 2016
"NSO Bell Building." Neighborhood Service Organization. NSO, 2015. Web. 3 Feb.

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Paradise, Julia. "Medicaid Moving Forward." Kaiser Family Foundation. 09 Mar. 2015.
Web. 24 Mar. 2016.
Patient Protection and Affordable Care Act, S. 3590, 111th Cong. 392 (2010) (enacted).
"Top Causes of Homelessness." HomeAid. Web. 21 Mar. 2016.