LOS ANGELES — A new bill, recently introduced to the California Assembly, hopes to shorten the distance between people experiencing homelessness and their doctors by helping the doctors come to them.

The Street Medicine Act, otherwise known as Assembly Bill 369, was proposed by Los Angeles-area State Sen. Sydney Kamlager on February 2.

What You Need To Know

  • California Assembly Bill 369, proposed by State Sen. Sydney Kamlager, would make it easier for practitioners of street medicine to treat unhoused patients

  • Street medicine practitioners are health care providers who go to where their unhoused patients are and offer primary care services

  • The bill proposed by Kamlager would create mechanisms for providers to bill Medi-Cal, while easing restrictions on who unhoused patients can be treated by

  • Kamlager believes that, by expanding preventive primary care to the streets, people experiencing homelessness will be less likely to visit hospitals and emergency rooms

Kamlager recently won the March 2 Special Election to represent Senate District 30. Previously, she represented the 54th Assembly District. Her move to the California Legislature’s upper house, she said, should have no significant effects on the bill’s path through the legislature.

Street medicine is a practice that takes care of people — especially those who are unhoused — where they are on the streets, on the sidewalks, in underpasses, wherever. It means that a person who might not be able to find transportation to see their general practitioner can still get primary care.

“Out in the streets, on the streets — literally, on asphalt. I’ve worked on some dirt roads,” said Dr. Mary Marsifee, Program Director of UCLA’s Student Run Homeless Clinic. “We see chronic disease patients, like a diabetic who is out of their meds, or someone with sky-high blood pressure, dental disorders, respiratory infections — everything.”

This bill hopes to meet the needs of people experiencing homelessness by removing existing barriers toward entering the health care system, such as a lack of transportation, a mailing address, or a state-issued ID or driver’s license.

“There are over 150,000 people experiencing homelessness in California — nearly 60,000 of them are in L.A. County alone — who have little to no access to health care due to their circumstances,” Kamlager said. “We know that mainstream health care models are not filling the complex needs of this population, one of our most vulnerable populations, and a fix is really needed.”

Generally speaking, people experiencing homelessness suffer significantly worse health outcomes than the general population, and as such, are 10 times more likely to die than people who are housed. Chronic health issues, which may be easier to treat among people in the general population, can escalate quickly among the unhoused.

AB 369 aims to solve this by streamlining the financial issues involved in homeless health care. As it stands now, health care providers can’t bill Medi-Cal (California’s health care financial assistance program) for work on the street.

The bill would create a payment mechanism that would require the state to issue Medi-Cal reimbursements to providers working in street medicine. 

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And doctors need to bill, if only to break even on costs, Marsifee said. So, for Kamlager, this bill would allow the government to take on the cost burden of street medicine — just as it’s done with Covered California, with the Affordable Care Act, and with Medi-Cal.

It would also require the State Department of Health Care Services to create a program giving unhoused people full-scope Medi-Cal benefits; and it would ease restrictions that limit unhoused Medi-Cal recipients  to only seeing an assigned primary care provider.

“The primary care provider they’re assigned to, that’s their doctor — they’re the only one who can really bill for their primary care services,” Marsifee said. “But also, even if the primary care provider went out on the streets, they still couldn’t bill for their services — they have to have a brick and mortar facility.”

So, with those requirements pushed aside, street medicine providers would be able to meet their patients where they are, and have an actual way to bill for them.

As for the cost to the state and its citizens, Kamlager said that the bill encourages the state to apply for federal waivers and additional funding sources. She added that, ideally, costs would go down as Medi-Cal-paid preventive health care on the streets would keep unhoused people from needing lengthy, expensive hospital stays — which would be paid for by Medi-Cal anyway.

Dr. Susan Partovi, medical director for Homeless Health Care Los Angeles, said that the bill looked promising on her first read.

“It’s addressing something that we were aware of 13, 14, 15 years ago. When we first started doing street medicine, we were like well, we can’t bill for this, we’ll have to do it out of our own pockets,” Partovi said.

However, Dr. Partovi said she feels that in many cases, federal Medicaid expansion has eased the burden on federally-qualified health care providers.

Her wish list consists largely of housing: emergency housing, temporary supportive housing, and psychiatric care, leading the way toward permanent housing.

Kamlager acknowledged that this bill is a connective link that eases cost burdens and that more must happen.

“We have to stamp out the stigma of what housing looks like while we address this crisis, and still provide them access to regular, ongoing health care,” Kamlager said.