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                              Protecting Vulnerable Patient Populations from Climate Hazards: A Referral Guide for Health Professionals
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Protecting Vulnerable Patient Populations from Climate Hazards: A Referral Guide for Health Professionals








  
  
    

  
      



This resource is intended to inform education and referrals in clinical settings for patients who are vulnerable to climate change’s health impacts, and can be used by health and human services providers to address climate-related threats to their clients’ well-being.

This guide summarizes resources that can address patients’ social determinants of health and mitigate health harms related to climate change. These resources include social services and assistance programs to which patients can be referred, as well as references for anticipatory guidance and counseling to help patients prepare for potential hazards.
                        **Background**
    Climate change affects the frequency, severity, and distribution of extreme weather events such as heat waves, wildfires, drought, hurricanes, and flooding. Exposure to these events can cause direct harm, exacerbate underlying medical conditions, and affect mental and behavioral health.

Harm from climate-related impacts is unequally distributed due to differences in populations’ exposure, sensitivity, and adaptive capacity.1 Low-income communities and communities of color, for example, are likely to experience disproportionate exposure to poor environmental conditions and climate-related hazards. People with chronic medical conditions, children, pregnant women, and older adults can be physiologically more susceptible to environmental exposures. Systemically marginalized populations have diminished adaptive capacity to respond and recover from exposure to hazards because of limitations in access to resources.

Clinical teams in healthcare settings routinely identify and care for patients with unmet health-related social needs and medical vulnerabilities that put these patients at higher risk from climate-related hazards. They can play a critical role in informing themselves and patients about how to mitigate these risks, and helping them to connect to protective programs and services through referrals and care coordination.

This guide includes resources for patient education, data and tools for providers, and information about federal programs that patients can use. This is not intended to be a fully comprehensive list but rather a practical and targeted set of federal resources for use in clinical settings, relevant to providing focused health protection for vulnerable patients from climate-related hazards.
                        **Referral Resources for Patients***The summer season brings risks of climate-related exposures such as heat and wildfires. The following are federal programs which can provide year-round relief to eligible individuals, and are protective for those at particular risk of health harms from climate-related exposures. These programs increase access to cooling, weatherization, air filtration, and mold remediation, while also reducing the costs of related utility bills (e.g., electricity and water).*
    **LIHEAP******

HHS’ Low-Income Home Energy Assistance Program (LIHEAP) helps keep families safe and healthy through initiatives that assist families with home energy costs. LIHEAP benefits target households with low incomes, particularly those that have a high home energy burden (percentage of income that goes to heating and cooling bills) and/or have members who are elderly, disabled or young children. LIHEAP provides federal funds to reduce the costs associated with home energy bills, energy crises, weatherization, and minor energy-related home repairs. Depending on where households live, LIHEAP may be able to help with summer cooling costs. To find their local LIHEAP office and to access benefits, households should visit energyhelp.us or call the National Energy Assistance Referral hotline at 1-866-674-6327.

**LIHWAP**

HHS’ Low-Income Household Water Assistance Program (LIHWAP) provides funds to assist low-income households with water and wastewater bills. LIHWAP benefits target households with low incomes that have high home water burdens, meaning they pay the greatest proportion of their income towards their home drinking water and/or wastewater services. Households or referring provides should check with their state, territory, or tribe to confirm eligibility rules in their area. To find local offices and access LIHWAP benefits, visit Waterhelp.info.

**Weatherization Assistance Program******

The U.S. Department of Energy's (DOE) Weatherization Assistance Program (WAP) reduces energy costs for low-income households by increasing the energy efficiency of their homes. Under DOE guidelines, households at or below 200% of the poverty income guidelines, or households receiving Supplemental Security Income or Aid to Families with Dependent Children, are considered eligible for weatherization services. (In addition, each state or territory may elect to use the U.S. Department of Health & Human Services (HHS) Low-Income Energy Assistance Program (LIHEAP) criteria of 60% of state-median income.) These steps outline how to apply for WAP services.

**Cooling Centers**

Finding and accessing resources for cooling centers differs at the state and county level. Calling or visiting the website of a state’s 2-1-1 program (a guide to local community services) can connect individuals with resources for extreme heat, including Extreme Heat Cooling Programs. This information is sometimes located at the county or city level. Select local cooling centers may also open temporarily for extreme heat events. Information on these centers can also often be found through local news sources. Find cooling centers by state.

**Medicaid**

Using state plan amendments, demonstrations and other authorities, states have been able to use Medicaid funds to address environmental health concerns, as well as the social determinants of health that have significant influence over how populations experience climate stresses. In some states, Medicaid can provide air conditioning and/or air filters as a medically necessary treatment option for people with certain chronic conditions. For example, the Centers for Medicare & Medicaid Services approved a Medicaid 1115 waiver from the Oregon Health Plan to allow coverage of medically necessary air conditioners when certain requirements are met.

For more information about Medicaid coverage, contact your state’s Medicaid office or directly reach out to your client’s managed care organization.

**Medicare Advantage**

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies. Select Medicare Advantage plans offer supplemental benefits that address the social and environmental factors associated with improved health. Plans can tailor their supplemental benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions, such as air conditioning for enrollees with asthma. Plans may also include installation and servicing of equipment as part of the benefit. Learn more about what Medicare Advantage Plans cover.

**Disaster Supplemental Nutrition Assistance Program (D-SNAP)**

The Disaster Supplemental Nutrition Assistance Program (D-SNAP) gives food assistance to low-income households with food loss or damage caused by a natural disaster. Before operating D-SNAP in a disaster area, a state must receive an Individual Assistance declaration from the President. The state must then request and receive approval from USDA’s Food and Nutrition Service (FNS) to operate a D-SNAP. Households that normally do not qualify for SNAP benefits may qualify for D-SNAP, and SNAP recipients may receive increased benefits under D-SNAP. Learn more about D-SNAP
                        **Planning and Preparedness Information for Patients***These references may be useful sources of information about climate hazards for providers to help inform patients and clients about how to monitor, anticipate, and prepare.*
    **Climate and Health Outlook******

The Climate and Health Outlook is a seasonal forecast from the HHS Office of Climate Change and Health Equity (OCCHE) to inform health professionals and the public on how health may be affected by climate events and seasonal weather changes in the coming months. It also includes resources that providers and patients can use to proactively manage climate-related threats.

**HEAT.gov**

HEAT.gov is the web portal for the interagency National Integrated Heat Health Information System (NIHHIS). This website was launched in 2022 to provide the public and decision-makers with clear, timely and science-based information to understand and reduce the health risks of extreme heat. Heat-related illnesses and death are largely preventable with proper planning, education, and action. Heat.gov serves as the premier source of heat and health information for the nation to reduce the health, economic, and infrastructural impacts of extreme heat.

**Tips for People Who Take Medication: Coping with Hot Weather**

The impacts of climate change, such as hotter weather, may have negative effects on physical and mental health. Those taking certain medications, such as medications to treat mental health conditions (psychotropic medications), are more at risk from heat exposure than people not taking these medications. This resource from the Substance Abuse and Mental Health Services Administration (SAMHSA) offers relevant strategies for addressing such challenges.

**Ready.gov**

Ready is a national public service campaign designed to educate and empower the American people to prepare for, respond to and mitigate emergencies, including natural and man-made disasters. Its pages on Extreme Heat, Floods, Wildfires, and Severe Weather contain helpful information for individuals and families to prepare for and respond to climate-related hazards.

**Climate Change and Extreme Heat: What You Can Do to Prepare**

The U.S. Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC) developed this booklet to identify steps that individuals can take now to prepare for an extreme heat event—and to help families, friends, and neighbors. This booklet answers some of the key questions about extreme heat in a changing climate: why extreme heat is on the rise, how it might affect health, and how to reduce health risk before and during an extreme heat event.
                        **Background Resources and Data for Providers***These links may give providers additional background information and population-level data relevant to climate-related health hazards and planning tools in their area.*
    **Environmental Justice Index**

The Environmental Justice Index (EJI) is a national, place-based tool designed to measure the cumulative impacts of environmental burden through the lens of human health and health equity. It provides community level scores and analysis to help states, providers and public health officials understand where they should focus attention and assistance.

**emPOWER Map**

The HHS emPOWER Map can show where Medicare beneficiaries or those who rely upon electricity-dependent medical and assistive equipment reside.

**Extreme Heat Vulnerability Mapping Tool**

This tool overlays National Oceanic and Atmospheric Administration (NOAA) projected heat events on the CDC's Social Vulnerability Index (SVI) to determine county-level vulnerability. The SVI ranks each county on 15 social factors, including poverty, lack of vehicle access, and crowded housing, and groups them into four related themes.

**Heat & Health Tracker**

The CDC Heat & Health Tracker provides local heat and health information so communities can better prepare for and respond to extreme heat events. Use the tool to explore how extreme heat affects your county, populations who are at risk, and response resources.

**The National Risk Index**

The National Risk Index is a dataset and online tool to help identify the United States communities most at risk for 18 natural hazards. The Risk Index leverages available source data for natural hazard and community risk factors to develop a baseline relative risk measurement for each United States county and Census tract.

**OSHA-NIOSH Heat Safety Tool**

The Occupational Health and Safety Administration (OSHA)/National Institute for Occupational Safety and Health (NIOSH) Heat Safety Tool is a useful resource for planning outdoor work activities based on how hot it feels throughout the day. The tool features real-time location-specific heat index and hourly forecasts, as well as occupational safety and health recommendations from OSHA and NIOSH.

**SAMHSA’s Disaster Technical Assistance Center (DTAC)**

The Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center helps states, U.S. territories, tribes, and local entities deliver an effective mental health and substance use-related response to disasters.

**U.S. Department of Agriculture Rural Development (USDA RD) Disaster Resiliency and Recovery Guide**

USDA RD developed *Disaster Resiliency and Recovery Resources: A Guide for Rural Communities* as a resource for rural communities seeking disaster resiliency and recovery assistance. USDA RD offers programs and servicing options that can help rural residents, businesses, and communities impacted by disaster, and support long-term planning and recovery efforts that build for the future.

In addition to the resources noted here, the landmark Inflation Reduction Act (IRA) makes significant new resources available to healthcare providers and communities to support investments in resilience and renewable infrastructure; we encourage you to monitor the OCCHE website (linked below) to stay up to date on the latest opportunities.
      **Non-Governmental Resources**
    This referral guide focuses on federal programs and resources for use in clinical settings to protect vulnerable patients from climate-related health hazards. There are many additional resources available from a host of additional organizations. For example, the Climate Resilience for Frontline Clinics Toolkit, developed collaboratively by Americares and the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, provides useful resources for health care providers, patients and administrators at free clinics and community health centers to meet climate-related health care challenges. Providers are encouraged to research further information from such organizations, as well as local programs available to patients and clients.
                        About OCCHE:

The Office of Climate Change and Health Equity addresses the impact of climate change on the health of the American people, particularly the most vulnerable individuals and communities. We encourage you to visit the OCCHE website and subscribe to the OCCHE email list.

OCCHE Website

OCCHE Resources to Support Resilience and Emissions Reduction

How to join OCCHE listserv
                        **Case story:** a senior with diabetes and social isolation, at risk from heat exposure and impaired access to medication
    **About La Maestra Community Health Centers**

La Maestra Community Health Centers is a Federally Qualified Health Center, providing primary and specialty services to over 45, 000 patients annually. The La Maestra Circle of Care model integratively addresses social determinants of health in primary and specialty services. La Maestra serves a culturally diverse patient base, speaking over 51 languages and dialects.  Its 17 clinic sites are located in the Central, East, and South regions of San Diego County, all within the International US-Mexico border zone.

**Clinical vignette: Mrs. Rodriguez**

Mrs. Rodriguez is a 79-year-old woman with diabetes. She missed several clinic visits, and had a history of poor medication adherence. She was referred to La Maestra’s in-home care team, who found that Mrs. Rodriguez lived alone and had difficulty leaving her home because she was unable to navigate the pathway and landscaping near her home’s entrance with her broken walker. This caused her to miss her clinic appointments, which prevented her from having her labs drawn, which were required for her medication refills, and which she therefore had been unable to obtain. Her refrigerator was not functioning, so she was storing her insulin and food in an ice chest.  The windows and door of the apartment had missing seals, and she was struggling to pay her utility bills.

La Maestra’s care team connected with Mrs. Rodriguez’s Medicare managed care plan, which provided her with a mini refrigerator and a new, more functional walker. Her care team also referred her, through San Diego Gas & Electric, to HHS’s Low Income Home Energy Assistance Program (LIHEAP) to assist with her cooling costs, and to the Department of Energy’s Weatherization Assistance Program (WAP), through which her windows and doors were sealed.  In addition, her care team helped her to apply for San Diego County’s In Home Supportive Services Program, which provided assistance with housework and grocery shopping.

With the help of these interventions, Mrs. Rodriguez can afford her utility bills, safely store her medications, and use air conditioning on very hot days. She has been able to resume her social activities, attend her church, and exercise. She has also resumed her regular clinic visits, and her diabetes control has improved markedly.

**Discussion:**

Because of her utility insecurity, age, and social isolation, Mrs. Rodriguez was at risk for health harms from extreme heat exposure. She also required access to refrigeration for essential medications, making her additionally vulnerable to utility disruptions. The risk of health harms from these climate-related hazards was reduced by La Maestra’s care team’s interventions to address Mrs. Rodriguez’s unmet health-related social needs, including referrals to LIHEAP, WAP, and Medicare resources for essential equipment.

Additional resources from this referral guide, such as the Climate and Health Outlook and HEAT.gov,  may be useful for Mrs. Rodriguez and her care team, for providing anticipatory guidance and counseling, and for learning about local heat exposure risks.

*To learn more about HRSA health centers and the health center program, visit :**https://bphc.hrsa.gov/about-health-centers**.*

*To find a HRSA health center near you, visit:**https://findahealthcenter.hrsa.gov/*
                        **Case Story:** a patient with Chronic  Obstructive Pulmonary Disease (COPD) and depression, at risk from utility insecurity and housing hazards
    **About Nasson Health Care**

Nasson Health Care is a Federally Qualified Health Center embedded in a Community Action Agency in Southern Maine, serving about 8000 patients annually, and offering primary care, dental, and behavioral health services. All patients are screened for social drivers of health (SDOH) needs, and are connected to a case manager to address their needs.

**Clinical vignette: Mrs. Lee**

Mrs. Lee has chronic obstructive pulmonary disease (COPD) and depression. In a primary care visit, she shared in her routine SDOH screening that she was struggling with her energy bills and housing costs, and she reported dilapidated conditions in her home. Her doctor was concerned about how poor air quality in her home and her utility insecurity may impact her medical conditions, and referred Mrs. Lee to Nasson’s SDOH case worker. The case worker helped Mrs. Lee to connect with HHS’s Low Income Home Energy Assistance Program (LIHEAP). Through LIHEAP, she received assistance with her energy bills, and home weatherization assistance. The energy- and safety-related home repairs for which she was eligible include insulation, window repair, and cleaning and tuning of her heating system. These interventions improved her home’s safety and comfort, including its air quality.

**Discussion:**

Mrs. Lee was at-risk from exposure to extreme weather events and poor air quality as a result of her chronic medical conditions, utility insecurity, and housing hazards. Nasson’s SDOH screening and referral program helped to connect Mrs. Lee with LIHEAP, through which she received assistance to help prevent health harms from these climate-related risks. Southern Maine experiences days of poor outdoor air quality, and Mrs. Lee’s home is now a safer haven for her on those days.

Resources from this guide that could also be useful to Mrs. Lee and her care team might include the Climate & Health Outlook, and SAMHSA’s *Tips for People Who Take Medication: Coping With Hot Weather*. These may be helpful in providing counseling about how psychotropic medications can increase Mrs. Lee’s risk from heat exposure (and how she can protect herself, including information about regional cooling centers).

*To learn more about HRSA health centers and the health center program, visit :**https://bphc.hrsa.gov/about-health-centers**.*

*To find a HRSA health center near you, visit:**https://findahealthcenter.hrsa.gov/*
                        Endnotes

1  EPA. 2021. Climate Change and Social Vulnerability in the United States: A Focus on Six Impacts. U.S. Environmental Protection Agency, EPA 430-R-21-003. www.epa.gov/cira/social-vulnerability-report

                    
  


Content created by Office of the Assistant Secretary for Health (OASH) Content last reviewed May 26, 2023 Back to top
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