The Health of the Homeless - Health Care For The Homeless

In 1987 Congress passed the Stewart B. McKinney Homeless Assistance Act (PL 100-77) to provide services to the homeless, including job training, emergency shelter, education, and health care. Title VI of the Act funds Health Care for the Homeless (HCH) programs. HCH has become the national umbrella under which most homeless health-care initiatives operate. In 1994 there were 119 HCH programs in the United States; by 2005, 172 programs provided health care to about 600,000 people each year. In the year 2000 the government appropriated $88 million for HCH programs, almost double the $46 million appropriation of 1987, the first year of the program. The president's proposed FY 2006 budget included approximately $175 million for HCH programs.

Nonprofit private organizations and public entities, including state and local government agencies, may apply for grants from the program. The grants may be used to continue to provide services for up to one year to individuals who have obtained permanent housing if services were provided to them when they were homeless.

The goal of the HCH program is to improve health status for homeless individuals and families by improving access to primary health care and substance abuse services. HCH provides outreach, counseling to clients explaining available services, case management, and linkages to services such as mental health treatment, housing, benefits, and other critical supports. Access to around-the-clock emergency services is available, as well

TABLE 7.4
Profile of clients served by Health Care for the Homeless programs, 2003
SOURCE: Adapted from data provided by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 2005, http://bphc.hrsa.gov/hchirc/about/prog_successes.htm (accessed March 31, 2005)

Characteristic	Percent
Male	59.0
Female	41.0
Age 0-14	11.0
Age 15-19	4.0
Age 20-44	53.0
Age 45-64	28.0
Age 65	2.0
African American	37.0
White	35.0
Hispanic	19.0
Asian/Pacific Islander	2.0
Native American/Alaskan Native	2.0
Lived in shelter	43.0
Lived on the street	11.0
No medical insurance	71.0
Enrolled in Medicaid	22.0
Enrolled in Medicare	3.0
Private insurance	2.0
Other public insurance	3.0
Living at or below poverty level	92.0

as help in establishing eligibility for assistance and obtaining services under entitlement programs.

Table 7.4 shows characteristics of people treated in HCH centers in 2003. The majority of clients (59%) were male. Almost two-thirds (60%) of homeless clients were members of minority groups: African-Americans made up 37%; Hispanics, 19%; Asians/Pacific Islanders, 2%; and Native Americans/Alaskan natives, 2%.

Clients between the ages of twenty and forty-four represented the largest portion of people served by the HCH programs (53%), followed by individuals between the ages of forty-five and sixty-four (28%), children up to age fourteen (11%), and teenagers between the ages of fifteen and nineteen (4%). Homeless persons over sixty-five comprised 2% of clients served.

Of clients seen in HCH centers, 43% lived in shelters at some point during treatment, while 11% lived on the street. The remainder lived in transitional housing, with family or acquaintances, or in some other type of temporary living arrangement. The majority (71%) of HCH users had no medical care coverage. Of those who had some type of insurance, 22% were enrolled in Medicaid, 3% were enrolled in Medicare, 2% had private insurance, and 3% had some other type of insurance.