Health Care

Housing is a key component of health and health care. Accessing to stable housing and supportive services are critical for the recovery of people experiencing homelessness.

Poor Health and Homelessness

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, compared to the general population. On a given night in 2014, nearly 20 percent of the homeless population had serious mental illness or conditions related to chronic substance abuse, according to the 2014 Point-In-Time Count. Thousands of people with HIV/AIDS experience homelessness on a given night.

Physical and Behavioral Health Issues

Physical health 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.

The Mental Health Parity and Addiction Equity Act of 2008 requires that health insurance plans cover behavioral health treatment such as therapy equally to that of physical health treatments.

Health Care Access

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.

Federally Qualified Health Centers and Health Care for the Homeless Clinics, which are available in most communities across the U.S. provide some basic health services to homeless persons without cost. In addition, the Affordable Care Act (ACA) allows states to expand their Medicaid public health insurance program to cover more people with very low incomes. Previously, Medicaid was limited to covering persons with children or with a disability. The ACA has also increased the number of community-based care options, such as with “Health Homes.”

Health Care Solutions

Housing is a key component of health and health care. Moreover, effective strategies to end homelessness must always take into account the extent of health conditions and disability faced by homeless people.

For chronically homeless people, the intervention of 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. With the advent of the ACA, funding through Medicaid will be a key financing component for the supportive services in permanent supportive housing. 


Library Resources

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.
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.