Health Care for the Homeless: How Black Adults Get Care Now

You can see a doctor, a dentist, a therapist, and an addiction counselor, and get help enrolling in Medicaid, without insurance, without a fixed address, and without a photo ID in your pocket. The federal Health Care for the Homeless program funds clinics that saw 1,583,165 patients experiencing homelessness in 2025, and the regulation that governs them says no person shall be denied service for inability to pay. On a single night in January 2024, 771,480 people were experiencing homelessness in the United States, the highest count HUD has recorded, and 32 percent of them identified as Black. This guide is the door.

Health Care for the Homeless (HCH) is section 330(h) of the Public Health Service Act, the law that funds community health centers. A center that takes 330(h) money agrees to serve "a special medically underserved population comprised of homeless individuals," a definition that covers anyone who lacks housing, including people in an emergency shelter or transitional housing. The clinic may keep treating you for up to 12 months after you move into permanent housing.

The statute lists what every health center must provide: primary care (family medicine, internal medicine, pediatrics, obstetrics, gynecology); lab and x-ray; preventive care including prenatal visits, immunizations, screenings, and preventive dental; emergency services; pharmacy; referrals to specialists and to mental health and substance use care; case management, including help "establishing eligibility for and gaining access to" Medicaid and housing programs; outreach and transportation; and patient education. HRSA's compliance manual adds that a center funded under 330(h) "must, in addition to these required primary health services, provide substance use disorder services": detoxification, outpatient and residential treatment, and rehabilitation.

Fees follow income. The regulation for health center grants requires each one to "operate in a manner such that no person shall be denied service by reason of his inability to pay," and HRSA says a health center must "serve everyone, even if they cannot pay." If you have no income, say so; the fee is zero. Our guide to community health centers explains the scale.

Three routes, all free:

1. HRSA's Find a Health Center tool (findahealthcenter.hrsa.gov). Enter a ZIP code or city. Every result is bound by the no-denial rule; many hold 330(h) funding or run a site inside a shelter. Our own community health center finder lists more than 14,000 of these sites by city.
2. The National Health Care for the Homeless Council's HCH Grantee Directory (nhchc.org/grantee-directory), "a starting point to finding health care resources for people experiencing homelessness." Click your state for every federally funded HCH project.
3. 211. Dial 2-1-1 from any phone. United Way runs it, every call is confidential, and one call covers health care, shelter, and housing help.

When you call or walk in, say it plainly: "I am experiencing homelessness and I need to be seen. I do not have insurance." Then ask: Does your sliding fee go to zero? Can a case manager help me apply for Medicaid today? Do you have a street medicine or outreach team? Bring whatever you have, but do not stay away because you have nothing.

Federal Medicaid rules were written with this situation in mind. Under 42 CFR 435.403, your state of residence is the state where you live and intend to reside, "including without a fixed address," and a state may not deny Medicaid "because an individual has not resided in the State for a specified period." You do not need a lease, a utility bill, or a minimum length of stay.

The application still asks for an address, because the state has to mail you a decision and a card. CMS's guidance for enrollment assisters (version 2.0, June 2025) says you can list "an address of a shelter, friend, or relative within the state" or a P.O. box. Ask the shelter, a drop-in center, or the clinic's case manager whether you can receive mail there.

Identity without an ID card. Federal rules list what a state must accept as proof of identity, and the list ends with a backstop: "the agency must accept an affidavit signed, under penalty of perjury, by a person other than the applicant who can reasonably attest to the applicant's identity." It does not have to be notarized. If citizenship or immigration status cannot be verified right away, 42 CFR 435.956 requires a "reasonable opportunity period" of up to 90 days during which the state "may not delay, deny, reduce or terminate benefits" for an otherwise eligible person. The clinic's case manager is required by statute to help you through this. One limit: in a state that has not expanded Medicaid, an adult without dependent children or a disability may not qualify. If you lost Medicaid at renewal because the mail never reached you, our guide to Medicaid renewal shows how to get it back.

Two services exist because a hospital discharge to a sidewalk is a discharge to nowhere. Medical respite care, in the words of the National Institute for Medical Respite Care, is "acute and post-acute care for people experiencing homelessness who are not ill enough to remain in a hospital but are too ill to recover on the streets": a bed, meals, and nursing follow-up after surgery, an infection, a wound, or a pregnancy complication. The institute keeps a national directory at nimrc.org. In a hospital, ask the discharge planner for a respite referral before discharge, and ask again if the first answer is no.

Street medicine is care delivered where unsheltered people are. The Street Medicine Institute describes it as "the direct provision of health care to the unsheltered homeless where they live" and has helped build programs in more than 140 cities. Many HCH clinics run street or mobile teams; ask for one by name. A team can check blood pressure, dress a wound, refill medication, test for HIV and hepatitis C, and get you a respite bed or an appointment.

The gap is measured. In a representative survey of 3,200 adults experiencing homelessness in California (October 2021 to November 2022), 39.1 percent had used no outpatient care in the prior year and 38.9 percent had used an emergency department in the prior six months. Going without outpatient care was 71 percent more common among people who were unsheltered and less common among people with insurance.

Any Medicare-participating hospital with an emergency department is bound by EMTALA. CMS summarizes the duty: the hospital must provide a medical screening examination when you ask for care "regardless of an individual's ability to pay" and must stabilize an emergency medical condition, including active labor. The bill is a separate fight. A nonprofit hospital must have a written financial assistance policy under section 501(r)(4) of the tax code; ask for it by name. Our guide to hospital charity care walks through the application, and urgent care versus the ER explains when the cheaper door is the right one.

HUD's 2024 Annual Homelessness Assessment Report, published December 2024, counted 771,480 people experiencing homelessness on a single night in January 2024, "the highest ever recorded." In HUD's words, people who identify as Black "made up just 12 percent of the total U.S. population and 21 percent of the U.S. population living in poverty but were 32 percent of all people experiencing homelessness." Among people in families with children, about 38 percent identified as Black. In the nationally representative Health and Retirement Study, 16.8 percent of Black baby boomers reported a period of homelessness in their lives.

Homelessness is itself a health condition. A 2014 review in The Lancet found higher rates of premature death, especially from suicide and unintentional injury, and an increased prevalence of infectious disease, mental disorders, and substance use disorders. In a cohort of 28,033 adults seen at Boston Health Care for the Homeless Program from 2003 through 2008, the leading causes of death were drug overdose, cancer, and heart disease, and overdose caused one-third of deaths under age 45. None of that is written into the person. It is what happens when the system offers an emergency room and nothing before it.

1. Today: dial 211 or search findahealthcenter.hrsa.gov and ask for the Health Care for the Homeless clinic. Any health center in the results is bound by the same no-denial rule.
2. At the first visit: ask for a case manager and start the Medicaid application the same day, with a mailing address and a phone number that will still work next month. Leave with the outreach team's contact and a refill plan.
3. If you are hospitalized: ask for medical respite before discharge and for the financial assistance application before the bill arrives.
4. Once enrolled: choose a regular clinician. Our directory lets you find a Black primary care clinician by state and city; ask whether the practice accepts Medicaid.
5. Veterans: call 877-424-3838. The VA runs its own homeless health and housing programs.