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Gun Violence Is a Plague. Could Medicaid Help?
The Health 202

Gun Violence Is a Plague. Could Medicaid Help?

To tackle America’s gun problem, a growing number of states are allowing Medicaid dollars to fund community-based violence programs intended to stop shootings. The idea is to boost resources for violence prevention programs, which have been overwhelmed in some cities by a spike in violent crime since the covid-19 pandemic. 

An infusion of reliable funding, their advocates say, could allow these nonprofits to expand their reach to more residents most at risk of being shot — or of shooting someone. That’s the plan in Chicago, where Arne Duncan, the former U.S. education secretary, leads the violence prevention group Chicago CRED.

  • We’re trying to build a public health infrastructure to combat gun violence,” Duncan told me. “Having Medicaid start to be a player in this space and create those opportunities could be a game changer.”

In 2020, many cities around the country confronted a rise in shootings and homicides after officials responding to the pandemic shut down schools, businesses and critical social services. That same year, police murdered George Floyd, a Black man in Minneapolis, sparking nationwide protests and calls to cut police funding. Americans, already armed to the hilt, rushed to buy more guns.

While the pandemic has receded, gun violence has surged in some cities. Gun ownership is at a historic high in the United States, which is estimated to have more guns than people. Programs that worked a few years ago in places like Oakland, Calif. — which had won acclaim for slashing its gun violence —  can’t keep up.

Gun violence also brings a hefty price tag. Studies from the Government Accountability Office and Harvard Medical School have shown that the cost of caring for gunshot survivors ranges from $1 billion in initial treatments to $2.5 billion over 12 months. And it’s not only gunshot victims who need medical help. 

“The patients that we see, there’s a lot of grief. Parents losing their children, grandparents losing their grandchildren. That impacts people’s health tremendously,” said Noha Aboelata, founding CEO of Roots Community Health Center in Oakland. “Entire neighborhoods have ongoing stress and trauma.” 

Exactly how taxpayer dollars should be spent is up for debate, as I discovered in Oakland. Although there’s a growing call to spend money on violence prevention programs, some believe the answer is more police. 

With gun-control legislation stalled in Congress, the Biden administration has opened up federal Medicaid dollars to violence prevention. President Biden announced the novel approach in April 2021, and now the money is starting to flow to interested states.

“These are concrete things that we can do that avoid the debates around the Second Amendment,” said Kyle Fischer, policy and advocacy director for The Health Alliance for Violence Intervention, which lobbied for the policy change.

But the process to unlock the funding has been lengthy, and it’s unclear how much money will ultimately be spent on these programs. Because Medicaid is a state-federal program intended to provide health care for low-income residents, states must also approve spending the money on violence prevention. So far, only California, Colorado, Connecticut, Illinois, Maryland, New York and Oregon have passed laws, Fischer said.

In Illinois, which two years ago became one of the first states to approve Medicaid reimbursement for violence prevention, Chicago CRED hopes to get approval for its program next spring.

Despite the long and often bureaucratic process, Medicaid dollars are incredibly attractive for community organizations that have historically relied on philanthropic donations and grants, which can vary year to year.  

“Medicaid is reliable,” Fischer said. “If you’re doing the work, you’re qualified for it, and you are taking care of patients. You get reimbursed for the work that you do.”

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