New measure of personal reporting to the Croatian Health Insurance Fund in order to retain the right to health insurance additionally aggravates position of the homeless
The Civil Rights Project Sisak (hereinafter: CRP Sisak) has been dealing with the issue of homelessness and has been assisting the homeless in exercising their rights by providing free legal assistance for many years. When it comes to homelessness, registration of residence of homeless persons has turned out to be one of the main issues that needs to be regulated promptly as registered residence is a prerequisite for the realization of a number of rights, including the right to health care.
With this text, we would like to draw attention to another problem that arose with the recent introduction of a measure that require personal reporting to the Croatian Health Insurance Fund (hereinafter: CHIF) in order to retain the status of insured persons. This measure came into effect on 1 April 2023.
Namely, with the adoption of the Law on Amendments to the Law on Compulsory Health Insurance (“Official Gazette”, 33/2023; hereinafter: the Law), certain categories of insured persons of the CHIF are required to report regularly in person to the CHIF. This includes, among other things, insured persons who, on the date of entry into force of the Law, had status of insured persons as persons with residence or approved permanent residence or long-term residence in the Republic of Croatia because they registered with the CHIF within the prescribed period. These persons must, within 90 days from the date of entry into force of the Law, and no later than 29 June 2023, personally approach the nearest CHIF’s branch office in order to verify the circumstances based on which their status was determined. The same obligation remains in force even after the first personal report to the CHIF. The insured persons must report to the CHIF in person once every three months for further regular verification of the circumstances on the basis of which their status was determined, except for the time they are registered with the of the Croatian Employment Bureau as unemployed persons.
If insured persons do not personally access the CHIF within the prescribed deadline (no later than 29 June 2023, and then once every three months), the CHIF will deregister them from the compulsory health insurance ex officio without issuing a decision.
The question arises, how does this measure affect the homeless? As stated in the introduction, the condition for entry into the compulsory health insurance system implemented by the CHIF in accordance with the Law on Compulsory Health Insurance is regulated civil status in the Republic of Croatia, i.e. is registered residence or permanent residence in the case of a foreigner. The legislator tried to protect the homeless by prescribing that it is possible to determine the address of a social welfare institution or at other accommodation service providers as the residence for those who do not have a place and address of residence or funds with which he/she could satisfy the need for housing. With this, only the small number of homeless people is protected as practice shows that the homeless often give up from registration. The is mainly so due to the fact that the procedure for registering residence is long and demanding, the homeless have difficulties to obtain required extensive documentation due to their poor economic situation and the social welfare centres themselves often delay the processing of the application requests.
Because of this, and due to the fact that the procedure must be repeated in case of moving to another place under the competency of other social welfare institution, homeless people often give up on registration. The measure of personal reporting therefore only applies to homeless people who are registered at the addresses of social welfare institutions or at other accommodation service providers. However, these people are often not available or use electronic means of communication, so they do not even have the opportunity to familiarize themselves with the obligation to report in person, which leads to the risk of losing the right to health insurance.
When it comes to the problem of the right to health insurance for the homeless, it is important to emphasize that a homeless person cannot acquire the status of an insured person in the mandatory health insurance or obtain health care at the expense of the CHIF’s funds without registered residence or permanent residence,. Exceptionally, in accordance with Article 15 of the Law on Compulsory Health Insurance persons with residence or approved permanent residence in the Republic of Croatia who are incapable of independent living and work and do not have the means to support themselves have the right to compulsory health insurance as insured persons based on the decision issued by the competent administrative body of the county, that is, the City of Zagreb if they cannot exercise their right to compulsory health insurance on other grounds. But how realistic is it that the homeless will actually realize such a right? The obligation to report to the administrative authorities of the counties often presupposes a lengthy process for which sick people have neither the strength nor the will, so the vast majority of homeless people unfortunately remain invisible to the system.
Given that the homeless represent specific vulnerable category of citizens, it is necessary to approach the issue of the homeless in more affirmative way and provide them with the right to health care regardless of their regulated residence. To this end, in its 2021 report, the Ombudsman recommended to the Ministry of Health to prepare a proposal for amendments to the regulations on mandatory health insurance and health care, based on which the homeless will have the right to free health care regardless of their regulated residence. CRP Sisak supports this recommendation and advocates that the issue of health care for the homeless is addressed adequately in order to additionally protect this category of citizens and facilitate the procedure for their registration of residence through Amendments to Art. 6 of the Residence Act.