Is ‘Street Medicine’ the Next Frontier for Cities Addressing Drug, Homelessness Crisis?

Beginning October 1, doctors can be reimbursed for providing medical care to homeless patients in the streets courtesy of American taxpayers.

Spencer Platt/Getty Images
Philadelphia's Kensington neighborhood, seen here on July 19, 2021, is plagued by rampant drug abuse. Spencer Platt/Getty Images

Medical caretakers will now be eligible for reimbursement for practicing “street medicine,” after a Medicaid expansion goes into effect Sunday. 

The change, authorized in June by the Centers for Medicare and Medicaid Services — will allow healthcare providers — including physicians, nurse practitioners, midwives, and psychologists — to provide care outside of the office, as doctors increasingly look for ways to treat drug addiction and expand medical and mental healthcare to homeless people.

The new CMS defines a “non-permanent location on the street” where “where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals” as a place of service under Medicaid.

While doctors and cities across the country run more than 100 street medicine programs, Pennsylvania helped lead the charge to change Medicaid when it became the third state to recognize street medicine this summer, following California and Hawaii.

The state is home to Philadelphia’s Kensington Avenue — the epicenter of the xylazine crisis, which, as The New York Sun has reported, the federal government calls “the deadliest drug threat our country has ever faced.” Xylazine, an animal tranquilizer that is frequently mixed with illicit drugs without the user’s knowledge, causes severe skin wounds that can lead to amputation if untreated.

The new program is likely to raise questions about the future of Medicaid and legal abilities to use public funding for healthcare for the homeless, as well as spark conversation about what can be done on the street-level to treat drug addiction and other health issues plaguing cities like Philadelphia.  

Although doctors can already volunteer their services outside of clinics, Pennsylvania’s Department of Human Services says it hopes “allowing providers to bill for services” will help “improve health outcomes” and increase care for homeless Medicaid recipients. 

“People experiencing homelessness can have complex needs and face many barriers to health care, but meeting people where they are can make a difference,” department secretary, Val Arkoosh, said. “By creating a path for Medicaid to cover street medicine, we are making it easier for health care providers to offer the care they need and deserve.” 

By meeting patients where they are to prevent and treat disease, Dr. Arkoosh said, those individuals become better prepared to take steps towards stability, and hopefully, housing. 

More doctors and nurses are being educated about addiction, which is a vital part of street medicine, a physician’s assistant who treats patients in Philadelphia, Baltimore, and Washington, D.C. affected drug addiction, Jonathan Cohen, tells the Sun. Mr. Cohen has volunteered street medicine services such as wound care to individuals living in tents on Kensington Avenue prior to the Medicaid change.

“I’ve seen addiction in every role that I’ve been — I’ve worked in surgery, emergency medicine, addiction medicine, I spent eight years in Iraq and Afghanistan, I saw it there, it is everywhere,” he tells the Sun. “We need more specialists that want to do those types of things like going out into the street or working in treatment centers or doing addiction care in the emergency department.”

Many of the patients Mr. Cohen sees have severe skin wounds from xyalzine, which he says are often very treatable with medical wound care. 

The change may mark a new era in public health and how doctors are able to treat patients outside office walls. It also may bring challenges about the scope and definition of healthcare that can be provided on the streets.

Street medicine is about “reducing any power dynamic,” a physician’s assistant who practices street medicine in New Mexico, Lindsay Fox, said. A patient may need lots of medical services, but may more urgently need “food, safety, water, shelter,” Ms. Fox said. “As a medical provider, I have to be understanding of that. If a burrito will make the situation better, then that’s better than any pill I might prescribe.”

The New York Sun

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