To the dedicated teams at Sunshine House, Prevention Point Philadelphia, Project HOME, Merakey, and all the tireless organizations on the front lines in Kensington and across our city: The ground is shifting under our feet. The current government shutdown is a direct result of a legislative impasse over new federal requirements that are poised to create significant new challenges for the individuals we serve, particularly those struggling with homelessness and addiction. This is not a moment for despair, but for strategic action.
Here's what you need to know and how we can prepare.
The Looming Policy Hurdles
The new federal requirements, which are a central point of contention in the ongoing government shutdown, introduce three major barriers that will directly impact our clients:
Work Requirements: A new "community engagement" mandate would require most Medicaid recipients to prove they are working, volunteering, or in school for at least 80 hours per month. While exemptions exist for those with substance use disorders or other qualifying disabilities, the administrative burden of proving this can be overwhelming for someone living on the streets. We know firsthand that finding stable housing and addressing addiction are full-time jobs in themselves. This requirement could become a trap, causing many to lose coverage not because they are unwilling, but because they are unable to navigate the bureaucracy.
Reduced Federal Funding: A key element of the current legislative fight is a significant cut to the enhanced federal matching rate (the Federal Medical Assistance Percentage, or FMAP) for states that expanded Medicaid. This reduction will put a severe strain on state budgets, including Pennsylvania's. This could lead to a ripple effect, potentially forcing the state to scale back on services, cut provider payment rates, or tighten eligibility rules. The very services that our clients rely on—from detox and rehab to medication-assisted treatment (MAT)—could be the first to feel the pinch.
Annual Re-enrollment: The move to a mandatory annual re-enrollment process is another critical challenge. For individuals without a permanent address or consistent access to a phone or computer, receiving and responding to official mail can be impossible. This simple administrative change threatens to create a massive wave of unintentional disenrollment, leaving people without a safety net when they need it most.
A Coordinated Response Is Our Only Path Forward
This isn't just about policy; it's about the lives we touch every day. The people we serve on the streets of Kensington and beyond—who are already facing unimaginable obstacles—are the ones who will be hit hardest. Their ability to access life-saving medical care, including addiction treatment, is at risk.
What can we do?
Educate and Empower Our Clients: We must become navigators for our clients, helping them understand these new rules and guiding them through the complex process of proving their eligibility or securing an exemption. This means making our outreach materials accessible and our conversations clear.
Advocate on Their Behalf: We must use our collective voice to advocate for our clients. This means working with policymakers at the local and state levels to streamline the exemption process and secure funding for crucial services. It also means raising awareness about how the current political standoff in Washington directly threatens the well-being of our community.
Strengthen Our Network: This is the time for even greater collaboration. We must share resources, best practices, and information with one another. Let's create a unified front that ensures no one falls through the cracks. Reach out to the City of Philadelphia's Office of Homeless Services and other key stakeholders to share our concerns and propose solutions.
We have always been our clients' most powerful advocates. Now, more than ever, they need us to show up with renewed purpose and a plan. This new landscape is challenging, but together, we can meet it head-on.
How to Talk to Our Clients
When you're out on the streets, the last thing someone wants is a confusing lecture about government policy. Here's a simple and empathetic way to approach this conversation with our clients:
Be a Guide, Not a Giver of Bad News: Start with a message of solidarity. "You are not alone. We're here for you." Don't start with the scary parts.
Keep it Simple: Instead of policy jargon, use a direct, clear-eyed approach. Say, "The money for your healthcare, including Medicaid, is at risk because of arguments in Washington, D.C. This is not your fault."
Focus on the Direct Impact: Explain what's at stake in relatable terms, avoiding complex policy language. Here's how you can rephrase the key issues:
Work Requirements: "Some new rules could require you to prove you're working or volunteering for many hours a month. We know that surviving on the streets and fighting addiction is a full-time job. We will help you with the paperwork to get an exemption."
Reduced Funding: "They're talking about cutting the money that pays for programs you rely on, like detox and rehab. We're going to fight to make sure those services are still there for you."
Annual Re-enrollment: "There's a new rule coming that will require you to re-enroll in your healthcare every year. For people without a permanent address, this is a major problem. We will help you keep your information up to date so you don’t lose coverage."
End with Action and Hope: Always finish with a clear next step and a message of hope. "Your health matters more than any political argument. We will continue to be your advocates, and we will not rest until your healthcare is safe. Let's make sure we have your contact info so we can keep you in the loop."
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