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New Medicaid policy boosts 'street medicine' in PA

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Monday, July 1, 2024   

Philadelphia is addressing its opioid crisis by deploying mobile medical units to provide Medicaid-funded "street medicine" to the unhoused population.

This initiative was made possible by a recent Pennsylvania policy change, allowing the city to bill Medicaid for outreach site medicine.

Maire St. Ledger, family nurse practitioner from Project HOME's Epstein Street Medicine program, said the opioid epidemic has significantly increased homelessness in Philadelphia, and its mobile units aim to offer both essential care and dignity to unhoused people.

"There are a number of organizations that are providing medical care to people who are unhoused," said St. Ledger. "But we're the only team that we know of providing primary care. So, there are a lot of people that will go out with vans who will do point-of-care testing for HIV, for example. There's another van that just does wound care, but we do all of that."

St. Ledger highlighted the program's significant impact on participants -- aiming to improve medical outcomes, build trust, and enhance access to health-care and support services with holistic, trauma-informed and harm-reduction care.

She noted a few years ago, MPOX spread rapidly, but collaboration with the local health department and community partners helped prevent further spread through vaccination.

St. Ledger said they rely heavily on their outreach teams to build relationships with the participants, which helps the mobile unit assist people by providing them with resources.

"They try to engage with patients or with people who were unhoused," said St. Ledger. "It might just be, in the beginning, bringing them some water, bringing them clean socks or a blanket - building those relationships, getting them referred to housing, to shelters, to detox, to rehab, whatever it might be."

Dr. Judy Chertok is a Family Medicine and Addiction Medicine Physician and Associate Professor at the University
of Pennsylvania collaborating with Prevention Point Philadelphia on the Overdose Surge Response Bus, launched in the summer of 2020.

Using city data to identify overdose hotspots, the team deploys its mobile unit to provide crucial resources to the hardest-hit communities.

"We collaboratively work to do some canvassing and provide lots of harm-reduction supplies, Narcan," said Chertok, "and then, for people that are interested, they can meet with the doctor and do same day starts of medication like Buprenorphine for addiction."

Chertok said a new survey on the Mobile Overdose Response Program examines several aspects, including the general demographics of the first 237 patients.


It also analyzes housing rates, substance-use severity, and assessed for predictors of engagement and care after using the mobile unit.

"So the unit sees people for a few weeks, and then links them to ongoing care," said Chertok. "And so we try to look to see if there are any facilitators of what help someone get from this mobile space into ongoing care and stay on medication."

Support for this reporting was provided by The Pew Charitable Trusts.




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