Health Care

Stable housing and supportive services are critical to help people experiencing homelessness move toward recovery.

Homelessness and health concerns often go hand in hand. An acute behavioral health issue, such as an episode of psychosis, may lead to homelessness, and homelessness itself can exacerbate chronic medical conditions or lead to debilitating substance abuse problems. At the most extreme, a person can become chronically homeless when his or her health condition becomes disabling and stable housing is too difficult to maintain without help.

People living in shelters are more than twice as likely to have a disability, according to the Department of Housing and Urban Development. On a given night in 2012, nearly 40 percent of the homeless population had serious mental illness or conditions related to chronic substance abuse. Thousands of people with HIV/AIDS experience homelessness on a given night. Half of veterans in shelters are disabled.

Medical conditions such as diabetes and heart disease are also found at high rates among the homeless population, in addition to injury and physical ailments from living outdoors. Many people experiencing homelessness have also experienced trauma, either resulting from homelessness or in some way leading to it. Behavioral health issues and trauma are found disproportionately among unaccompanied youth who are homeless.

Treatment and preventive care can be difficult for homeless people to access, because they often lack insurance coverage, or are unable to engage health care providers in the community. This lack of access can lead a homeless individual to seek medical care only once his or her condition has worsened to the point that a trip to the emergency room is unavoidable.

The extent of health conditions and disability should be considered when designing effective, efficient strategies to end homelessness. For chronically homeless people, permanent supportive housing provides stable housing coupled with supportive services as needed – a cost-effective solution to homelessness for those with the most severe health, mental health, and substance abuse challenges.

Spotlight

Library Resources

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Federal Policy Brief | November 9, 2012
This policy brief discusses how Medicaid health homes can help improve the behavioral and physical outcomes for vulnerable people experiencing homelessness and lead to positive housing outcomes.The brief explains the Medicaid health home benefit under the Affordable Care Act, and reviews models that have already been approved by the U.S. Department of Health and Human Services.
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Solutions Brief | March 25, 2011
Clearly health care reform creates opportunities to improve assistance to chronically homeless people. Those concerned to combine housing and services should get involved early to ensure that the interests of people they care about are protected.
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Report | December 3, 2009
This is an issue brief presenting the ways state mental health agencies can work cooperatively with community members and lawmakers to prevent and end homelessness for those afflicted with severe mental illness. Key strategies are examined in this brief, as well as case studies of states that have successfully implemented some of these strategies.
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Video | August 31, 2009
Peggy Bailey, program and policy analyst at the National Alliance to End Homelessness, explains how health care fits into discussions about homelessness, and outlines the Alliance's priorities in the health care reform debate.
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Other | April 29, 2009
Click here for additional resources on how mental health and substance use issues affect homelessness. Materials include "Chronic Homelessness," "Christian Community Health Center in Chicago, Illinois: Providing Supportive Housing and Health Care," and "Amethyst Inc. in Columbus, Ohio: Helping Addicted Women to Gain and Maintain Sobriety."
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Other | April 29, 2009
Click here to access additional resources related to health care and Medicaid. Materials include "New Targeted Case Management Rule and Homelessness," "Medicaid Coverage for Rehabilitation Services," "Medicaid Proof of Citizenship," and "Protecting Health Care for the Homeless Programs."
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Fact Sheets | August 10, 2006
This fact sheet examines issues facing homeless people who have HIV/AIDS.