Resource Center

Join CHCF in Sacramento on Wednesday, March 12, 2025 for a briefing about these supports and their importance for helping people move from homelessness to housing. The briefing will begin with an overview of how homelessness impacts a person’s health by Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF. She will draw from the landmark California Statewide Survey of People Experiencing Homelessness. Following the presentation, Michelle Schneidermann, MD, director of people-centered care at CHCF, will moderate a discussion about the role Medi-Cal is playing in California’s homelessness response and how that role can be strengthened and improved through critical partnerships across the health, homelessness, and housing sectors.

A new UCSF BHHI study challenges misconceptions about drug use among people experiencing homelessness in California. While only 37% of homeless individuals regularly use illicit drugs, lifetime use is high, and 27% began using after losing housing. The study highlights the difficulty of accessing treatment, with only 7% receiving care and 1 in 5 actively seeking help but unable to get it. Margot Kushel, MD, emphasized the complex relationship between drug use and homelessness, stating, “People are telling us that it helps them survive,” she said. “It keeps them awake and alert. They are using it either because they are traumatized, they have been assaulted, they are afraid or depressed, using it as coping to make it all go away.”

A groundbreaking UCSF BHHI study challenges common perceptions about drug use among people experiencing homelessness. Researchers found that less than half of this population regularly used drugs, with methamphetamine being the most common substance, not opioids. Many respondents wanted treatment but struggled to access it, highlighting barriers to care. The study emphasizes that homelessness and substance use are interconnected and advocates for reducing barriers to treatment and prioritizing housing solutions. "We need to reduce barriers to substance use treatment, and that includes prioritizing people’s ability to return to housing,” said BHHI faculty member Ryan Assaf, PhD, MPH, the study’s lead author.

In 2024, for the second year in a row, a record number of people in the U.S. experienced homelessness on a single night, according to the U.S. Department of Housing and Urban Development (HUD). The homelessness crisis is fueled by skyrocketing housing costs, which have put homes out of reach for hundreds of thousands of people. Nearly half of renters spend more than 30 percent of what they make on housing, according to the Census Bureau. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They’re not spending it on food. They’re not spending it on health care. They’re not putting it away for a rainy day."

Rising cost of living, demographic trends have pushed many older South Florida seniors into homelessness. To blame are rising costs, particularly for housing, that outpace many older people’s fixed incomes. Natural disasters, a lack of affordable housing and long-term economic dynamics that have disadvantaged those born between the mid-1950s and the mid-1960s also factor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "What determines the rate of homelessness in a community is its availability or lack of availability of housing for low-income people."

In this op-ed, Trina Johnson PhD, MSc, postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights how the overdose death rates for white people had fallen dramatically by but it isn't the same for Black people. These disparities have been attributed to structural determinants including inadequate access to harm reduction services, as well as a treatment system that is not designed to meet the needs of all communities. "We can create a model for equity and antiracism in addiction treatment that can inform all areas of medicine, so all patients and communities can thrive." Dr. Johnson writes.

The scale of devastation wrought by the deadly wildfires in Pacific Palisades and Altadena has been unimaginable. Entire neighborhoods have been wiped out, homes reduced to smoldering ruins, and acres of hillside consumed by relentless flames. In this episode of Life Examined, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins authors George Bonanno, PhD and Carolyn Korsmeyer, PhD to talk with host Jonathan Bastian about trauma, resilience, and why our homes are integral to who we are . Dr. Kushel said, "You have that physical safety, hopefully, that acceptance for who you are, and you can just be you. And there are very few other places where that is true."

In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, highlights the frequency people experiencing homelessness are exposed to violence. Across the country, people are viewing the presence of people experiencing homelessness on public transportation as a thread, leading efforts to remove individuals sleeping on public transportation. "Throughout literature, sleep has been a metaphor for death. But, in real life, sleep should mean neither death nor arrest. We need to focus on real solutions — increasing housing affordability and the services that allow people to thrive — instead of demonizing tired, frightened people" Dr. Kushel writes.

America’s homeless population swelled to its highest level in recorded history in 2024 according to an annual count of individuals living in emergency shelters, transitional housing or on the streets. California continues to have the largest homeless population of any state — 187,084 in 2024 — and the highest rate of unsheltered people, according to the U.S. Department of Housing and Urban Development’s point-in-time estimate released Friday, December 27, 2024. However, California's increase of 3.1% from 2023 was smaller relative to other states.

Over the past year, Nicole Santa Cruz, and her colleagues Ruth Talbot, Asia Fields, Maya Miller investigated how cities have sometimes ignored their own policies and court orders, which has resulted in them taking homeless people’s belongings during encampment clearings. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, if officials, alongside case managers and health care professionals, worked with unhoused people over weeks, rather than days, before sweeping an encampment to help them get inside, they wouldn’t be separated from their belongings and their possessions wouldn’t need to be stored in warehouses.

Since their introduction in 2009 under President Barack Obama, vulnerability surveys have aimed to assess the eligibility of homeless individuals for housing assistance. However, recent findings suggest that these surveys may inadvertently perpetuate racial disparities, particularly affecting Black homeless populations. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "If you’re a White person, the more likely you are to rank higher than if you’re a Black person, so you’re more likely to get selected for housing."

Vulnerability questionnaires were created to determine how likely a person is to get sick and die while experiencing homelessness, and the system has been widely adopted during the past decade to help prioritize who gets housing. National homelessness experts and local leaders say such personal questions exacerbate racial disparities in the ranks of the nation’s unhoused, particularly as more people experiencing homelessness compete for scarce taxpayer-subsidized housing amid a deepening affordability crisis. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "This whole system was piloted on this older White population in Boston, so it does a poor job of capturing the needs of Black folks, who don’t tend to be as sick as White folks — they’re more broke."

The first safe parking site in Los Angeles County opened up November 2024 in the Crenshaw neighborhood. People living in RV's around LA now have the opportunity to move with their oversized vehicles into a gated secure parking lot on county property. The county will operate the site and all residents must own the RV they're living in. The goal is to move people living at the safe parking site into permanent supportive housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "People were not willing to give up their RV for an option that they knew would in a short period of time leave them worse off than they were currently. "

Body camera footage of pregnant homeless woman puts Kentucky's street camping ban in the spotlight. Kentucky is among several states that passed bans on street camping and it recently got a glimpse of how it works in a video showing police giving a citation to a homeless woman going into labor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "You add the stresses of homelessness, the sleep deprivation, the fear, the shame, the stigma, the lack of access to health care and you really are escalating the risk for the mom."

A growing number of people, many of them older and homeless, are freezing to death during winter. In 2023, 166 Californians died from hypothermia, double the number who died in 2015. People who experience homelessness are particularly susceptible to hypothermia because so many older, vulnerable adults live outside, where they are exposed to the weather. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "A changing climate, more temperature extremes, more soaking rains — people are older and thus unable to even tolerate it, so they get much sicker, faster."