California is trying to tap federal health care funding to cover rent for homeless people and those at risk of losing their housing. Yet, health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable housing shortage. “We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

In this episode of the Prioritizing Equity series, Dr. Emily Cleveland Manchanda speaks with a panel about health care planning and caring for patients experiencing houselessness. The panel included, Dez Martinez, Denise De Las Nueces, MD, Margot Kushel, MD, Stephen Brown, MSW, and Yinan Lan, MD. Dr. Kushel, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "If you look at the states with the highest percentage of their population experiencing houselessness, those are the states with the lowest level of housing. So, we need to raise our voices and say every place we can that the solution to homelessness is housing."

About two-thirds of those who were kicked off state Medicaid rolls lost it for technical reasons like incorrectly filling out paperwork. In Montana, 120,000 people lost Medicaid as the state re-evaluated everyone's eligibility. Homeless service providers and experts have stated that many unhoused people have lost their Medicaid coverage. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It doesn’t seem like such a big deal to fill out paperwork," but "Put yourself in the position of an elder who’s experiencing homelessness and has lost their vision, who has no access to [a] computer, no access to [a] car, doesn’t have [a] cell phone."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was a guest on KQED Forum discussing the role health care, low wages, and lack of affordable housing play in Oakland’s growing homelessness crisis. Dr. Kushel said, "There is a myth that the homeless population comes from other communities. That simply isn't true. What we see is about 70%-85% of people experiencing homelessness are from that community." She added that shelters are often "large, warehouse-like environments" where risk of COVID-19 transmission can be very high. Although some emergency shelter (preferably non-congregate) is needed, the solution to homelessness is permanent housing.

In this op-ed, Morgan Philbin, PhD, MHS, associate director at the Benioff Homelessness and Housing Initiative and director of the Educations Program, calls for progressive states to become safe havens for LGTBQ+ adolescents. She highlights the various discriminatory policies that have been introduced across the US and how those policies force LGTBQ+ individuals to move, often to more expensive areas. Dr. Philbin writes, "While supportive policies are imperative to counteract the discriminatory legislation enacted nationwide, progressive states must also develop policies and programs to support LGBTQ+ adolescents who are being forced to move there to access healthcare and maintain their physical and mental wellbeing." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Since the US Supreme Court ruled in the case of City of Grants Pass v. Johnson in June 2024, there has been an increase in the number of encampment sweeps. After the ruling, Governor Newsom of California issued an executive order directing state and local officials to dismantle homeless encampments. Street medicine services have never been more important as they provide lifesaving services by resupplying vital medication or medical supplies, hospitalizing patients with severe mental or physical health conditions, and finding medical respite care facilities. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "It is very straightforwardly the case that displacement costs more than a lot of other strategies that we could use."

Unhoused patients have worse surgical outcomes than the general population, resulting in premature mortality. Researchers conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease. The researchers identified 5 themes, including, but not limited to: patients and clinicians face multiple challenges meeting preoperative requirements; although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions; clinicians perceive that unhoused patients have negative postoperative experiences in the hospital.

In this op-ed, DeForrest (DeDe) Hancock, a UCSF Benioff Homeless Housing Initiative Lived Expertise Advisory Board member, tells her story about experiencing homelessness. She writes, [when] “I was homeless, 2009 to 2016, I came to believe that we are all ordinary people simply each living out the scripts of our lives. Some of our scripts include life-challenges which provide lived experience to build the expertise and skills for survival.”

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness. Researchers aimed to understand the relationship between race and the experience of homelessness for older adults. They developed a theoretical model of the way experiences with overt and structural racism may lead to and perpetuate homelessness for older Black adults. Researchers recommend that efforts aimed at ending homelessness target the effects of structural racism with polices.

As of January 2024, Californian landlords accepting Section 8 vouchers or other housing subsidies may not use credit reports when screening tenant applications. This policy reform will greatly benefit people who have experienced intimate partner violence. The financial instability can cascade into all parts of survivors lives. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, “There are only so many places you can hide when you are vulnerable.”

Angelenos exiting the carceral system often fall into homelessness due to barriers to housing and employment. In this episode of HOMELAND, a 10-episode series that brings clarity to the homelessness crisis, host Ben Kay speaks with Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, and experts to explore the intersection of homelessness and incarceration and ask a simple but profoundly human question: Do we believe in second chances?

The Centre for Homelessness Impact May 2024 Research Network Meeting features presentations from Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, Beth Watts-Cobbe, PhD, a senior research fellow at the Institute for Social Policy, Housing, and Equalities Research at Heriot-Watt University, and Niamh Flannigan, Implementation Lead at the Centre for Homelessness Impact, highlighting landmark pieces on research and policy. Dr. Kushel presented on the California Statewide Study of People Experiencing Homelessness. Dr. Kushel said, "We need to build housing, create housing at every price point, but particularly for those with extremely low income."

Maria Raven, MD, Chief of Emergency Medicine at UCSF and a faculty advisor at BHHI, was quoted in this piece about a UCSF study about Project Welcome Home showing that permanent supportive housing can help keep chronically homeless people with severe health and substance-abuse issues housed. Margot Kushel, MD, coauthored the study.

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. Researchers administered structured interviews including assessments of health, history of homelessness, social support, and life course. They found that compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Further research on the newly homeless individuals and cohabiters in this cohort may elucidate more clearly the trajectories of these different phenotypes of homelessness.

In the state of California, the three major utility companies, have nearly doubled electricity rates over the last decade. With growing increase in energy demands, the rising utility costs are pushing families already at the margins to the brink of homelessness. Many people are forced to making an impossible choice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I think recognizing energy insecurity as a contributor to this crisis, this is the next frontier that we need to really worry about."

The proportion of single homeless adults over the age of 50 is increasing. In this longitudinal cohort study, researchers examined the prevalence of and risk of falling in a cohort of older homeless adults. Researchers interviewed participants every 6 months for 3 years. They found a high prevalence of falls. Participants reported a prevalence of falls higher than older adults with a mean age of 78 in the general population. Researchers recommended identifying people at high risk of falls reducing unsheltered homelessness.