President Joe Biden recently declared an end to COVID as a national emergency, and the World Health Organization declared it is no longer a public health emergency. But homelessness is a pervasive issue that has many complex layers that interact with one another and cause severe and tangled negative outcomes for people who experience them.

Requiring an address in order to have access to the necessary benefits is inhumane and inequitable. One problem is Medicaid has not asked individuals to update their mailing addresses for at least three years due to the pandemic.

In March of this year, because the President and governors, including Illinois Governor J.B. Pritzker, did not renew the COVID emergency declarations, there is now an end to continuous and automatic coverage, and all recipients must update their addresses to receive notices and renewal forms to remain covered.

Before the pandemic, people typically had to “redetermine” eligibility for health care every 12 months. The pandemic temporarily stopped that practice to ensure that fewer people would be without medical coverage while at high risk of contracting COVID-19.  As a result of the Pandemic Health Emergency ending, beneficiaries once again need to redetermine eligibility to remain covered. This creates opportunities for our vulnerable neighbors to lose their coverage due to failure to complete paperwork even if they’re eligible.

Another major issue is many Supplemental Nutrition Assistance Program beneficiaries are seeing their benefits reduced, also because the SNAP Emergency Allotment has ended.

During COVID, the USDA granted waivers for some states to provide increased SNAP benefits to address the economic crises and provide more benefits to those in need. However, they have now returned to the more traditional practices to determine eligibility and benefit amounts. As devastating as this may seem, people losing their benefits due to an issue that can be addressed is even worse.

Although updating important information with the Department of Human Services is critical, many people experiencing homelessness, including those who are doubled up, may be unable to provide an address or have moved from the location where they once were due to their transient nature.

In Illinois, for example, the state has released a toolkit to provide support and guidance. The Pennsylvania Department of Human Services says over the next 12 months all recipients can renew their policies. In Michigan, the Healthy Michigan Plan offers online resources to secure benefits.

But what about those in other states who do not have access to these online resources and tools?

Creating low-barrier, accessible resources is a point of advocacy for this population as they rely on these very supports to live. Minimizing disruption in services, like Medicaid, is crucial to the health and well-being of this population.

Decreasing food supplements increases the possibility of food insecurity,  already prevalent for those experiencing homelessness, which is increased among African Americans since the pandemic began in 2020. African Americans make up only about 29% of the population in Chicago, but account for 70% of the homeless population.

If DHS asks that everyone update their addresses to receive the appropriate renewal forms, there must be a provision for those without a stable address or a reliable location to access and receive important information about their healthcare benefits.

Not everyone in this population has access to a case manager or supportive friend to help them navigate some of the most difficult systems around.  Large and prevalent health disparities plague impoverished communities. Creating an opportunity to challenge these barriers to wellness is an essential step in the right direction.

Historically, disparate health outcomes are driven by multiple factors, and not just the lack of access to healthcare. At its core, health equity recognizes how the social determinants of health impact the health and livelihood of the unsheltered, including food insecurity.

There must be a system that creates innovative, equitable solutions that address the many concerns related to obtaining benefits.

Some people without health insurance are likely not to seek medical care. Perhaps allowing more flexibility for individuals who are within the Homeless Management Information System, HMIS, and listed as experiencing homelessness or housing insecurity within the last year could be one route to support efforts of protection from loss of benefits.

Anyone who knows a person experiencing homelessness can assist them with finding a shelter, church, or community center that allows them to utilize their address as a way to obtain these documents so that no coverage is lost.

People experiencing homelessness may select to use a mail service known as general delivery. This allows individuals without permanent addresses to receive mail at participating local post offices.

The Postmaster can approve the application if the applicant provides a valid point of contact such as place of employment, charitable institution, shelter, or other social services office, shows a valid ID, or is known to the Postmaster or employees.

The end of COVID is a good thing. The end of benefits for those experiencing homelessness is a tragedy that can be avoided. An address should not be the only reason someone stays alive.