NLIHC Joins National Health Care for the Homeless Council Letter Opposing Reconciliation Bill’s Impacts on People Experiencing Homelessness

By Kayla Springer, Policy Intern and Kayla Blackwell, Housing Policy Analyst 

NLIHC has joined the National Health Care for the Homeless Council’s letter urging Senate and Committee on Finance leaders to oppose the House reconciliation bill (H.R. 1), highlighting the bill’s negative impact on people experiencing homelessness. As the letter argues, the reconciliation bill places a heavy administrative burden on unhoused individuals and healthcare providers, making it nearly impossible for unhoused individuals to retain Medicaid coverage and access critical health services. 

House Republicans passed the reconciliation bill on May 22 (see Memo, 6/2) with the goal of passing a final bill into law before the July 4 recess. The bill seeks to make permanent a wide range of tax cuts originally approved in 2017 at the cost of massive cuts to several key public assistance programs, including Medicaid. The Congressional Budget Office estimated that the proposed administrative changes to Medicaid would result in cuts of at least $716 billion, and approximately 15 million people would lose health coverage by 2034.  

These changes particularly threaten the health of unhoused individuals. “Medicaid is critical to addressing the health care needs of people experiencing homelessness. It allows unhoused people to access comprehensive, system-wide health care that better enables them to manage their health, work, go to school, and seek housing and other basic needs. Medicaid is also critical for homeless health care providers because it pays for the comprehensive care they deliver, thus reducing uncompensated care and increasing financial stability,” the letter states.  

The letter cites four of the bill’s provisions as particularly threatening for unhoused Medicaid recipients: requirements for address verification, citizenship verification, frequent eligibility redeterminations, and work requirements. For the many unhoused individuals who live in temporary or non-addressed spaces, it’s impossible to provide a verifiable address. Similarly, a lack of stable housing or safe storage spaces makes it difficult for unhoused individuals to maintain documents that might provide proof of citizenship, which are also expensive and administratively burdensome to replace. Finally, unreliable access to mail, phones, or the internet presents a barrier to receiving regular eligibility redetermination notices or completing monthly work requirement reports. Although over half of the people experiencing homelessness work, losing health coverage will only further destabilize and increase barriers to employment.  

“These changes will create paperwork and administrative burdens so great that it will be nearly impossible for unhoused individuals to maintain Medicaid coverage, limiting access to critical care and yielding worse health and housing outcomes. Providers will also lose revenue and be burdened by spending clinic time filling out paperwork to keep patients covered rather than delivering care,” the letter writes.  

Ultimately, the reconciliation bill and its cuts to Medicaid pose a serious threat to the health of people experiencing homelessness, creating significant barriers to retaining coverage and administrative inefficiencies in the health care system. Alongside the National Health Care for the Homeless Council and other organizations, NLIHC recognizes Medicaid’s critical role in meeting the health care needs of unhoused individuals and calls for a rejection of the House reconciliation bill.  

Read the letter here.