Public Health Care for Homeless People: Access, Barriers, and Strategies for Comprehensive Care

Key Takeaways

• Homeless people face significant barriers in attempting to access healthcare, including lack of insurance, difficulties with transportation, and social stigma within medical environments.

• Between 2020 and 2024, policy developments including the expansion of Medicaid coverage, increased availability of telehealth services, and community-based care have attempted to bridge the gap in unhoused populations’ ability to access care.

• The COVID-19 pandemic highlighted the urgent need for improved healthcare access for the homeless, leading to temporary policy shifts that could influence long-term change.

• New models such as street medicine, mobile clinics, and Housing First approaches show promising results in providing comprehensive care.

The Crisis of Healthcare for the Unhoused

Homelessness has long been one of the most pressing public health challenges facing the United States. The U.S. Department of Housing and Urban Development (HUD), counted 653,104 people experiencing homelessness on a single night in 2023, the highest number since the organization’s Point-in-Time count began in 2007.¹

Homeless people face a number of barriers to access healthcare, from financial and systemic obstacles to logistical and psychological challenges. Without stable housing, individuals often struggle to maintain consistent medical treatment, resulting in increased emergency room visits, worsening chronic conditions, and higher mortality rates within the homeless population. 

Between 2020 and 2024 policymakers, healthcare providers, and advocates have worked to increase healthcare access for the homeless. These efforts may point the way towards societal improvement in the health outcomes of homeless people in 2025 and beyond.

Although homeless individuals may seek to access care, they experience a range of obstacles that limit their ability to receive it. These include: 

Lack of Health Insurance and Affordability

Although the Affordable Care Act (ACA)’s expansion of Medicaid coverage has helped some low-income individuals gain coverage, many homeless people still remain uninsured for a variety of reasons, including administrative hurdles, a lack of identification documents, or eligibility restrictions. In addition, worries about the affordability of copayments or medication costs often deter homeless individuals from seeking necessary care, even when they qualify for public health benefits.

Transportation and Geographic Challenges

Although some have access to cars, many homeless individuals rely on public transportation. This is an issue since these systems are often unreliable or unavailable, particularly in rural or suburban areas, making transit to far flung medical offices a significant hurdle for homeless people seeking care. Even if they do manage to get to a medical office, their distance to healthcare facilities and a lack of stable mailing addresses may also prevent homeless individuals from scheduling or attending follow-up appointments.

Stigma and Discrimination in Healthcare Settings

Multiple indicate that homeless individuals frequently encounter bias within the healthcare system. A study from the National Institute of Health (NIH) found that the majority of homeless people surveyed had experienced discrimination and mistreatment from healthcare professionals, discouraging them from seeking medical attention when they needed it in the future.²  Because of this fear of mistreatment, emergency departments often serve as primary care providers for the homeless, which leads to fragmented care and inadequate chronic disease management.

Mental Health and Substance Use Disorders

According to one study, 76.2% of homeless people suffer from mental health disorders, while another found that 66% of homeless people surveyed said that the stress of homelessness exacerbated their existing mental health conditions.^3,4 Despite these elevated numbers, access to mental health care remains difficult for most homeless people. This is especially true since addiction services, including harm reduction programs and medication-assisted treatment programs aimed at homeless people, are underfunded despite their effectiveness in reducing homelessness-related mortality.

Over the past four years, there have been significant shifts in public health policy and healthcare delivery for homeless populations. Key developments include:

Medicaid Expansion and Policy Adjustments

In 2021, The American Rescue Plan Act increased Medicaid funding to states, which allowed for expanded healthcare access for low-income and homeless individuals. Some states used this funding to introduce Medicaid "street medicine" waivers, which enabled mobile healthcare teams to bill Medicaid for the on-site treatment of homeless patients, increasing access to care.⁵

The COVID-19 Pandemic’s Impact on Homeless Healthcare

During the COVID-19 pandemic, emergency federal funding allowed for expanded telehealth services, vaccine distribution, and temporary housing for unhoused individuals. Cities including San Francisco and New York piloted the use of hotel-based medical respite programs, which provided safe recovery spaces for homeless individuals affected by COVID-19 and other medical issues.

Expansion of Street Medicine and Mobile Health Clinics

Over the past few years, the use of street medicine teams, which bring healthcare directly to encampments and shelters where homeless people live, have gained traction in cities nationwide. Federally Qualified Health Centers (FQHCs) have expanded these mobile street medicine units to reach unsheltered individuals, where they are tasked with providing primary care, vaccinations, and wound treatment, in addition to other medical services.

Housing First Initiatives and Integrated Care Models

The use of Housing First programs, which prioritize getting homeless people into stable housing situations before addressing their medical and mental health needs, have shown positive outcomes in reducing healthcare costs and use of emergency department services, fewer hospitalizations, and less time hospitalized.⁶ In addition to Housing First programs, collaborative care models, which integrate medical, behavioral, and social services, have gained federal funding through the Department of Health and Human Services (HHS) and HUD.

In 2025 and beyond, there are multiple key trends and policy shifts that are expected to shape public health care for homeless populations:

Greater Integration of Healthcare and Housing Policies

Due to the success of existing Housing First policies, federal and state governments are increasingly recognizing that stable housing is an essential first step in connecting homeless people with effective healthcare. Proposed legislation aims to expand permanent supportive housing initiatives that link healthcare services with housing assistance.

Growth of Technology in Homeless Healthcare

Telehealth technologies enabling remote visits to doctors and other healthcare providers  continue to be utilized for mental health counseling and medical consultations. While initially expanded during the COVID-19 pandemic, these services are critical for homeless people who may struggle to find transportation to medical appointments. 

Strengthening Harm Reduction and Behavioral Health Services

More cities are adopting harm reduction strategies to manage the needs of their homeless populations. These include the creation of safer supervised injection sites, as well as expanded access to naloxone for opioid overdose prevention. Additionally, an increasing number of federal grants are aimed at supporting integrated behavioral health and addiction treatment centers for unhoused populations.

Increasing access to healthcare for homeless people is a critical public health challenge that requires a multi-faceted approach. While there have been promising developments in recent years, systemic barriers remain that continue to make it difficult for this population to access the healthcare they desperately need. A continued focus on policy innovation, funding increases, and community-based care models will be essential to closing healthcare gaps for homeless individuals as we continue to address this critical issue.

By creating policies aimed at both the immediate healthcare needs and the root causes of homelessness, the United States can build a more sustainable and inclusive healthcare system that ensures every individual—regardless of housing status—has access to the medical care they need.