Let\u2019s take a closer look.<\/p>\n
What\u2019s the backstory?<\/p>\n
Street medicine programs bring health care straight to people living outside on sidewalks, in riverbeds or under bridges all across California. Physicians typically drive dozens of miles a day and carry backpacks to visit unhoused patients directly in tents, makeshift shelters, vehicles or wherever patients happen to be.<\/p>\n
Here in L.A. County, more than 47,000 people live outdoors \u2014 the region is home to the largest unsheltered population in the country. <\/p>\n
That population faces disproportionate rates <\/a>of chronic disease, mental health disorders and addiction than the overall population. L.A. County\u2019s unhoused residents die at 4.5 times the rate<\/a> of the overall population, according to the public health department. <\/p>\n When USC Street Medicine director Brett Feldman started practicing street medicine in Southern California a decade ago, there were just six teams across the state, he said. <\/p>\n Feldman said it was a \u201cradical fringe movement\u201d at the time. Since then, teams like Feldman\u2019s have been welcomed into the mainstream health care system, and today there are more than 70 programs across the state. Over a dozen are based in L.A. County. <\/p>\n A big shift came in 2022, when California\u2019s Department of Health Care Services issued guidance to Medi-Cal health plans, enabling street medicine providers to be reimbursed and designated as primary care providers for unhoused patients. <\/p>\n The following year, the federal centers for Medicare and Medicaid created a new billing code for street medicine, making it reimbursable under Medicare and Medicaid nationwide.<\/p>\n As the co-founder and director of the University of Southern California\u2019s influential street medicine<\/a> program, Feldman currently oversees six teams who treat about 1,200 patients per year.<\/p>\n But, because state rules for Medicaid managed care health plans require patient care be coordinated through a sole primary care provider, programs like Feldman\u2019s often can\u2019t provide a full-range of care to their unhoused patients.<\/p>\n Katia Cnop of USC Street Medicine approaches a tent of a patient in Los Angeles. <\/p>\n How does insurance coverage for people experiencing homelessness currently work in California?<\/p>\n More than 80% of unhoused Californians have health insurance, according to a 2023 UCSF study<\/a>. The coverage is mostly provided through Medi-Cal, the state\u2019s Medicaid program, which provides free or subsidized health insurance to disabled and low-income people. <\/p>\n Still, studies show<\/a> unhoused Angelenos disproportionately rely on emergency rooms and ambulance transports for basic medical care. <\/p>\n Most members of local Medi-Cal plans, like L.A. Care or Health Net, are invited to choose a primary care provider through a package in the mail. That doctor is then tasked with coordinating all their care within the network. <\/p>\n For those who can\u2019t get mail, a primary care doctor is assigned automatically. The vast majority of unhoused Californians \u2014 more than 90% according to a state legislative analysis<\/a> \u2014 have never visited their primary care doctor or used their insurance benefits. Still, that physician remains the only one who can order them \u201cmedically necessary services<\/a>,\u201d under current Medicaid rules.<\/p>\n Feldman, with USC\u2019s street medicine program, said he encounters patients daily who he\u2019s unable to help. Under the current rules, he can\u2019t order them X-rays, prescribe a wheelchair or make referrals to a specialist.<\/p>\n \u201cWhen I see them on the street, I’m not their assigned primary care provider, and I can’t order basic things for them,\u201d Feldman said. \u201cOnly the person who they’re not seeing can order those things.\u201d<\/p>\n Assembly Bill 543<\/a>, which Feldman helped craft with the bill\u2019s author Assemblymember Mark Gonz\u00e1lez, would change that. Co-authors include Assemblymembers Sade Elhawary, John Harabedian, Celeste Rodriguez, Pilar Schiavo and Matt Haney.<\/p>\n \u201cIt makes it so that regardless of [primary care provider] assignment, we can order what they need based on their medical necessity,\u201d Feldman said.<\/p>\n The bill passed unanimously through the state Assembly this summer. It\u2019s now scheduled for a state Senate appropriation committee hearing on Aug. 29.<\/p>\n Assemblymember Mark Gonz\u00e1lez, center, at a press conference in Los Angeles with Mayor Karen Bass and a Congressional delegation on June 13, 2025. <\/p>\n (<\/p>\n Courtesy Assemblymember Mark Gonz\u00e1lez<\/p>\n )<\/p>\n Why do advocates say reforms are needed?<\/p>\n Medi-Cal managed care health insurance plans, funded by state taxpayers, get paid at a per-patient per-month rate. That money is paid out regardless of whether patients use the coverage. <\/p>\n The system works for most people on Medi-Cal, Feldman said \u2014 patients typically stay away from the doctor when they\u2019re feeling well, keeping costs down. But without reliable access to phones or transportation, unhoused patients struggle to make and keep medical appointments. <\/p>\n There\u2019s a huge gap between the insurance benefits unhoused patients are eligible for and the benefits they\u2019re actually able to use, according to a 2023 street medicine landscape report<\/a> authored by Feldman. <\/p>\n \u201cThere are certain groups, insurance groups, who are creating so many different barriers to being preventative,\u201d said Gonz\u00e1lez, the state lawmaker who authored the bill. \u201cYou cannot do that if your goal here is to heal people.\u201d <\/p>\n Some Medi-Cal health insurance plans acknowledge the challenges, including L.A. Care, the nation\u2019s largest publicly operated health plan with more than 2 million members. <\/p>\n \u201cWe recognize it as a problem,\u201d said Charlie Robinson, senior director of the community health department at L.A. Care. \u201cIt\u2019s a very normal circumstance for most members — you need to go to your PCP first and then they can refer you. But it doesn’t fit well with this population.\u201d<\/p>\n L.A. Care covers about 70% of unhoused people in L.A. County on Medi-Cal, the agency estimates. <\/p>\n The health plan says it has found another workaround to the problem, launching its own \u201cfield medicine\u201d pilot<\/a> last year. That effort partners with street medicine programs and allows those practitioners to become primary care providers within L.A. Care\u2019s network. <\/p>\n Still, the agency is \u201cconceptually aligned\u201d with AB 543, Robinson told LAist.<\/p>\n Yelipsa Madera (L) Michael Gallagos (M) and Brett Feldman (R) are part of the Keck School of Medicine of USC’s Street Medicine teams.<\/p>\n (<\/p>\n Robert Garrova \/ LAist <\/p>\n )<\/p>\n How much would the new legislation cost taxpayers?<\/p>\n The California Department of Finance is opposing the street medicine bill, citing cost concerns. The state agency, which advises Gov. Gavin Newsom\u2019s office on fiscal policy, wrote in a recent analysis<\/a> that AB 543 would cost the state tens of millions of dollars each year in new spending that hasn\u2019t been approved through the state\u2019s budget process. <\/p>\n \u201cEfforts to expand the scope of Medi-CAL should be considered as part of the annual budget process,\u201d the agency wrote, arguing against new legislation. <\/p>\n The bill, if approved, would also require new coordination between providers and street medics and new tracking numbers. <\/p>\n The state\u2019s finance department noted that Newsom vetoed similar street medicine legislation in 2021 after it passed unanimously through the California Legislature. <\/p>\n Gonz\u00e1lez argues the proposed legislation is proactive and cheaper than unhoused people visiting emergency rooms.<\/p>\n \u201cThis is the first line of defense,\u201d Gonz\u00e1lez said. \u201cStreet medicine is preventative so that we don’t clog up those resources.\u201d <\/p>\n For now, street medicine providers say they are absorbing a lot of the costs of doing things that insurance plans are already being paid to do, but aren\u2019t.<\/p>\n![\"A](\"https:\/\/scpr.brightspotcdn.com\/dims4\/default\/02057bc\/2147483647\/strip\/true\/crop\/3556x2231+0+0\/resize\/792x497!\/quality\/90\/?url=http%3A%2F%2Fscpr-brightspot.s3.us-west-2.amazonaws.com%2F28%2F7c%2F5ccb425b4eb8bc55fa6078e1e812%2Fstreet-medicine-tent-aiko.jpg\")
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