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Background: Patients living on the streets often have challenges with scheduling and getting to appointments, obtaining insurance coverage, and managing their healthcare needs. Street Medicine offers an innovative way of meeting these needs.

Objective: This study analyzed how government policies can remove barriers to care for patients experiencing homelessness. Root causes of homelessness were considered. The study evaluated street and shelter medicine as approaches to improving care for patients experiencing homelessness. This project considered how government policies can incentivize, invest in, and remove barriers that affect street and shelter medicine as well as other access to care for patients experiencing homelessness.

Methods: A literature review about the history, benefits, ethics, and limitations of street and shelter medicine was conducted. The study then looked at federal, state, and local laws, regulations, memoranda, court cases, and policies and considered how they impact homelessness and street medicine. Public healthcare financing was then evaluated. This study then assessed both policy proposals that had become law as well as those that had failed in the legislative process. This study then considered where the current system has barriers to care and evaluated how policy changes could benefit patients experiencing homelessness.

Results:

• The punitive approach to homelessness harms health, demoralizes individuals, and increases mortality.
• According to the National Alliance to End Homelessness, 3-6 times as many patients experiencing homelessness have chronic diseases like heart disease, diabetes, and HIV.
• Patients experiencing homelessness have high rates of traumatic brain injury, with one 2025 study finding at least one TBI in nearly 73.5% of patients.
• Patients experiencing homelessness have high utilization of expensive healthcare with one Los Angeles study showing an average of 2.7 annual hospitalizations and 5.0 annual ED visits.
• One 2021 analysis found fewer than 30% of those experiencing homelessness who have Medi-Cal had ever seen their primary care provider.
• California spends more than half of its Medi-Cal spending on just five percent of its highest-cost needs patients.
• Street medicine can save the system money when factoring in avoided emergency department visits, hospital visits, and skilled nursing facility visits.
• The Centers for Medicare and Medicaid Services (CMS) recently developed new service codes that allow for streets or shelters as places of service.
• California AB 543 was recently signed into law allowing Medi-Cal managed care plans to contract with street medicine providers
• California has created a Homelessness and Housing Incentive Program (HHIP) which incentivizes managed care plans to invest in services for those experiencing homelessness.
• LA Cares has used HHIP and other funding to create a field medicine plan that allows for billing street medicine encounters.
• Federal 330H Grants have enabled federally qualified health centers to expand care for patients experiencing homelessness.

Conclusion: There are many ways to improve health care for those experiencing homelessness. The current system relies all too often on charitable funding. Governments can provide additional Medicaid-linked dollars to heath institutions that engage in street medicine training programs. CMS or states could increase reimbursement rates for patients who identify as homeless. States can bypass federal restrictions and strengthen street medicine through Medicaid 1115 Waivers. Medicare Advantage special needs plans can be developed that focus on the common medical and social needs of patients experiencing homelessness. Street and shelter medicine benefits patients best as an adjunct to brick-and-mortar empaneled primary care providers. Many patients experiencing homelessness are empaneled to providers in distant areas. Agencies could create streamlined ways for patients experiencing homelessness to switch between empaneled primary care providers. The National Health Service Corps could create new loan-repayment incentives to encourage street medicine practice. Providers could receive higher capitation for patients experiencing homelessness. Health systems could develop shared-savings payment models to incentivize street medicine. Ultimately, homelessness must be addressed with changes to housing policies, healthcare costs, and a shift away from the punitive approach towards homelessness. In the meantime, there are many ways that governments can reduce barriers to care for patients experiencing homelessness.