Improving health depends on accessing health care services and engaging in appropriate treatment. People experiencing homelessness have higher rates of chronic medical conditions, acute illnesses, and behavioral health issues compared to their housed counterparts, which contributes to poor health and earlier mortality. This population also experiences greater barriers to accessing care because they tend not to have a consistent mailing address, often lack transportation, face stigma and discrimination when accessing care, and must prioritize meeting basic survival needs such as finding food, shelter, and safety on a daily basis. Poor health is a leading cause of homelessness, and the experience of homelessness creates new health problems while worsening current ones. Combined, these factors make it hard to regain housing stability.
One of the most common barriers to accessing health care is a lack of health insurance, which pays for services. Prior to the Affordable Care Act (ACA), people experiencing homelessness were uninsured at high rates because they were not generally eligible for public programs such as Medicaid or Medicare and could not afford private insurance. Health Care for the Homeless (HCH) programs, as part of the larger HRSA-funded health center program, are dedicated to providing comprehensive primary care, behavioral health, and support services to people who are homeless regardless of their insurance status or ability to pay. But absent reimbursements from insurance, these safety net providers are more limited in the care they can offer and in their ability to refer patients to a broader range of needed care, such as hospital and skilled nursing services, more intensive addiction and mental health treatment, and other specialty care.
In 2023, there were 298 HCH programs in 4,455 locations that provided comprehensive primary care, substance use and mental health treatment, and supportive services to 985,226 patients. This fact sheet describes the health insurance mix of those patients and illustrates why the ACA’s Medicaid expansion is critical to meeting the health care needs of an unhoused population.