People experiencing homelessness in California face high rates of chronic illness and disability, and numerous barriers to care. Nearly half of adults experiencing homelessness rate their health as poor or fair—about four times the rate in the general U.S. population. These health challenges make it harder for people to obtain and retain housing, and homelessness worsens health, trapping people in a vicious cycle.
As the homeless population ages, these burdens deepen, with profound implications for individuals, communities, and the systems that serve them. California’s homelessness crisis is a public health crisis, demanding coordinated responses across housing, healthcare, and social service systems.
This report, based on the California Statewide Study of People Experiencing Homelessness (CASPEH), examines the connection between poor health and homelessness, the barriers people face in accessing care, and evidence-based recommendations for policymakers, healthcare leaders, public health agencies, Continuum of Care leaders, and social service systems.
Key Findings
- Poor health is pervasive: Nearly half (45%) of adults experiencing homelessness rated their health as poor or fair—four times higher than the general population.
- Chronic disease is common: Six in ten (60%) reported at least one chronic condition, and more than one in four (28%) reported two or more. Hypertension (30%), chronic lung disease (25%), and heart disease or stroke (15%) were most frequent.
- Tobacco use is common and contributes to poor health: Seven in ten (70%) adults experiencing homelessness smoke—six times the national rate.
- Physical limitations are widespread: Over one-third (34%) of adults reported difficulty with at least one daily activity (ADL) such as bathing, dressing, or eating. Among adults aged 50 and older, nearly half (43%) had at least one ADL limitation.
- Access to care is limited despite insurance: While most (83%) had health insurance—primarily Medi-Cal—only half (52%) had a regular place for care and fewer than four in ten (39%) had a primary care provider.
- High rates of acute care use: More than one-third (37%) visited an emergency department in the past six months without being admitted, and one in five (21%) were hospitalized.
Key Recommendations
- Expand and stabilize Medicaid coverage for people experiencing homelessness.
- Scale street medicine and shelter-based care models that deliver primary and urgent care in non-traditional settings.
- Enhance medical respite programs for people discharged from hospitals without stable housing.
- Create accessible, supportive housing designed for people with disabilities and chronic disease.
- Invest in culturally and linguistically responsive care to build trust and equity across diverse communities.
We thank the California Health Care Foundation (CHCF) for supporting this work