Guide to health care for unhoused people

By SingleCare Team | Sep. 21, 2022 Medically reviewed by Karen Berger, Pharm.D.

Federal data shows that 1.5 million people experience housing insecurity every year, but the actual numbers may be much higher than that. Unhoused people often experience poorer health outcomes than the general population; however, the reasons are varied and not always resolved simply by better health care.

Still, finding access to affordable, quality care and supportive services can make a difference. Housing insecurity itself can initially be caused by failing health or a significant injury that disrupts employment. Health care, for this reason, is a good step to getting unhoused people into a secure situation. Here are the resources available to make positive health steps in the complicated circumstances that often accompany housing insecurity.

Who is considered unhoused?

The National Health Care for the Homeless Council (NHCHC)—with the support of the Health Resources and Services Administration (HRSA)—outlines that housing insecurity can be many different things:

Living in a car
Staying in a shelter or hotel
Sleeping in encampments or abandoned buildings
Living in transitional housing

Others may be considered unhoused, according to Health and Human Services (HHS), while not always defined as such by Housing and Urban Development (HUD). These include people leaving incarceration or treatment facilities with no solid housing plans upon their exit, as well as those in supportive housing where treatment services are offered. It can even include those who “couch surf” or live with friends or relatives when they can, with no plan for permanent housing in the near future.

Knowing who is unhoused and who may be close to it can help identify those most at-risk for health problems, as well as connect them to the resources designed for their unique needs. Many programs available through HHS offer emergency services to those who may be looking at losing their home very soon, due to eviction or a change in home ownership. Knowing what resources are available, even if they aren’t needed now, can eliminate some uncertainty, and provide those without safe housing some form of continuation of care for existing health problems—as well as maintain a preventative course of care for future issues.

Trends in health care for unhoused people

It’s probably not surprising to hear that the housing insecure have a higher risk of health issues than the general population. According to the NHCHC, “Health outcomes are a reflection of housing status, ability to access care, availability of safe food and water, mental and social health status, environmental factors, and community support.”

The relationship between housing insecurity and health care

Not only is housing insecurity often caused by a series of uncontrollable negative events such as declining health, it can keep unhoused people from gaining ground in their efforts to find a suitable place to live. Poor health, medical issues, and serious mental illness are significant causes of sustained housing insecurity, and it can be harder to regain physical and mental health without a home.

Unhoused people experience higher incidences of common health problems including diabetes (18% vs. 9% for the housed population), HIV (20% vs. 1%), and depression (49% vs. 8%). Housing insecurity adds additional stressors and can create new problems from the lack of privacy and safety to adverse weather conditions to a lack of access to nutritious and filling meals.

Navigating health care as an unhoused person

Whether someone is newly unhoused or has been struggling with stable housing for some time, it’s best not to put off forming a plan for getting ongoing health services. There are many options available, but not all are available in all areas. The choices will be determined by the state they live in and the nearby community resources.

Fortunately, the solutions available are similar across the country.

For the not-yet-unhoused

If someone is expecting to be unhoused, it’s vital to get help before the housing displacement occurs. HUD can provide resources for keeping people in their homes as long as possible with knowledge of both federal and local programs available:

For those who still have a place to live, looking into resources now may prevent housing insecurity or shorten the time without adequate housing and support services.

Many of these resources are also available to the currently unhoused. See individual program details for more information.

Healthcare plans for unhoused people

While there isn’t any health insurance coverage specific to unhoused people, many existing programs, including public health programs, are designed to ensure no one goes without access to quality health services and ongoing support. Currently, Medicare, Medicaid, and related programs also provide free services and partnerships with organizations to help improve overall health outcomes. These services may include screenings, transportation, or support groups not maintained by the healthcare plan specifically.

Medicaid

The Affordable Care Act (ACA) expanded Medicaid in many states to include adults making at or below 138% of the federal poverty level. This number typically includes many unhoused adults. Medicaid offers a broader range of services than some private health plans and Original Medicare. It may pay for dental care, eyeglasses, and hearing devices in addition to mental health and substance abuse programs. While the federal healthcare marketplace will direct those who qualify to apply for Medicaid, this is done at the state level. Contacting a local HHS office in person or online is the best way to take the first step in finding out if someone qualifies.

Children’s Health Insurance Program (CHIP)

For infants, children, and teenagers under age 19 who don’t have qualifying coverage elsewhere, the CHIP program offers another option for healthcare coverage. It is funded through the federal and state governments, and as with Medicaid, administered at the state level. When a family applies for health coverage on the marketplace, they may be referred to their state HHS office to apply for CHIP.

CHIP can fill in the gaps for families who make too much money to qualify for Medicaid but don’t make enough to afford private health insurance. According to Medicaid.gov, “The upper eligibility levels in separate CHIPs range from as low as 170 percent of the federal poverty level (FPL) up to 400 percent of the FPL, and vary by state.”

Depending on the state, some pregnant women may qualify for healthcare coverage through this program as well, and be covered for a short time after giving birth to their baby.

Medicare

For unhoused adults ages 65 and older as well as some younger adults with qualifying health conditions, Medicare could be another option. While the enrollment process can be a bit more difficult for unhoused people to initiate, coverage may range from free to low-cost for the most basic care including hospitalization coverage.

It is important that unhoused adults enroll in the Medicare program as early as possible to get the best access to low-cost coverage. Since there is a premium for many covered services, however, this isn’t always an option. It is possible to have both Medicaid and Medicare coverage at the same time, with Medicaid covering costs that aren’t covered by Medicare and leaving the insured with little, if any, out-of-pocket costs.

Medicare Advantage, which covers a wider variety of services than Original Medicare, could be eyed as a possibility for covering more unhoused adults in the future; although system-wide changes would need to take place for it to be an effective option for people who don’t have Medicaid as a backup.

Community programs and services for unhoused people

While emergency rooms have earned a reputation for being the place people go when they can’t find health care elsewhere, they are a poor substitute for regular, ongoing care for both preventative and illness or injury treatment. Unhoused people have a higher rate of illness than the general population and die, on average, 12 years earlier. This statistic highlights how important it is to give unhoused people steady medical care that helps with acute issues, encourages long-term lifestyle changes that will help them extend their life, and have a better quality of life.

Shelter-based clinics

For those who have access to a local unhoused shelter, there may be more services offered than a warm meal and a place to shower. In fact, many shelters have their own small, private clinics that serve those staying at the shelter, providing everything from simple first aid treatment to help for drug abuse and infectious diseases. They may also prescribe and arrange for the refill of life-saving meds like those for high blood pressure and COPD.

Shelter-based clinics often coordinate ongoing care plans with an outside primary care clinic or physician group, so that the residents of the shelter can have a continuation of care if they move out of the shelter and seek care on their own.

Not all shelters provide healthcare services on-site, but those that do can reduce emergency room visits and urgent care needs significantly within the unhoused population living there.

Find a shelter near you here, then inquire about what on-site health services they may offer.

Community health centers

Community health centers offer free or low-cost health services to all qualifying community members including unhoused people. Services vary by location with some contracting with specialists to focus on a specific population in aging or pediatric care, and others offering more specialty services like nutrition counseling or reproductive care. Many clinics offer language translation services to serve the broader community, and transportation and ongoing health education.

Because community health centers are federally funded, they are also called Federally Qualified Health Centers (FQHCs). These small clinics serve over 29 million people and over 1.2 million unhoused patients and generate $24 billion in healthcare savings. They can often catch problems before they result in visits to the emergency room or hospital, with the cost of care at a community health clinic between 11% and 69% cheaper than what it costs to go to the ER.

Search by location or name for the center near you.

More resources for unhoused people

While many in the unhoused people demographic share the same challenges, some groups are more at-risk or could benefit from solutions designed with them in mind.

Resources for unhoused veterans

Veterans are more likely to experience housing insecurity than other groups, and special resource pages have been set up to direct veterans to those solutions most appropriate for their needs. These include:

HUD – The federal agency has a list of resources specifically for veterans who are experiencing housing insecurity.
Veterans Crisis Line – A 24/7 online chat may assist veterans looking for help.
Department of Labor – The Veterans’ Employment and Training Service (VETS) gives a list of programs for getting skills, finding work, and keeping employment—which can all help with overcoming housing insecurity.

Resources for unhoused LGBTQ

According to HUD, the LGBTQ community is more likely to become unhoused and stay unhoused than their peers, with youth at a higher risk. Currently, 20% to 40% of unhoused youth identify as a member of the LGBTQ community.

Resources:

Resources for unhoused women and families

Women experience higher rates of housing insecurity, domestic violence, and abuse. They may be looking for a shelter that only houses other women, or they may need Well Woman checks that handle female-specific reproductive issues. Womenshelters.org has a national list of shelters for women. Help for domestic abuse of any gender can be accessed here.

Resources for unhoused children and teens

Homeless youth can access resources through their parents with programs like CHIP and Medicaid offering free and low-cost healthcare coverage. In addition, teens who are at risk of violence in the home or who consider themselves runaways can access the National Runaway Safeline website or call 1-800-Runaway for answers to questions and resources near them. Safe Place offers a listing of areas where youth can find help across the country.

Resources for rural communities

Many of the groups, clinics, and shelters in the U.S. are located in urban areas where they can reach the most unhoused people at once. This leaves rural unhoused people with few resources near them and long drives to get the help they need. Many of the services available, including transportation to their nearest shelter or clinic, are organized through National Community Action Partnerships. The NCAP website, while not an exhaustive list, does include groups by state that can put unhoused people in touch with community leaders and nonprofit organizations.

Resources for Spanish-speaking adults

Not everyone seeking resources is fluent in English. This list of resources for Spanish-speaking unhoused people provides some good places to seek help.

Resources for pet owners

Unhoused people are like everyone else when it comes to the love of their pets. Not having a place to live means they often give up ownership of a cat or dog, or that pet goes without food or health care when they need it most. Pets of homeless people is a website listing pet-friendly shelters, as well as places to get animal wellness checks and care when needed.