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Health Care for the Homeless Program

 October 2005

What is the National Coalition for the Homeless (NCH) seeking?

NCH urges Congress to reauthorize and appropriate funds for the Health Care for the Homeless (HCH) program, a primary and related health services program targeted to people experiencing homelessness. NCH is urging Congress to reauthorize HCH at a $172 million level for a multi-year period and to adopt statutory amendments to strengthen the program. In addition, NCH is seeking at least $172 million in FY 2006 for the HCH program as part of an overall $2.0 billion appropriation for the Consolidated Health Center account.

What is the HCH program?

The HCH program (authorized in Section 330(h) of the Public Health Service Act [PHSA]) makes grants to community-based organizations in order to assist them in planning and delivering high-quality, accessible health care to people experiencing homelessness.

What is the history of the HCH program?

The first federal response to the crisis of homelessness was the passage of the Stewart B. McKinney Homeless Assistance Act of 1987. Recognizing that people experiencing homelessness lacked access to health care and that the mainstream health care safety net system was not responding to these unmet needs, Congress included in the McKinney Act a health program specifically for them—Health Care for the Homeless. This federal program extended the success of an earlier Robert Wood Johnson/Pew Memorial Trust activity, which demonstrated that health care services specifically targeted to people experiencing homelessness could dramatically improve access to care for this vulnerable population.

Congress reauthorized the HCH program in 1996 via the Health Centers Consolidation Act. That law consolidated community health centers, migrant health centers, health centers for residents in public housing, and HCH projects under a single, five-year authorization, but retained each of the four programs as a distinct activity.
Who administers the HCH program?

The HCH program is administered by the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services (HHS). The program is located within HRSA’s Bureau of Primary Health Care (BPHC), Division of Programs for Special Populations (DPSP), Health Care for the Homeless Branch.

How does the HCH program work?

The HCH program is a competitive grant program. Under this mechanism, organizations seeking federal funds to provide primary health and addiction services to people experiencing homelessness submit an application to HRSA. Applications are reviewed by an independent expert panel consisting of HRSA staff and outside experts. The applicant must:

  • describe the target population;
  • demonstrate the target population’s health services need;
  • outline a plan to provide the health services required by law; and,
  • agree to a number of requirements that are a condition for receiving funds.

What are the requirements that HCH projects must meet as a condition for receiving federal HCH funds?

As a condition for receiving federal HCH funds, the grantee must assure that it will:

  • establish a governance body that include significant participation from consumers of the health services offered by the project, including people who are experiencing or who have experienced homelessness;
  • make the statutorily-required primary health services available and accessible promptly, as appropriate, and in a manner which assures continuity;
  • establish and maintain relationships with other health care providers;
  • develop an ongoing relationship with at least one hospital;
  • have an arrangement with the State Medicaid agency to be reimbursed for health services provided to Medicaid beneficiaries;
  • make every reasonable effort to collect appropriate reimbursement for health services provided to persons entitled to public or private health insurance;
  • establish a schedule of fees or payments for the provision of services and a schedule of discounts based on a participant’s ability to pay;
  • have an ongoing quality improvement system;
  • use accounting procedures and other requirements as prescribed by the Secretary;
    develop a plan, budget, and data collection system;
  • conduct an annual financial audit; and
  • make records available to HHS upon request.

Who can receive HCH program funds?

HCH projects are initiated and managed at the community level. Any local public or private, nonprofit entity is eligible to apply for HCH funds, including freestanding nonprofit organizations, community health centers, hospitals, local health departments, shelters, and homeless coalitions. Organizations that receive HCH funds are called "HCH projects" or "grantees."

How many HCH projects are there?

HRSA currently funds 172 HCH projects in all the states, the District of Columbia, and Puerto Rico, along with 300 subcontractors and 70 government and private contractors.

What services do HCH projects provide?

HCH projects are required to provide the following health services:

  • basic health services related to family medicine, internal medicine, pediatrics, obstetrics, and gynecology;
  • diagnostic laboratory and radiologic services;
  • preventive health services, including prenatal and perinatal screening; screening for breast and cervical cancer; well child services; immunizations against vaccine-preventable diseases;
  • screenings for elevated blood lead levels, communicable diseases, and cholesterol; pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care; voluntary family planning services; and preventive dental services;
  • emergency medical services;
  • pharmaceutical services;
  • addiction services;
  • referrals to providers of medical services and other health-related services;
  • patient case management services (including counseling, referral and follow-up) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
  • services that enable individuals to use the services of the health center (including outreach, transportation, and translation); and
  • education of patients and the general population served by the health center regarding the availability and proper use of health services

Where and how are HCH project services provided?

Service delivery sites vary by project, but typically include fixed-site health clinics, homeless shelters and soup kitchens, mobile medical units, and street outreach teams. Services are provided either directly, by contract with another organization, or by referral to another organization.

Who is eligible to receive services from an HCH project?

HCH projects are required to use their HCH funds to serve homeless people, who are defined in the law as "an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations and an individual who is a resident in transitional housing."

How many people does the HCH program serve?

In 2004, 172 grantees provided service to well over 600,000 homeless people per year at hundreds of accessible locations in 50 states, the district of Columbia, and the Commonwealth of Puerto Rico.

59 percent of participants were male; 41 percent were female.

 53 percent were ages 20-44 years; 28 percent were ages 45-64; 11 percent were ages 0-14; 4 percent were ages 15-19; and people 65 and over made up 2 percent. 

More than 85 percent had no financial resources. 71 percent had no medical care resources. 22 percent were Medicaid eligible.

How much federal funding does the HCH program receive?

Congress appropriates funds annually for the HCH program. HCH funds are included in a single appropriation for the consolidated health center account. The HHS Secretary is then authorized to distribute appropriated amounts among the HCH and three other health center programs. HHS currently directs 8.6 percent of the total health center appropriation to the HCH program, in keeping with the allocation decision made by Congress for the first year of authorization.

In Fiscal Year 2004 (which runs from October 1, 2003 through September 30, 2004), Congress appropriated $1.37 million for HCH programs.

For further information, contact Michael Stoops, NCH Acting Executive Director, at 202/462-4822, x.19 or at mstoops@nationalhomeless.org