Healthcare for the Homeless Risks

Homeless Healthcare Risks

Despite increasing costs, demands, and declining reimbursement rates, some practices are still focus on serving the poor and homeless. As part of an overall contribution to the health of the community, this decision though rewarding, comes with some risks.

Community Clinics

Due to this population’s unique needs and traditionally poor access to healthcare, services are provided in the context of Community Clinics of Federally Qualified Healthcare Clinics (FQHC’s). FQHC’s are licensed differently than private practices and receive a somewhat higher reimbursement rate due to the complex and chronic healthcare concerns these practices address. Typically professional liability insurance coverage is modified to respond to the unique needs of these clinics.


In response to accessibility issues, The Health Care for the Homeless (HCH) Program started in 1985. With all the national attention focused on the “repeal and replacement efforts,” interestingly enough, the Health Care for the Homeless President, Kevin Lindamood said that before Obamacare, only 30 percent of the patients they saw had health insurance. The group provides health care to people without homes as well as others who are in transition to more settled lives. “Now [it’s] 90 percent of our clients, from 30 percent insured to 90 percent insured, either through Medicaid or Medicare,” he said. “That’s a transformation.”


Homeless advocates argue that better health coverage eventually reduces costly ER visits. In the same way, coverage helps keep people off the streets, dealing with chronic problems, such as mental health issues. Respite care programs for qualified homeless individuals leaving an acute care stay serve as an impactful solution in both Monterey County, California, as well as in about 70 locations across the US. However, they need additional recuperation time, to get well and find housing. Remarkably, reducing ER visits and hospital stays are consistent with these programs at about a 67%.

Healthcare for the Homeless Risks


Although rewarding for many, and the pros may outweighing the cons, there are unique risks associated with community clinics. The Federal Tort Claims Act (FTCA) provides medical malpractice protection for FTCA covered entities, providing covered activities following an annual approval (deeming) process.  Gaps in FTCA protection are created when you don’t meet the definition of covered entity OR what constitutes covered activities. Serving this populations opens up opportunities for exposures that are not covered by the government. Ask yourself if the FTCA provides the protection and peace of mind you need for your clinic, providers, volunteers, board members, officers and patients?

Consider the following scenarios:

  • Is there a written contract in place between your covered entity and every individual contracted provider?
  • Do you have independent contractors working less than an average of at least 32.5 hours per week?
  • Are there any contracts between your covered entity and individual providers professional corporations?
  • Do you have any employees not receiving a salary on a regular basis?
  • Could there be any alternate billing arrangements which would fall outside of the FTCA requirements?

If any of these scenarios apply to your organization, we can assist in bridging the FTCA gap with a simple, affordable solution.

For more information, give us a call directly at 1-800-317-6411 or email us at 

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