Health Care

Poor health is both a cause and a result of homelessness. Many people are reduced to homelessness because of poor health, which can rapidly escalate into employment problems, financial difficulties and housing issues.  Over half of personal bankruptcies in the U.S. result from health issues. Homeless persons also suffer from multiple health problems at a much higher rate than the general population due to increased exposure to the elements, disease, violence, unsanitary conditions, malnutrition, stress, and addictive substances. Additionally, conditions that require regular, uninterrupted treatment, such as tuberculosis and HIV/AIDS, are extremely difficult to treat or control among those without adequate housing.

Many homeless people who are ill and need treatment do not receive adequate medical care. Barriers can include a lack of knowledge about where to get treated, lack of access to transportation, and lack of identification. Psychological barriers also exist, such as embarrassment, nervousness about filling out the forms and answering questions properly, and self-consciousness about appearance and hygiene when living on the streets.

Without health care insurance, many homeless people simply cannot pay for health services. As a result, many homeless people utilize hospital emergency rooms as their primary source of health care. Not only is this an ineffective form of care since it provides little continuity, but it is also very expensive for hospitals and the government.

Taking Action

The majority of homeless people do not have health insurance or the ability to pay for needed care. In extreme situations, many turn to emergency rooms despite being costly and inappropriate for ongoing care. Federally funded Health Care for the Homeless (HCH) projects provide primary care without regard to one’s ability to pay, but these health centers reach less than a million out of the three to four million homeless individuals annually who desperately need care. You can get involved by advocating for:

• Medicaid Expansion – Medicaid provides the consistent health coverage needed to prevent and treat the health issues of individuals experiencing homelessness.
• Reliable coverage through Medicaid will improve financial security, stabilize health, and help prevent and reduce homelessness.
• The expansion of Medicaid will improve state budgets and lower health costs with savings on uncompensated care and reduced spending on hospitalization and criminal justice for individuals with severe behavioral health needs.

NCH works to promote the comprehensive and integrated treatment needs of homeless persons within the context of health reform. We support effective implementation of Medicaid expansion for people living in or near poverty.

Publications

• National Health Care for the Homeless Council (NHCHC) -  Homelessness and Health: What’s the Connection?
• National Health Care for the Homeless Council (NHCHC) - Medicaid Expansion Improving Health & Stability, Reducing Costs & Homelessness 
• National Health Care for the Homeless Council (NHCHC) - Study Shows Homelessness Increases Vulnerability to Violence
• United States Conference of Mayors Report on Hunger and Homelessness
• U.S. Department of Housing and Urban Development (HUD) - 2016 Annual Homeless Assessment Report (AHAR) to Congress: Point-in-Time Estimates of Homelessness
• Whitbeck, Les B. - Mental health and Emerging Adulthood among Homeless Young People. Psychology Press

Other Resources

• Library Index - The Health of the Homeless: Substance Abuse
• National Institute of Mental Health - Mental Health Information