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Geiger Gibson Program in Community Health

Milken Institute School of Public Health

Medicaid Cuts Will Undermine Essential Care for Community Health Center Patients Experiencing Homelessness

July 30, 2025
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Data Note

July 2025

by the Geiger Gibson Program Team

 

Community health centers provide a wide array of primary and preventive  medical and behavioral health care services to people who have difficulty accessing care, reaching one in five uninsured people, one in three people living in poverty, and one in five rural residents in 2023.1 Roughly three hundred of the nation’s nearly 1,400 health centers have dedicated  federal Health Care for the Homeless grant funding through the Health Resources and Services Administration (HRSA). However, virtually all CHCs serve patients experiencing homelessness or who are housing insecure, and in 2023, nearly 5 percent of all health center patients, or 1.4 million people, had experienced homelessness sometime that year.2 People served by CHCs are disproportionately likely to have experienced homelessness. According to the most recently available Point-in-Time estimates conducted by the Department of Housing and Urban Development (HUD) in January 2024, only 0.23 percent of individuals nationally (771,480  of 338,732,767 U.S. residents) experienced homelessness.

Both HUD and health center program estimates suggest that homelessness is increasing. The 2024 HUD estimate represents a record number of people experiencing homelessness, and an 18 percent increase from the previous year. 3The most recently available health center data, from HRSA’s annual Uniform Data System (UDS), suggests that the number of CHC patients experiencing homelessness is rising as well, increasing nearly 7 percent between 2022 and 2023.4

Past research indicates that people experiencing homelessness are likely to have poor health status and are especially likely to experience a range of health problems, including chronic conditions, mental and behavioral health challenges, premature births, infectious diseases, and skin disorders5 that are exacerbated by their lack of housing. Yet the causal relationship between homelessness and health problems is complex, and few studies provide insight into the specific health needs of homeless people due to the difficulty of obtaining detailed data on this population.

While people experiencing homelessness face many barriers to care, a recent study finds that Medicaid is important in helping individuals experiencing homelessness get access to CHC care and services.6 With the passage of HR.1, the One Big Beautiful Bill Act ( OBBBA), the Congressional Budget Office has estimated that 16 to 17 million more people - including vast numbers covered by Medicaid - will become uninsured.7 A recent analysis finds that homeless individuals will be disproportionately affected by Medicaid cuts and likely to lose coverage because they lack a stable address and would have difficulty complying with paperwork requirements and frequent eligibility check.8 Lack of coverage is a known barrier to obtaining services and often leads to forgoing necessary care.9 Beyond deeply limiting access to essential care and services for individuals and families, research suggests that the losses will disrupt the healthcare delivery system and substantially decrease revenue to essential safety-net providers, including community health centers, that rely on Medicaid revenue to support their core operations and services.10 To better understand what is at stake, this data note provides a brief overview of the particular health care needs of community health center patients experiencing homelessness, using data from the HRSA Health Center Patient Survey(2022).

The 2022 Health Center Patient Survey (HCPS) provides a unique opportunity to gain insight into the health needs of community health center patients, including those who are experiencing or who have experienced homelessness.11 Unlike the annual Uniform Data System reports, patients, and not centers, provided responses to this survey. While not available every year, the survey is designed to be nationally representative, and enables a rare national snapshot of patient perspectives on their own health and the services that they receive at community health centers. Highlighted below are key findings related to the prevalence of significant health conditions and needs of patients who identified as being or having been homeless.

Reported Health Conditions

Patients who were experiencing homelessness at the time of the survey were more likely than housed individuals to report ever having asthma, liver disease, depression, schizophrenia, bipolar disorder, or experience using a variety of harmful substances (Table 1). Patients who had ever experienced homelessness were also more likely to report ever having hypertension, weak or failing kidneys, cardiovascular disease, generalized anxiety disorder, or panic disorder. Among the most common conditions, roughly 44 percent of patients who had ever experienced homelessness also reported having had hypertension, and over half of patients currently experiencing homelessness had ever had asthma. More than 60 percent of patients who had ever experienced or who were currently experiencing homelessness reported a history of depression. Though not as common, patients who had ever experienced homelessness were nearly twice as likely to report ever having cardiovascular disease, 2.9 times as likely to report ever having weak or failing kidneys, or 4.8 times as likely to report ever having schizophrenia, relative to patients who had never experienced homelessness.

Health Status and Needs of Homeless Individuals

In examining recent health needs, patients who reported that they were experiencing homelessness at the time of the survey were more likely to report needing medication in the past year, as well as needing mental health care, alcohol treatment, or drug treatment in the past year, relative to patients who had housing (Table 2). Patients who had ever experienced homelessness were also more likely to report having fair or poor health, needing medical or dental care, having an asthma episode, or having pneumonia in the past year, relative to patients who had never experienced homelessness. Both patients who were currently experiencing homelessness and those who had ever experienced homelessness were also more likely to experience a range of social needs relative to those who were not currently or who never had experienced homelessness, including uninsurance, unemployment, a lack of food, and a lack of safety.

Community health centers are the backbone of the nation’s primary care safety net, dedicated to serving under-resourced communities and particularly vulnerable special populations, including those who are homeless. Health centers work to improve access to care and reduce disparities, exceeding Healthcare Effectiveness Data and Information Set (HEDIS) clinical quality benchmarks for key metrics including hypertension and diabetes control while reducing overall costs to the healthcare system.12

As illustrated above, community health center patients who have experienced homelessness are more likely than sheltered people to be in fair or poor health and have a range of chronic health care conditions and needs, both during and after periods of homelessness. Identifying these needs is essential to developing effective engagement strategies and care plans. HCPS survey data also indicate that health center patients who are or have been homeless are more likely to report having Medicaid coverage.13

Community health centers serve all patients regardless of their ability to pay and will continue to do so. But the "One Big Beautiful Bill Act" (OBBBA) recently signed into law will result in one-trillion dollars in cuts to federal Medicaid spending, and reauthorization of the Community Health Center Fund (CHCF), set to expire on September 30, 2025, is uncertain. Both Medicaid and the CHCF are indispensable, and these cuts deeply threaten health center sustainability and their capacity to continue to meet the needs of the most vulnerable communities and populations, including those experiencing homelessness.14 Additionally, individuals experiencing homelessness are the focus of the Administration’s recent Executive Order (EO), "Ending Crime and Disorder on America's Streets."15 While the EO specifically identifies the expectation that health centers will meet the needs of homeless individuals and provide “comprehensive services for individuals with serious mental illness and substance use disorder, including crisis intervention services,” drastic Medicaid cuts undermine health centers’ ability to effectively do so.