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Keywords

Keywords: Affordable Care Act coverage gap; health fair; homeless population; health disparities; Alachua County; Community Based Participatory Research

Abstract

Introduction. In states such as Florida that did not expand Medicaid, a large number of economically disadvantaged individuals do not qualify for subsidies to buy health insurance through the Affordable Care Act (ACA) 2. This leaves the health needs of Florida’s homeless population largely unaddressed. Nearly 48.1% of Alachua County’s homeless population has disabling conditions 16. This confirms a pressing need to understand the homeless population's healthcare needs, knowledge, and barriers in accessing healthcare. Methods. We used a Community-Based Participatory Research model in conducting health fairs and needs assessment surveys, incentivizing participation, and providing education about existing resources. The surveys were conducted at two homeless meal service sites and consisted of 22 questions regarding access to healthcare, utilization, and satisfaction. Health fairs consisted of blood pressure, blood glucose, and mental health screening. Patient participation was encouraged through games, prizes and food. Results. Of the population we surveyed, 100% have income levels below $11,490, therefore all uninsured fall into the ACA coverage gap. Those less than 65 years of age do not qualify for Medicare unless disabled. Some qualify for Medicaid as shown in tables. Fifty-eight percent were uninsured and did not get any treatment for their illnesses. Additionally, 67% had no knowledge of free local healthcare clinics. Discussion/Conclusion. The majority of this population falls into the ACA Coverage Gap, lacks knowledge about free community clinics, and inappropriately uses the ED. Future implications of this research involve advocacy to expand Medicaid in Florida and enroll those who are eligible for health insurance. Vital goals include outreach by free healthcare clinics to make healthcare more accessible, as well as building trust with the community through continued outreach initiatives. A community-Based Participatory Research Model is an effective tool to increasing collaboration among diverse members of the community in order to bring meaningful and positive change to the health of populations.