research report about poverty and homelessness

• Open access
• Published: 22 August 2017

Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples

• Mzwandile A. Mabhala   ORCID: orcid.org/0000-0003-1350-7065 1 , 3 ,
• Asmait Yohannes 2 &
• Mariska Griffith 1  

International Journal for Equity in Health volume  16 , Article number:  150 ( 2017 ) Cite this article

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It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation, with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing, to understanding the social context of homelessness and social interventions to prevent it.

However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves. This study aims to examine the stories of homeless people to gain understanding of the social conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

Twenty-six semi-structured interviews were conducted with homeless people in three centres for homeless people in Cheshire North West of England.

The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience capacity to cope with life challenges created by series of adverse incidents in one’s life. The data show that final stage in the process of becoming homeless is complete collapse of relationships with those close to them. Most prominent pattern of behaviours participants often describe as main causes of breakdown of their relationships are:

engaging in maladaptive behavioural lifestyle including taking drugs and/or excessive alcohol drinking

Being in trouble with people in authorities.

Homeless people describe the immediate behavioural causes of homelessness, however, the analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation [ 1 , 2 , 3 , 4 , 5 ], with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing [ 6 ], to understanding the social context of homelessness and social interventions to prevent it [ 6 ].

Several studies explain the link between social factors and homelessness [ 6 , 7 , 8 , 9 , 10 ]. The most common social explanations centre on seven distinct domains of deprivation: income; employment; health and disability; education, skills and training; crime; barriers to housing and social support services; and living environment [ 11 ]. Of all forms, income deprivation has been reported as having the highest risk factors associated with homelessness [ 7 , 12 , 13 , 14 ]: studies indicate that people from the most deprived backgrounds are disproportionately represented amongst the homeless [ 7 , 13 ]. This population group experiences clusters of multiple adverse health, economic and social conditions such as alcohol and drug misuse, lack of affordable housing and crime [ 10 , 12 , 15 ]. Studies consistently show an association between risk of homelessness and clusters of poverty, low levels of education, unemployment or poor employment, and lack of social and community support [ 7 , 10 , 13 , 16 ].

Studies in different countries throughout the world have found that while the visible form of homelessness becomes evident when people reach adulthood, a large proportion of homeless people have had extreme social disadvantage and traumatic experiences in childhood including poverty, shortage of social housing stocks, disrupted schooling, lack of social and psychological support, physical, sexual, and emotional abuse, neglect, dysfunctional family environments, and unstable family structures, all of which increase the likelihood of homelessness [ 10 , 13 , 14 ].

Furthermore, a large body of evidence suggests that people exposed to diverse social disadvantages at an early age are less likely to adapt successfully compared to people without such exposure [ 9 , 10 , 13 , 17 ], being more susceptible to adopting maladaptive coping behaviours such as theft, trading sex for money, and selling or using drugs and alcohol [ 7 , 9 , 18 , 19 ]. Studies show that these adverse childhood experiences tend to cluster together, and that the number of adverse experiences may be more predictive of negative adult outcomes than particular categories of events [ 17 , 20 ]. The evidence suggests that some clusters are more predictive of homelessness than others [ 7 , 12 ]: a cluster of childhood problems including mental health and behavioural disorders, poor school performance, a history of foster care, and disrupted family structure was most associated with adult criminal activities, adult substance use, unemployment and subsequent homelessness [ 12 , 17 , 21 ]. However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves.

This paper adopted Anderson and Christian’s [ 18 ] definition, which sees homelessness as a ‘function of gaining access to adequate, affordable housing, and any necessary social support needed to ensure the success of the tenancy’. Based on our synthesis of the evidence, this paper proposes that homelessness is a progressive process that begins at childhood and manifests itself at adulthood, one characterised by loss of the personal resources essential for successful adaptation. We adopted the definition of personal resources used by DeForge et al. ([ 7 ], p. 223), which is ‘those entities that either are centrally valued in their own right (e.g. self-esteem, close attachment, health and inner peace) or act as a means to obtain centrally valued ends (e.g. money, social support and credit)’. We propose that the new paradigm focusing on social explanations of homelessness has the potential to inform social interventions to reduce it.

In this study, we examine the stories of homeless people to gain understanding of the conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

The design of this study was philosophically influenced by constructivist grounded theory (CGT). The aspect of CGT that made it appropriate for this study is its fundamental ontological belief in multiple realities constructed through the experience and understanding of different participants’ perspectives, and generated from their different demographic, social, cultural and political backgrounds [ 22 ]. The researchers’ resulting theoretical explanation constitutes their interpretation of the meanings that participants ascribe to their own situations and actions in their contexts [ 22 ].

The stages of data collection and analysis drew heavily on other variants of grounded theory, including those of Glaser [ 23 ] and Corbin and Strauss [ 24 ].

Setting and sampling strategy

The settings for this study were three centres for homeless people in two cities (Chester and Crewe) in Cheshire, UK. Two sampling strategies were used in this study: purposive and theoretical. The study started with purposive sampling and in-depth one-to-one semi-structured interviews with eight homeless people to generate themes for further exploration.

One of the main considerations for the recruitment strategy was to ensure that the process complies with the ethical principles of voluntary participation and equal opportunity to participate. To achieve this, an email was sent to all the known homeless centres in the Cheshire and Merseyside region, inviting them to participate. Three centres agreed to participate, all of them in Cheshire – two in Chester and one in Crewe.

Chester is the most affluent city in Cheshire and Merseyside, and therefore might not be expected to be considered for a homelessness project. The reasons for including it were: first, it was a natural choice, since the organisations that funded the project and the one that led the research project were based in Chester; second, despite its affluence, there is visible evidence of homelessness in the streets of Chester; and third, it has several local authority and charity-funded facilities for homeless people.

The principal investigator spent 1 day a week for 2 months in three participating centres, during that time oral presentation of study was given to all users of the centre and invited all the participants to participate and written participants information sheet was provided to those who wished to participate. During that time the principal investigator learned that the majority of homeless people that we were working with in Chester were not local. They told us that they came to Chester because there was no provision for homeless people in their former towns.

To help potential participants make a self-assessment of their suitability to participate without unfairly depriving others of the opportunity, participants information sheet outline criteria that potential participants had to meet: consistent with Economic and Social Research Council’s Research Ethics Guidebook [ 25 ], at the time of consenting to and commencing the interview, the participant must appear to be under no influence of alcohol or drugs, have a capacity to consent as stipulated in England and Wales Mental Capacity Act 2005 [ 26 ], be able to speak English, and be free from physical pain or discomfort.

As categories emerged from the data analysis, theoretical sampling was used to refine undeveloped categories in accordance with Strauss and Corbin’s [ 27 ] recommendations. In total 26 semi-structured interviews were carried out. Theoretical sampling involved review of memos or raw data, looking for data that might have been overlooked [ 27 , 28 ], and returning to key participants asking them to give more information on categories that seemed central to the emerging theory [ 27 , 28 ].

The sample comprised of 22 male and 4 female, the youndgest participant was 18 the eldest was 74 years, the mean age was 38.6 years. Table 1 illustrates participant’s education history, childhood living arrangements, brief participants family and social history, emotional and physical health, the onset of and trigger for homelessness.

Ethical approval

Ethical approval was obtained from the Research Ethics Committee of the University of Chester. The centre managers granted access once ethical approval had been obtained, and after their review of the study design and other research material, and of the participant information sheet which included a letter of invitation highlighting that participation was voluntary.

Data analysis

In this study data collection and analysis occurred simultaneously. Analysis drew on Glaser’s [ 23 ] grounded theory processes of open coding, use of the constant comparative method, and the iterative process of data collection and data analysis to develop theoretical explanation of homelessness.

The process began by reading the text line-by-line identifying and open coding the significant incidents in the data that required further investigation. The findings from the initial stage of analysis are published in Mabhala [ 29 ]. The the second stage the data were organised into three themes that were considered significant in becoming homeless (see Fig. 1 ):

Engaging in maladaptive behaviour

Being in trouble with the authorities.

Being in abusive environments.

Social explanation of becoming homeless. Legend: Fig. 1 illustrates the process of becoming homeless

The key questions that we asked as we continued to interrogate the data were: What category does this incident indicate? What is actually happening in the data? What is the main concern being faced by the participants? Interrogation of the data revealed that participants were describing the process of becoming homeless.

The comparative analysis involved three processes described by Glaser ([ 23 ], p. 58–60): each incident in the data was compared with incidents from both the same participant and other participants, looking for similarities and differences. Significant incidents were coded or given labels that represented what they stood for, and similarly coded or labeled when they were judged to be about the same topic, theme or concept.

After a period of interrogation of the data, it was decided that the two categories - destabilising behaviour, and waning ofcapacity for resilience were sufficiently conceptual to be used as theoretical categories around which subcategories could be grouped (Fig. 1 ).

Once the major categories had been developed, the next step consisted of a combination of theoretical comparison and theoretical sampling. The emerging categories were theoretically compared with the existing literature. Once this was achieved, the next step was filling in and refining the poorly defined categories. The process continued until theoretical sufficiency was achieved.

Figure 1 illustrates the process of becoming homeless. The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience created by a series of adverse incidents in one’s life. Amongst the frequently cited incidents were being in an abusive environment and losing a significant person in one’s life. However, being in an abusive environment emerged from this and previously published studies as a major theme; therefore, we decided to analyse it in more detail.

The data further show that the final stage in the process of becoming homeless is a complete collapse of relationships with those with whom they live. The most prominent behaviours described by the participants as being a main cause of breakdown are:

Engaging in maladaptive behaviour: substance misuse, alcoholism, self-harm and disruptive behaviours

Being in trouble with the authorities: theft, burglary, arson, criminal offenses and convictions

The interrogation of data in relation to the conditions within which these behaviours occurred revealed that participants believed that their social contexts influenced their life chance, their engagement with social institution such as education and social services and in turn their ability to acquire and maintain home. Our experiences have also shown that homeless people readily express the view that behavioural lifestyle factors such as substance misuse and engaging in criminal activities are the causes of becoming homeless. However, when we spent time talking about their lives within the context of their status as homeless people, we began to uncover incidents in their lives that appeared to have weakened their capacity to constructively engage in relationships, engage with social institutions to make use of social goods [ 29 , 30 , 31 ] and maturely deal with societal demands.

Being in abusive environments

Several participants explicitly stated that their childhood experiences and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults.

It appears that childhood experiences remain resonant in the minds of homeless participants, who perceive that these have had bearing on their homelessness. Their influence is best articulated in the extracts below. When participants were asked to tell their stories of what led to them becoming homeless, some of their opening lines were:

What basically happened, is that I had a childhood of so much persistent, consistent abuse from my mother and what was my stepfather. Literally consistent, we went around with my mother one Sunday where a friend had asked us to stay for dinner and mother took the invitation up because it saved her from getting off her ass basically and do anything. I came away from that dinner genuinely believing that the children in that house weren’t loved and cared for, because they were not being hit, there was no shouting, no door slamming. [Marco]

It appears that Marco internalised the incidents of abuse, characterised by shouting, door slamming and beating as normal behaviour. He goes on to intimate how the internalised abusive behaviour affected his interaction with his employers.

‘…but consistently being put down, consistently being told I was thick, I started taking jobs and having employers effing and blinding at me. One employer actually used a “c” word ending in “t” at me quite frequently and I thought it was acceptable, which obviously now I know it’s not. So I am taking on one job after another that, how can I put it? That no one else would do basically. I was so desperate to work and earn my own money. [Marco]

Similarly, David makes a connection between his childhood experience and his homelessness. When he was asked to tell his life story leading to becoming homeless, his opening line was:

I think it [homelessness] started off when I was a child. I was neglected by my mum. I was physically and mentally abused by my mum. I got put into foster care, when I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. [David]

David and Marco’s experiences are similar to those of many participants. The youngest participant in this study, Clarke, had fresh memories of his abusive environment under his stepdad:

I wouldn't want to go back home if I had a choice to, because before I got kicked out me stepdad was like hitting me. I wouldn't want to go back to put up with that again. [I didn't tell anyone] because I was scared of telling someone and that someone telling me stepdad that I've told other people. ‘[Be] cause he might have just started doing again because I told people. It might have gotten him into trouble. [Clarke]

In some cases, participants expressed the beliefs that their abusive experience not only deprived them life opportunities but also opportunities to have families of their own. As Tom and Marie explain:

We were getting done for child neglect because one of our child has a disorder that means she bruise very easily. They all our four kids into care, social workers said because we had a bad childhood ourselves because I was abused by my father as well, they felt that we will fail our children because we were failed by our parents. We weren’t given any chance [Tom and Marie]

Norma, described the removal of her child to care and her maladaptive behaviour of excessive alcohol use in the same context as her experience of sexual abuse by her father.

I had two little boys with me and got took off from me and put into care. I got sexually abused by my father when I was six. So we were put into care. He abused me when I was five and raped me when I was six. Then we went into care all of us I have four brothers and four sisters. My dad did eighteen months for sexually abusing me and my sister. I thought it was normal as well I thought that is what dads do [Norma]

The analysis of participants in this study appears to suggest that social condition one is raised influence the choice of social connections and life partner. Some participants who have had experience of abuse as children had partner who had similar experience as children Tom and Marie, Lee, David and his partners all had partners who experienced child abuse as children.

Tom and Marie is a couple we interviewed together. They met in hostel for homeless people they have got four children. All four children have been removed from them and placed into care. They sleep rough along the canal. They explained:

We have been together for seven years we had a house and children social services removed children from us, we fell within bedroom tax. …we received an eviction order …on the 26th and the eviction date was the 27th while we were in family court fighting for our children. …because of my mental health …they were refusing to help us.

Our children have been adopted now. The adoption was done without our permission we didn’t agree to it because we wanted our children home because we felt we were unfairly treated and I [Marie] was left out in all this and they pin it all on you [Tom] didn’t they yeah, my [Tom] history that I was in care didn’t help.

Tom went on to talk about the condition under which he was raised:

I was abandoned by my mother when I was 12 I was then put into care; I was placed with my dad when I was 13 who physically abused me then sent back to care. [Tom].

David’s story provides another example of how social condition one is raised influence the choice of social connections and life partner. David has two children from two different women, both women grew up in care. Lisa one of David’s child mother is a second generation of children in care, her mother was raised in care too.

I drink to deal with problems. As I say I’ve got two kids with my girlfriend Kyleigh, but I got another lad with Lisa, he was taken off me by social services and put on for adoption ten years ago and that really what started it; to deal with that. Basically, because I was young, and I had been in care and the way I had been treated by my mum. Basically laid on me in the same score as my mum and because his mum [Lisa] was in care as well. So they treated us like that, which was just wrong. [David]

In this study, most participants identified alcohol or drugs and crime as the cause of relationships breakdown. However, the language they used indicates that these were secondary reasons rather than primary reasons for their homelessness. The typical question that MA and MG asked the interview participants was “tell us how did you become homeless”? Typically, participants cited different maladaptive behaviours to explain how they became homeless.

Alvin’s story is typical of:

Basically I started off as a bricklayer, … when the recession hit, there was an abundance of bricklayers so the prices went down in the bricklaying so basically with me having two young children and the only breadwinner in the family... so I had to kinda look for factory work and so I managed to get a job… somewhere else…. It was shift work like four 12 hour days, four 12 hour nights and six [days] off and stuff like that, you know, real hard shifts. My shift was starting Friday night and I’ll do Friday night, Saturday night to Monday night and then I was off Tuesday, Wednesday and Thursday, but I’d treat that like me weekend you know because I’ve worked all weekend. Then… so I’d have a drink then and stuff like that, you know. 7 o’ clock on a Monday morning not really the time to be drinking, but I used to treat it like me weekend. So we argued, me and my ex-missus [wife], a little bit and in the end we split up so moved back to me mum's, but kept on with me job, I was at me mum’s for possibly about five years and but gradually the drinking got worse and worse, really bad. I was diagnosed with depression and anxiety. … I used to drink to get rid of the anxiety and also to numb the pain of the breakup of me marriage really, you know it wasn’t good, you know. One thing led to another and I just couldn’t stop me alcohol. I mean I’ve done drugs you know, I was into the rave scene and I’ve never done hard drugs like heroin or... I smoke cannabis and I use cocaine, and I used to go for a pint with me mates and that. It all came to a head about November/December time, you know it was like I either stop drinking or I had to move out of me mum's. I lost me job in the January through being over the limit in work from the night before uum so one thing led to another and I just had to leave. [Alvin]

Similarly, Gary identified alcohol as the main cause of his relationship breakdown. However, when one listens to the full story alcohol appears to be a manifestation of other issues, including financial insecurities and insecure attachment etc.

It [the process of becoming homeless] mainly started with the breakdown of the relationship with me partner. I was with her for 15 years and we always had somewhere to live but we didn't have kids till about 13 years into the relationship. The last two years when the kids come along, I had an injury to me ankle which stopped me from working. I was at home all day everyday. …I was drinking because I was bored. I started drinking a lot ‘cause I couldn't move bout the house. It was a really bad injury I had to me ankle. Um, and one day me and me partner were having this argument and I turned round and saw my little boy just stood there stiff as a board just staring, looking at us. And from that day on I just said to me partner that I'll move out, ‘cause I didn't want me little boy to be seeing this all the time. [Gary]

In both cases Gary and Alvin indicate that changes in their employment status created conditions that promoted alcohol dependency, though both explained that they drank alcohol before the changes in their employment status occurred and the breakdown of relationships. Both intimated that that their job commitment limited the amount of time available to drink alcohol. As Gary explained, it is the frequency and amount of alcohol drinking that changed as a result of change in their employment status:

I used to have a bit of a drink, but it wasn’t a problem because I used to get up in the morning and go out to work and enjoy a couple of beers every evening after a day’s work. Um, but then when I wasn't working I was drinking, and it just snowballed out, you know snowball effect, having four cans every evening and then it went from there. I was drinking more ‘cause I was depressed. I was very active before and then I became like non-active, not being able to do anything and in a lot of pain as well. [Gary]

Furthermore, although the participants claim that drinking alcohol was not a problem until their employment circumstances changed, one gets a sense that alcohol was partly responsible for creating conditions that resulted in the loss of their jobs. In Gary’s case, for example, alcohol increased his vulnerability to the assault and injuries that cost him his job:

I got assaulted, kicked down a flight of stairs. I landed on me back on the bottom of the stairs, but me heel hit the stairs as it was still going up if you know what I mean. Smashed me heel, fractured me heel… So, by the time I got to the hospital and they x-rayed it they wasn't even able to operate ‘cause it was in that many pieces, they weren't even able to pin it if you know what I mean. [Gary]

Alvin, of the other hand, explained that:

I lost my job in the January through being over the limit in work from the night before, uum so one thing led to another and I just had to leave. [Alvin]

In all cases participants appear to construct marriage breakdown as an exacerbating factor for their alcohol dependence. Danny, for example, constructed marriage breakdown as a condition that created his alcohol dependence and alcohol dependence as a cause of breakdown of his relationship with his parents. He explains:

I left school when I was 16. Straight away I got married, had children. I have three children and marriage was fine. Umm, I was married for 17 years. As the marriage broke up I turned to alcohol and it really, really got out of control. I moved in with my parents... It was unfair for them to put up with me; you know um in which I became... I ended up on the streets, this was about when I was 30, 31, something like that and ever since it's just been a real struggle to get some permanent accommodation. [Danny]

Danny goes on to explain:

Yes [I drank alcohol before marriage broke down but] not very heavily, just like a sociable drink after work. I'd call into like the local pub and have a few pints and it was controlled. My drinking habit was controlled then. I did go back to my parents after my marriage break up, yes. I was drinking quite heavily then. I suppose it was a form of release, you know, in terms of the alcohol which I wish I'd never had now. When I did start drinking heavy at me parents’ house, I was getting in trouble with the police being drunk and disorderly. That was unfair on them. [Danny]

The data in this study indicate that homelessness occurs when the relationships collapse, irrespective of the nature of the relationship. There were several cases where lifestyle behaviour led to a relationship collapse between child and parents or legal guardians.

In the next excerpt, Emily outlines the incidents: smoking weed, doing crack and heroin, and drinking alcohol. She also uses the words ‘because’, ‘when’ and ‘obviously’, which provide clues about the precipitating condition for her behaviours “spending long time with people who take drugs”.

I've got ADHD like, so obviously my mum kicked me out when I was 17 and then like I went to **Beswick** and stuff like that. My mum in the end just let me do what I wanted to do, ‘cause she couldn't cope anymore. …I mean I tried to run away from home before that, but she'd always like come after me in like her nightie and pyjamas and all that. But in the end she just washed her hands of me . [Emily]

Emily presented a complex factors that made it difficult for her mother to live with her. These included her mother struggle with raising four kids as a single parent, Emily’s mental health (ADHD], alcohol and drug use. She goes on to explain that:

Ummm, well the reason I got kicked out of my hostel was ‘cause of me drinking, so I'd get notice to quit every month, then I’d have a meeting with the main boss and then they'd overturn it and this went on every month for about six months. Also, it was me behaviour as well, but obviously drink makes you do stuff you don't normally do and all that shit. I lived here for six months, got kicked out because I jumped out the window and broke me foot. I was on the streets for six months and then they gave me a second chance and I've been here a year now. So that's it basically. [Emily]

There were several stories of being evicted from accommodation due to excessive use of alcohol. One of those is David:

I got put into foster care. When I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. It’s been going on now for about… I was thirty-one on Wednesday, so it’s been going on for about thirteen years, homeless on and off. Otherwise if not having shoplifted for food and then go to jail, and when I don’t drink I have lot of seizures and I end up in the hospital. Every time I end up on the street. I trained as a chef, I have not qualified yet, because of alcohol addiction, it didn’t go very well. I did couple of jobs in restaurants and diners, I got caught taking a drink. [David]

Contrary to the other incidents where alcohol was a factor that led to homelessness, Barry’s description of his story appears to suggest that the reason he had to leave his parents’ home was his parents’ perception that his sexuality brought shame to the family:

When I came out they I’m gay, my mum and dad said you can’t live here anymore. I lived in a wonderful place called Nordic... but fortunately, mum and dad ran a pub called […] [and] one of the next door neighbours lived in a mansion. His name was [….] [and] when I came out, he came out as in he said “I'm a gay guy”, but he took me into Liverpool and housed me because I had nowhere to live. My mum and dad said you can't live here anymore. And unfortunately, we get to the present day. I got attacked. I got mugged... only walked away with a £5 note, it’s all they could get off me. They nearly kicked me to death so I was in hospital for three weeks. By the time I came out, I got evicted from my flat. I was made homeless. [Barry]

We used the phrase “engaging in maladaptive behaviour” to conceptualise the behaviours that led to the loss of accommodation because our analysis appear to suggest that these behaviours were strategies to cope with the conditions they found themselves in. For example, all participants in this category explained that they drank alcohol to cope with multiple health (mental health) and social challenges.

In the UK adulthood homelessness is more visible than childhood homelessness. However, most participants in this research reveal that the process of becoming homeless begins at their childhood, but becomes visible after the legal age of consent (16). Participants described long history of trouble with people in authority including parents, legal guardians and teachers. However, at the age of 16 they gain legal powers to leave children homes, foster homes, parental homes and schools, and move outside some of the childhood legal protections. Their act of defiance becomes subject to interdiction by the criminal justice system. This is reflected in number of convictions for criminal offenses some of the participants in this study had.

Participants Ruddle, David, Lee, Emily, Pat, Marco, Henry and many other participants in this study (see Table 1 ) clearly traced the beginning of their troubles with authority back at school. They all expressed the belief that had their schooling experience been more supportive, their lives would have been different. Lee explains that being in trouble with the authorities began while he was at school:

‘The school I came from a rough school, it was a main school, it consisted of A, B, C, D and The school I came from [was] a rough school, it was a main school, it consisted of A, B, C, D and E. I was in the lowest set, I was in E because of my English and maths. I was not interested, I was more interested in going outside with big lads smoking weed, bunking school. I used to bunk school inside school. I used to bunk where all cameras can catch me. They caught me and reported me back to my parents. My mum had a phone call from school asking where your son is. My mum grounded me. While my mum grounded me I had a drain pipe outside my house, I climbed down the drain pipe outside my bedroom window. I used to climb back inside. [Lee]

Lee’s stories constructed his poor education experiences as a prime mover towards the process of becoming homeless. It could be noted in Table 1 that most participants who described poor education experiences came from institutions such as foster care, children home and special school for maladjusted children. These participants made a clear connection between their experiences of poor education characterised by defiance of authorities and poor life outcomes as manifested through homelessness.

Patrick made a distinct link between his school experience and his homelessness, for example, when asked to tell his story leading up to becoming homeless, Patrick’s response was:

I did not go to school because I kept on bunking. When I was fifteen I left school because I was caught robbing. The police took me home and my mum told me you’re not going back to school again, you are now off for good. Because if you go back to school you keep on thieving, she said I keep away from them lads. I said fair enough. When I was seventeen I got run over by a car. [Patrick]

Henry traces the beginning of his troubles with authorities back at school:

[My schooling experience]… was good, I got good, well average grades, until I got myself into [a] few fights mainly for self-defence. In primary schools, I had a pretty... I had a good report card. In the start of high school, it was good and then when the fights started that gave me sort of like a... bad reputation. I remember my principal one time made me cry. Actually made me cry, but eh... I don't know how, but I remember sitting there in the office and I was crying. My sister also stuck up for me when she found out what had happened, she was on my side; but I can’t remember exactly what happened at that time. [Henry]

Emily’s story provides some clues about the series of incidents - including, delay in diagnosing her health condition, being labelled as a naughty child at school, being regularly suspended from school and consequently poor educational attainment.

Obviously, I wasn't diagnosed with ADHD till I was like 13, so like in school they used to say that's just a naughty child. … So it was like always getting suspended, excluded and all that sort of stuff. And in the end [I] went to college and the same happened there. [Emily]

The excerpt above provides intimations of what she considers to be the underlying cause of her behaviour towards the authorities. Emily suggests that had the authorities taken appropriate intervention to address her condition, her life outcomes would have been different.

Although the next participant did not construct school as being a prime mover of their trouble with authorities, their serious encounters with the criminal justice system occurred shortly after leaving school:

Well I did a bit of time at a very early age, I was only 16… I did some remand there, but then when I went to court ‘cause I'd done enough remand, I got let out and went to YMCA in Runcorn. Well, that was when I was a kid. When I was a bit older, ‘cause it was the years 2000 that I was in jail, I was just trying to get by really. I wasn’t with Karen at the time. I was living in Crewe and at the time I was taking a lot of amphetamines and was selling amphetamines as well, and I got caught and got a custodial sentence for it. But I've never been back to jail since. I came out in the year 2000 so it's like 16 years I've kept meself away from jail and I don't have any intentions of going back. [Gary]

The move from school and children social care system to criminal justice was a common pathways for many participants in this study. Some including Lee, Crewe, David, Patrick spent multiple prison sentences (see Table 1 ). Although Crewe did not make connection between his schooling experiences and his trouble with law, it could be noted that his serious encounter with criminal justice system started shortly after leaving foster care and schooling systems. As he explains:

I was put into prison at age of 17 for arson that was a cry for help to get away from the family, I came out after nine months. I have been in prison four times in my life, its not very nice, when I came out I made a promise to myself that I’m never going to go back to prison again. [Crewe]

Lee recalls his education experience. He explained:

I left school when I was fifteen… then I went off the rails. I got kidnapped for three and half months. When I came back I was just more interested in crime. When I left school I was supposed to go to college, but I went with travellers. I was just more interested in getting arrested every weekend, until my mum say right I have enough of you. I was only seventeen. I went through the hostels when I was seventeen. [Lee]

None describe the educational experience with a similar profundity to Marco:

On few occasions I came out on the corridors I would be getting battered on to my hands and knees and teachers walk pass me. There was quite often blood on the floor from my nose, would be punched on my face and be thrown on the floor. …. It was hard school, pernicious. I would go as far as saying I never felt welcome in that school, I felt like a fish out of the water, being persistently bullied did my head in. Eventually I started striking back, when I started striking back suddenly I was a bad one. My mother decided to put me in … school for maladjusted boys, everyone who been there including myself have spent time in prison. [Marco]

The trouble with authorities that was observes in participants stories in this category appear to be part of the wider adverse social challenges that the participants in this study were facing. Crewe’s description of arson as a cry for help appears to be an appropriate summation of all participants in this category.

The participants’ description of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

The key feature that distinguish this study from comparable previous studies is that it openly acknowledges that data collection and analysis were influenced by the principles of social justice [ 28 , 30 , 31 ]. The resulting theoretical explanation therefore constitutes our interpretation of the meanings that participants ascribe to their own situations and actions in their contexts. In this study, defining homelessness within the wider socioeconomic context seemed to fit the data, and offered one interpretation of the process of becoming homeless.

While the participants’ experiences leading to becoming homeless may sound trite. What is pertinent in this study is understanding the conditions within which their behaviours occurred. The data were examined through the lens of social justice and socio-economic inequalities: we analysed the social context within which these behaviours occurred. We listened to accounts of their schooling experiences, how they were raised and their social network. The intention was not to propose a cause-and-effect association, but to suggest that interventions to mitigate homelessness should consider the social conditions within which it occurred.

Participants in this study identified substance misuse and alcohol dependency as a main cause of their homelessness. These findings are consistent with several epidemiological studies that reported a prevalence of substance misuse amongst the homeless people [ 32 , 33 , 34 , 35 , 36 ]. However, most these studies are epidemiological; and by nature epidemiological studies are the ‘gold standard’ in determining causes and effects, but do not always examine the context within which the cause and effect occur. One qualitative study that explored homelessness was a Canadian study by Watson, Crawley and Cane [ 37 ]. Participants in the Watson, et al. described ‘lack of quality social interactions and pain of addition. However, Watson et al. focus on the experiences of being homeless, rather than the life experiences leading to becoming homeless. To our knowledge the current study is one of very few that specifically examine the conditions within which homelessness occurs, looking beyond the behavioural factors. Based on the synthesis of data from previous studies, it makes sense that many interventions to mitigate homelessness focus more on tackling behavioural causes of homelessness rather than fundamental determinants of it [ 38 ]. From the public health intervention’ point of view, however, understanding the conditions within which homelessness occurs is essential, as it will encourage policymakers and providers of the services for homelessness people to devote equal attention to tackling the fundamental determinants of homelessness as is granted in dealing behavioural causes.

Participants in this study reported that they have been defiant toward people in positions of authority. For most of them this trouble began when they were at school, and came to the attention of the criminal justice system as soon as they left school at the age of 16. These findings are similar to these in the survey conducted by Williams, Poyser, and Hopkins [ 39 ] which was commissioned by the UK Ministry of Justice. This survey found that 15 % of prisoners in the sample reported being homeless before custody [ 39 ]; while three and a half percent of the general population reported having ever been homeless [ 39 ]. As the current study reveals there are three possible explanations for the increased population of homeless young people in the criminal justice system: first, at the age of 16 they gain legal powers to leave their foster homes, parents homes, and schools and move beyond some of the childhood legal protections; second, prior to the age of 16 their defiant behaviours were controlled and contained by schools and parents/legal guardians; and third, after the age of 16 their acts of defiant behaviour become subject to interdiction by the criminal justice system.

The conditions in which they were born and raised were described by some participants in this study as ‘chaotic’, abusive’, ‘neglect’, ‘pernicious’ ‘familial instability’, ‘foster care’, ‘care home’, etc. Taking these conditions, and the fact that all but one participants in this left school at or before the age of 16 signifies the importance of living conditions in educational achievement. It has been reported in previous studies that children growing up in such conditions struggle to adjust in school and present with behavioural problems, and thus, poor academic performance [ 40 ]. It has also been reported that despite these families often being known to social services, criminal justice systems and education providers, the interventions in place do little to prevent homelessness [ 40 ].

Analysis of the conditions within which participants’ homelessness occurred reveals the adverse social conditions within which they were born and raised. The conditions they described included being in an abusive environment, poor education, poor employment or unemployment, poor social connections and low social cohesion. These conditions are consistent with high index of poverty [ 37 , 41 , 42 ]. And several other studies found similar associations between poverty and homelessness [ 42 ]. For example, the study by Watson, Crowley et al. [ 37 ] found that there were extreme levels of poverty and social exclusion amongst homeless people. Contrary to previous studies that appear to construct homelessness as a major form of social exclusion, the analysis of participants’ stories in this current study revealed that the conditions they were raised under limited their capacity to engage in meaningful social interactions, thus creating social exclusion.

Homeless people describe the immediate behavioural causes of homelessness; however, this analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

Limitations

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Acknowledgements

The authors wish to thank all participants in this study; without their contribution it would not have been possible to undertake the research. The authors acknowledge the contribution of Professor Paul Kingston and Professor Basma Ellahi at the proposal stage of this project. A very special thanks to Robert Whitehall, John and all the staff at the centres for homeless people for their help in creating a conducive environment for this study to take place; and to Roger Whiteley for editorial support. A very special gratitude goes to the reviewers of this paper, who will have expended considerable effort on our behalf. 

This research was funded by quality-related research (QR) funding allocation for the University of Chester.

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The datasets generated during and/or analysed during the current study are not publicly available due to ethical restriction and privacy of participant data but are available from the corresponding author on reasonable request.

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MM wrote the entire manuscript, designed the study, collected data, analysed and interpreted data, and presented the findings. AY contributed to transcribing data and manuscript editing. MG contributed to data collection, and transcribed the majority of data. All authors read and approved the final manuscript.

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Mabhala, M.A., Yohannes, A. & Griffith, M. Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples. Int J Equity Health 16 , 150 (2017). https://doi.org/10.1186/s12939-017-0646-3

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Homelessness and the Persistence of Deprivation: Income, Employment, and Safety Net Participation

Homelessness is arguably the most extreme hardship associated with poverty in the United States, yet people experiencing homelessness are excluded from official poverty statistics and much of the extreme poverty literature. This paper provides the most detailed and accurate portrait to date of the level and persistence of material disadvantage faced by this population, including the first national estimates of income, employment, and safety net participation based on administrative data. Starting from the first large and nationally representative sample of adults recorded as sheltered and unsheltered homeless taken from the 2010 Census, we link restricted-use longitudinal tax records and administrative data on the Supplemental Nutrition Assistance Program (SNAP), Medicare, Medicaid, Disability Insurance (DI), Supplemental Security Income (SSI), veterans’ benefits, housing assistance, and mortality. Nearly half of these adults had formal employment in the year they were observed as homeless, and nearly all either worked or were reached by at least one safety net program. Nevertheless, their incomes remained low for the decade surrounding an observed period of homelessness, suggesting that homelessness tends to arise in the context of long-term, severe deprivation rather than large and sudden losses of income. People appear to experience homelessness because they are very poor despite being connected to the labor market and safety net, with low permanent incomes leaving them vulnerable to the loss of housing when met with even modest disruptions to life circumstances.

The Census Bureau has reviewed this data product for unauthorized disclosure of confidential information and has approved the disclosure avoidance practices applies to this release, authorization number CBDRB-FY2022-CES005-015. We thank the U.S. Census Bureau for their support, as well as John Abowd, Mark Asiala, George Carter, James Christy, Dennis Culhane, Kevin Deardorff, Conor Dougherty, Ingrid Gould Ellen, Anne Fletcher, Katie Genadek, Tatiana Homonoff, Kristin Kerns, William Koerber, Margot Kushel, Larry Locklear, Tim Marshall, Brian McKenzie, Brendan O’Flaherty, James Pugh, Trudi Renwick, Annette Riorday, Nan Roman, William Snow, Eddie Thomas, Matthew Turner, and John Voorheis for providing feedback and answering questions. We also thank participants in seminars at Yale University (Labor/Public Economics Workshop), the University of Chicago (Demography Workshop), APPAM, NTA, NBER Labor Studies, IRS/Census (Income Measurement Workshop), and the Institute for Research on Poverty. Ilina Logani and Mandana Vakil provided excellent research assistance. We appreciate the financial support of the Alfred P. Sloan Foundation, the Russell Sage Foundation, the Charles Koch Foundation, the Menard Family Foundation, and the American Enterprise Institute. Wyse thanks the National Institute on Aging for their support. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues

It took seven years for Abigail Judge to see what success looked like for one Boston homeless woman.

The woman had been sex trafficked since she was young, was a drug user, and had been abused, neglected, or exploited in just about every relationship she’d had. If Judge was going to help her, trust had to come first. Everything else — recovery, healing, employment, rejoining society’s mainstream — might be impossible without it. That meant patience despite the daily urgency of the woman’s situation.

“It’s nonlinear. She gets better, stops, gets re-engaged with the trafficker and pulled back into the lifestyle. She does time because she was literally holding the bag of fentanyl for these guys,” said Judge, a psychology instructor at Harvard Medical School whose outreach program, Boston Human Exploitation and Sex Trafficking (HEAT), is supported by Massachusetts General Hospital and the Boston Police Department. “This is someone who’d been initially trafficked as a kid and when I met her was 23 or 24. She turned 30 last year, and now she’s housed, she’s abstinent, she’s on suboxone. And she’s super involved in her community.”

It’s a success story, but one that illustrates some of the difficulties of finding solutions to the nation’s homeless problem. And it’s not a small problem. A  December 2023 report  by the U.S. Department of Housing and Urban Development said 653,104 Americans experienced homelessness, tallied on a single night in January last year. That figure was the highest since HUD began reporting on the issue to Congress in 2007 .

Abigail Judge of the Medical School (from left) and Sandra Andrade of Massachusetts General Hospital run the outreach program Boston HEAT (Human Exploitation and Sex Trafficking).

Niles Singer/Harvard Staff Photographer

Scholars, healthcare workers, and homeless advocates agree that two major contributing factors are poverty and a lack of affordable housing, both stubbornly intractable societal challenges. But they add that hard-to-treat psychiatric issues and substance-use disorders also often underlie chronic homelessness. All of which explains why those who work with the unhoused refer to what they do as “the long game,” “the long walk,” or “the five-year-plan” as they seek to address the traumas underlying life on the street.

“As a society, we’re looking for a quick fix, but there’s no quick fix for this,” said Stephen Wood, a visiting fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and a nurse practitioner in the emergency room at Carney Hospital in the Dorchester neighborhood of Boston. “It takes a lot of time to fix this. There will be relapses; there’ll be problems. It requires an interdisciplinary effort for success.”

A recent study of 60,000 homeless people in Boston found the average age of death was decades earlier than the nation’s 2017 life expectancy of 78.8 years.

Illustration by Liz Zonarich/Harvard Staff

Katherine Koh, an assistant professor of psychiatry at HMS and psychiatrist at MGH on the street team for Boston Health Care for the Homeless Program, traced the rise of homelessness in recent decades to a combination of factors, including funding cuts for community-based care, affordable housing, and social services in the 1980s as well as deinstitutionalization of mental hospitals.

“Though we have grown anesthetized to seeing people living on the street in the U.S., homelessness is not inevitable,” said Koh, who sees patients where they feel most comfortable — on the street, in church basements, public libraries. “For most of U.S. history, it has not been nearly as visible as it is now. There are a number of countries with more robust social services but similar prevalence of mental illness, for example, where homelessness rates are significantly lower. We do not have to accept current rates of homelessness as the way it has to be.”

“As a society, we’re looking for a quick fix, but there’s no quick fix for this.” Stephen Wood, visiting fellow, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Success stories exist and illustrate that strong leadership, multidisciplinary collaboration, and adequate resources can significantly reduce the problem. Prevention, meanwhile, in the form of interventions focused on transition periods like military discharge, aging out of foster care, and release from prison, has the potential to vastly reduce the numbers of the newly homeless.

Recognition is also growing — at Harvard and elsewhere — that homelessness is not merely a byproduct of other issues, like drug use or high housing costs, but is itself one of the most difficult problems facing the nation’s cities. Experts say that means interventions have to be multidisciplinary yet focused on the problem; funding for research has to rise; and education of the next generation of leaders on the issue must improve.

“This is an extremely complex problem that is really the physical and most visible embodiment of a lot of the public health challenges that have been happening in this country,” said Carmel Shachar, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation. “The public health infrastructure has always been the poor Cinderella, compared to the healthcare system, in terms of funding. We need increased investment in public health services, in the public health workforce, such that, for people who are unhoused, are unsheltered, who are struggling with substance use, we have a meaningful answer for them.”

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Wood, a nurse practitioner in the emergency room at Carney Hospital.

Kris Snibbe/Harvard Staff Photographer

Experts say that the nation’s unhoused population not only experiences poverty and exposure to the elements, but also suffers from a lack of basic health care, and so tend to get hit earlier and harder than the general population by various ills — from the flu to opioid dependency to COVID-19.

A recent study of 60,000 homeless people in Boston recorded 7,130 deaths over the 14-year study period. The average age of death was 53.7, decades earlier than the nation’s 2017 life expectancy of 78.8 years. The leading cause of death was drug overdose, which increased 9.35 percent annually, reflecting the track of the nation’s opioid epidemic, though rising more quickly than in the general population.

A closer look at the data shows that impacts vary depending on age, sex, race, and ethnicity. All-cause mortality was highest among white men, age 65 to 79, while suicide was a particular problem among the young. HIV infection and homicide, meanwhile, disproportionately affected Black and Latinx individuals. Together, those results highlight the importance of tailoring interventions to background and circumstances, according to Danielle Fine, instructor in medicine at HMS and MGH and an author of two analyses of the study’s data.

“The takeaway is that the mortality gap between the homeless population and the general population is widening over time,” Fine said. “And this is likely driven in part by a disproportionate number of drug-related overdose deaths in the homeless population compared to the general population.”

Inadequate supplies of housing

Though homelessness has roots in poverty and a lack of affordable housing, it also can be traced to early life issues, Koh said. The journey to the streets often starts in childhood, when neglect and abuse leave their marks, interfering with education, acquisition of work skills, and the ability to maintain healthy relationships.

“A major unaddressed pathway to homelessness, from my vantage point, is childhood trauma. It can ravage people’s lives and minds, until old age,” Koh said. “For example, some of my patients in their 70s still talk about the trauma that their parents inflicted on them. The lack of affordable housing is a key factor, though there are other drivers of homelessness we must also tackle.”

The number was the highest since the U.S. Department of Housing and Urban Development began reporting on the issue to Congress in 2007 .

Most advocates embrace a “housing first” approach, prioritizing it as a first step to obtaining other vital services. But they say the type of housing also matters. Temporary shelters are a key part of the response, but many of the unhoused avoid them because of fears of theft, assault, and sexual assault. Instead, long-term beds, including those designated for people struggling with substance use and mental health issues, are needed.

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Petrie-Flom’s Wood. “The data is pretty solid on this issue: If you have a substance-use disorder there’s likely some underlying, severe trauma. Yet, when we go to treat them, we address one but not the other. You’re never going to find success in the system that we currently have if you don’t recognize that dual diagnosis.”

Services offered to those in housing should avoid what Koh describes as a “one-size-fits-none” approach. Some might need monthly visits from a caseworker to ensure they’re getting the support they need, she said. But others struggle once off the streets. They need weekly — even daily — support from counselors, caseworkers, and other service providers.

“I have seen, sadly, people who get housed and move very quickly back out on the streets or, even more tragically, lose their life from an unwitnessed overdose in housing,” Koh said. “There’s a community that’s formed on the street so if you overdose, somebody can give you Narcan or call 911. If you don’t have the safety of peers around, people can die. We had a patient who literally died just a few days after being housed, from an overdose. We really cannot just house people and expect their problems to be solved. We need to continue to provide the best care we can to help people succeed once in housing.”

“We really cannot just house people and expect their problems to be solved.”  Katherine Koh, Mass. General psychiatrist

Koh works on the street team for Boston Health Care for the Homeless Program.

Photo by Dylan Goodman

The nation’s failure to address the causes of homelessness has led to the rise of informal encampments from Portland, Maine, to the large cities of the West Coast. In Boston, an informal settlement of tents and tarps near the intersection of Massachusetts Avenue and Melnea Cass Boulevard was a point of controversy before it was cleared in November.

In the aftermath, more than 100 former “Mass and Cass” residents have been moved into housing, according to media reports. But experts were cautious in their assessment of the city’s plans. They gave positive marks for features such as a guaranteed place to sleep, “low threshold” shelters that don’t require sobriety, and increased outreach to connect people with services. But they also said it’s clear that unintended consequences have arisen. and the city’s homelessness problem is far from solved.

Examples abound. Judge, who leads Boston HEAT in collaboration with Sandra Andrade of MGH, said that a woman she’d been working with for two years, who had been making positive strides despite fragile health, ongoing sexual exploitation, and severe substance use disorder, disappeared after Mass and Cass was cleared.

Mike Jellison, a peer counselor who works on Boston Health Care for the Homeless Program’s street team, said dismantling the encampment dispersed people around the city and set his team scrambling to find and reconnect people who had been receiving medical care with providers. It’s also clear, he said, that Boston Police are taking a hard line to prevent new encampments from popping up in other neighborhoods, quickly clearing tents and other structures.

“We were out there Wednesday morning on our usual route in Charlesgate,” Jellison said in early December. “And there was a really young couple who had all their stuff packed. And [the police] just told them, ‘You’ve got to leave, you can’t stay here.’ She was crying, ‘Where am I going to go?’ This was a couple who works; they’re employed and work out of a tent. It was like 20 degrees out there. It was heartbreaking.”

Prevention as cure?

Successes in reducing homelessness in the U.S. are scarce, but not unknown. The U.S. Department of Veterans Affairs, for example, has reduced veteran homelessness nationally by more than 50 percent since 2010.

Experts point out, however, that the agency has advantages in dealing with the problem. It is a single, nationwide, administrative entity so medical records follow patients when they move, offering continuity of care often absent for those without insurance or dealing with multiple private providers. Another advantage is that the VA’s push, begun during the Obama administration, benefited from both political will on the part of the White House and Congress and received support and resources from other federal agencies.

The city of Houston is another example. In 2011, Houston had the nation’s fifth-largest homeless population. Then-Mayor Annise Parker began a program that coordinated 100 regional nonprofits to provide needed services and boost the construction of low-cost housing in the relatively inexpensive Houston market.

Neither the VA nor Houston was able to eliminate homelessness, however.

To Koh, that highlights the importance of prevention. In 2022, she published research in which she and a team used an artificial-intelligence-driven model to identify those who could benefit from early intervention before they wound up on the streets. The researchers examined a group of U.S. service members and found that self-reported histories of depression, trauma due to a loved one’s murder, and post-traumatic stress disorder were the three strongest predictors of homelessness after discharge.

In April 2023, Koh, with co-author Benjamin Land Gorman, suggested in the Journal of the American Medical Association that using “Critical Time Intervention,” where help is focused on key transitions, such as military discharge or release from prison or the hospital, has the potential to head off homelessness.

“So much of the clinical research and policy focus is on housing those who are already homeless,” Koh said. “But even if we were to house everybody who’s homeless today, there are many more people coming down the line. We need sustainable policies that address these upstream determinants of homelessness, in order to truly solve this problem.”

The education imperative

Despite the obvious presence of people living and sleeping on city sidewalks, the topic of homelessness has been largely absent from the nation’s colleges and universities. Howard Koh, former Massachusetts commissioner of public health and former U.S. assistant secretary for Health and Human Services, is working to change that.

In 2019, Koh, who is also the Harvey V. Fineberg Professor of the Practice of Public Health Leadership, founded the Harvard T.H Chan School of Public Health’s pilot Initiative on Health and Homelessness. The program seeks to educate tomorrow’s leaders about homelessness and support research and interdisciplinary collaboration to create new knowledge on the topic. The Chan School’s course “Homelessness and Health: Lessons from Health Care, Public Health, and Research” is one of just a handful focused on homelessness offered by schools of public health nationwide.

“The topic remains an orphan,” said Koh. The national public health leader (who also happens to be Katherine’s father) traced his interest in the topic to a bitter winter while he was Massachusetts public health commissioner when 13 homeless people froze to death on Boston’s streets. “I’ve been haunted by this issue for several decades as a public health professional. We now want to motivate courageous and compassionate young leaders to step up and address the crisis, educate students, motivate researchers, and better inform policymakers about evidence-based studies. We want every student who walks through Harvard Yard and sees vulnerable people lying in Harvard Square to not accept their suffering as normal.”

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History of Homelessness

Homelessness has surged and receded throughout the nation’s history, with spikes during the colonial period, pre-industrial era, post-Civil War years, Great Depression, and today. 

While there are many drivers of modern-day homelessness, it is largely the result of failed policies; severely underfunded programs that have led to affordable housing shortages; wages that do not keep up with rising rents and housing costs; inadequate safety nets; inequitable access to quality health care (including mental health care), education, and economic opportunity; and mass incarceration. In effect, more than half of Americans live paycheck to paycheck and one crisis away from homelessness.

At the root of these systemic failures is historical and ongoing racism. From slavery and the Indian Removal Act to redlining and mass incarceration, people of color and other historically marginalized groups (such as LGBTQI+ youth) have been denied rights and excluded from opportunities in ways that continue to have negative impacts today.   

State of Homelessness

Homelessness in the United States is an urgent public health issue and humanitarian crisis. It impacts cities, suburbs, and rural towns in every state. Housing is a social determinant of health, meaning lack of it has a negative impact on overall health and life expectancy.  Tens of thousands of people die every year due to the dangerous conditions of living without housing—conditions that have worsened due to climate change’s rise in extreme weather. People who experience homelessness die nearly 30 years earlier than the average American—and often from easily treatable illnesses.

Given the pervasiveness of homelessness, most Americans—often unknowingly—have friends, family, coworkers, or neighbors who are experiencing homelessness today or who have experienced homelessness at some point in their lives.

While homelessness impacts people of all ages, races, ethnicities, gender identities, and sexual orientations, it disproportionately impacts some groups and populations. Compared to   the portion of the U.S. population they make up, people of color, for instance, are overrepresented in the population experiencing homelessness. 

People with preexisting health issues are also more likely to experience homelessness—particularly unsheltered—and they are  up to seven times more likely to lack health insurance. While rates of homelessness for people with severe mental health or substance use issues are high,  the majority of people experiencing homelessness have neither a severe mental health nor substance use issue. Furthermore, the large majority of Americans with mental health and substance use issues do not experience homelessness. 

Homelessness Data 

There are two main sources of federal homelessness data: the  Annual Homeless Assessment Report , published by the Department of Housing and Urban Development; and the  Annual Student Homelessness in America Report , published by the Department of Education’s technical assistance operator, the National Center for Homeless Education.

Several other agencies—including the departments of Agriculture and Defense; the Census Bureau; the Office of Head Start; and the Health Resources and Services Administration—collect data on homelessness that USICH publishes in reports, which can be found here .

Homelessness Fact vs. Fiction 

There are many myths about the causes of and solutions to homelessness, particularly the “Housing First” approach that has been proven by  decades of research to be effective and   cost-effective. Below are some of the most common myths—and the reality surrounding them:

Myth: People experiencing homelessness just need to get a job.   

Fact:  While employment helps people stay housed, it does not guarantee housing. As many as 40%-60% of people experiencing homelessness have a job, but housing is unaffordable because wages have not kept up with rising rents.  There is no county or state   where a full-time minimum-wage worker can afford a modest apartment. At minimum wage, people have to work 86 hours a week to afford a one-bedroom. Even when people can afford a home, one is not always available. In 1970, the United States had a surplus of 300,000 affordable homes. Today, only 37 affordable homes are available for every 100 extremely low-income renters. As a result, 70% of the lowest-wage households spend more than half their income on rent, placing them at high risk of homelessness when unexpected expenses (such as car repairs and medical bills) arise.

Myth: People experiencing homelessness choose to live outside in tents or cars.

Fact:  Homelessness usually happens because of economic reasons (such as job loss), and many p eople have nowhere else to go but outside. Many shelters are full or limited to people who are sober, straight, free of disability or criminal history, and/or willing to separate from their children, partners, or pets. These discriminatory policies leave parents, couples, pet owners, LGBTQI+ members, and people with addictions, disabilities, or criminal records on the streets, where they live in constant f ear of hunger, violence, storms, and infectious disease.  “Out of sight, out of mind” laws that make it illegal to sit or sleep in public outdoor spaces only exacerbate the revolving door between homelessness and incarceration, and they do not solve homelessness. Housing and supports solve homelessness—not handcuffs.

Myth: People experiencing homelessness are dangerous and violent.   

Fact:  Not having a home does not make someone a criminal, just like having a home does not make someone innocent of any and all crimes. According to data, people experiencing homelessness are far more likely to be victims of violent crime than to commit violent crime. But because of the infrequency of violent crimes committed by people experiencing homelessness, they tend to be considered “newsworthy” and attract more media attention.    

Myth:   Most people experiencing homelessness have a substance use and/or mental health disorder.

Fact:   While rates of homelessness for people with severe mental health or substance use disorders are high, the majority of people with no home also have no mental health or substance use disorder. Furthermore, the large majority of Americans with mental health or substance use disorders do not experience homelessness, demonstrating that mental health and substance use disorders do not cause homelessness.

Myth: Homelessness is not preventable.

Fact:  Homelessness is a policy choice, and the COVID-19 pandemic proved the power of prevention. During the pandemic, governments instituted eviction moratoriums, deployed emergency rental assistance, expanded unemployment assistance and the Child Tax Credit, and issued cash directly to millions of lower-income Americans. In effect, poverty dropped by 45%, millions of evictions were prevented, and homelessness remained steady during a time when a surge in homelessness would have been expected. 

Myth: Housing First only helps people get housing but does not address the issues that led them to homelessness—and could again.

Fact:  The Housing First approach recognizes that housing is the immediate solution to homelessness—but not the only solution. Housing First offers support (such as substance use treatment, legal aid, or job training) at the same time as housing and continues to offer support long after people are housed to prevent them from losing their home again. One element that sets Housing First apart from some other approaches is that it does not force people to accept support. F orced mental health or substance use treatment, for instance, is proven to be largely ineffective and to have unintended, harmful, even deadly consequences.   

Myth: Housing First is expensive and ineffective.

Fact:  Decades of research prove how effective and cost-effective Housing First can be.  Studies show that 9 out of 10 people remain housed a year after receiving Housing First assistance, and that housing can be three times cheaper than criminalization.   According to a recent study, Housing First pays for itself within 1.5 years and can reduce homelessness and government reliance—all while getting people back to work. 

Poverty Solutions at the University of Michigan

Explore Poverty Solutions’ research on homelessness in the journal articles, working papers, policy briefs, news releases, and ongoing research projects listed below.

Homelessness Research Scholars

Jennifer Erb-Downward

Director of Housing Stability Programs and Policy Initiatives

Barbara L. Brush

Carol J. and F. Edward Lake Professor of Population Health, School of Nursing

In the Media

The Alpena News | Apr. 11, 2024

Column: Kids should not be left behind

EdSource | Apr. 3, 2024

Only 1 in 6 homeless infants and toddlers enrolled in early childhood programs in California, study finds

New York Times / The Upshot | Oct. 2, 2023

The Americans Most Threatened by Eviction: Young Children

Publications.

By Jennifer Erb-Downward and Amanda Nothaft

By Kasia Klasa, Naquia Unwala, Scott L. Greer, Julia A. Wolfson, and Charley E. Willison

By Jennifer Erb-Downward and Michael Blakeslee

By SchoolHouse Connection and Poverty Solutions at the University of Michigan

By Jennifer Erb-Downward and Safiya Merchant

By Michael Evangelist and H. Luke Shaefer

By Jennifer Erb-Downward and Payton Watt

By Jennifer Erb-Downward

By Jennifer Erb-Downward and Michael Evangelist

News Releases

Developing youth leadership to end youth homelessness

Chronic housing instability poses educational risk for Detroit students

New policy brief from Wayne State University, Poverty Solutions reveals Detroit schools under-identify homeless students

Research projects.

Poverty Solutions supports several projects that aim to promote a better understanding of the causes and consequences of homelessness and identify potential points of intervention.

Work Related Transdiagnostic Cognitive Behavioral Therapy for Unemployed Homeless Persons with Anxiety and Depression

Improving Coordination to Reduce Service Gaps and Increase Efficacy in Child and Family Homelessness Policy and Programming The project: The national system for preventing and addressing homelessness, known as the Continuum of Care (CoC), is not well understood, and the capacity of these systems to successfully address homelessness has never been evaluated. The Continuums of Care are most often locally-organized groups of actors that receive funding from the federal government to create and…

Breaking the Cycle: Refining the Trauma-Informed Clinical Ethnographic Narrative Interview (CENI) The project: In 2016, over 9,700 family households across Michigan, accounting for 24,766 people, entered an emergency shelter due to homelessness. The majority of these households were headed by a single female with one or two children under 11 years of age. Prior research has demonstrated that more than 90% of mothers who become homeless…

Center for Urban Studies

New report indicates alternative shelters lead to better outcomes for people experiencing homelessness

by Katy Swordfisk April 16th 2024 Share

A new report from Portland State University’s Homelessness Research & Action Collaborative (HRAC) indicates that alternative shelters provide better outcomes for people experiencing homelessness than traditional shelters. The research, conducted by HRAC on behalf of Multnomah County’s Joint Office of Homeless Services (JOHS), analyzed the cost, participant experiences, and client outcomes in village-style and motel shelters as compared to more traditional congregate shelters.

"This research shows that motel and village shelters, which provide private living spaces that support the autonomy, dignity, and safety of clients, lead to better experiences and more positive outcomes than congregate shelters," said Jacen Greene, HRAC assistant director.

Village and motel shelter models have grown in recent years as an alternative to traditional shelters. In Portland, several villages have been constructed by community members and local agencies to better support the houseless population. This report shows that the village model is not only more desirable to people experiencing homelessness, but can be less expensive in some circumstances to build than congregate shelters. The success rate for moving an individual into housing is also higher than at traditional shelters.

“Alternative shelters provide participants with levels of privacy, autonomy, and safety that are not always present in congregate shelters,” according to the report. “These factors helped participants feel like they could pause, breathe, and work toward their goals."

As compared to other shelter models, villages have the lowest capital costs per unit when the land is free (as has been the case for villages in Portland), but are more expensive than motel or congregate shelters if land costs and pod replacements are factored in. Motel shelters are often faster to set up and are more flexible in terms of conversion to housing, but can be difficult to set up due to supply. In evaluating cost, HRAC found that moving a person into housing and providing supportive services — like rental assistance or vouchers — is comparable to the cost of providing a congregate shelter bed, and costs less than alternative shelters.

"We found that placing somebody into housing, paying their rent, and providing supportive services is usually a less costly alternative than any type of temporary shelter, and is the only approach that actually ends homelessness," Greene said.

These findings provide guidance to determine which type of shelter is most appropriate based on the circumstances of the population being served. An effective shelter strategy should:

• Utilize shelter types with individual, private rooms
• Size shelters to a smaller total number of units
• Center equity in services and programming
• Include identity-supportive shelters and/or programming
• Locate shelters close to essential services and amenities
• Consider long-term shelter costs and site usage/conversion potential in planning
• Incorporate input and feedback from people with lived experience of homelessness

“Ultimately, any shelter strategy should be viewed as a temporary stopgap until enough housing can be provided to address current and forecasted needs,” according to the report. “Someone in a shelter is still experiencing homelessness, and the only true solution to homelessness is to ensure that people who are housed are able to remain there, and people who are unhoused are placed in housing as soon as possible.” 

A way to support housing options for homelessness into a neighborhood

Donald Burnes, co-founder of the Burnes Institute for Poverty Research at the Colorado Center on Law and Policy, has been writing, teaching, and working on homelessness for the past 40 years. He talks about that work, places that have successfully responded to and reduced homelessness, and correcting misinformation about people who are unhoused

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Most of us tend to agree that we want to see an end to homelessness, that we would prefer to be part of the solution to help people who are unhoused acquire secure, permanent housing. When housing plans and options are suggested for various neighborhoods, though, the loudest response tends to be that we don’t want those options anywhere near us.

That’s what happened in Spring Valley earlier this month in response to the building of 150 proposed sleeping cabins on Jamacha Road near state Route 125. Residents cited concerns for safety and that they didn’t feel like their elected officials were listening to their concerns—something that has been repeated in communities across the country when these housing options are proposed.

Donald Burnes has seen this happen a lot in his work. As co-founder of the Burnes Institute for Poverty Research at the Colorado Center on Law and Policy , he’s also co-authored four books on the topic of homelessness (including “When We Walk By: Forgotten Humanity, Broken Systems, and the Role We Can Each Play in Ending Homelessness in America”), taught graduate level courses, and has been working in this area for the past 40 years. While there are more people experiencing homelessness today than when he started, he still believes in our collective ability to end homelessness, but it’ll take providing people with an accurate picture of people who are unhoused, correcting misinformation about crime and safety issues, and approaching conversations by engaging with as many people who will be affected, as early in the process as possible. He took some time to talk about his own work and research, and places that have successfully reduced homelessness and created a more welcoming and supportive community. (This conversation has been edited for length and clarity. For a longer version of this conversation, )

Q: Recently, a group of residents in San Diego County’s Spring Valley community voiced their opposition to a proposed plan that would provide housing/shelter options in the form of sleeping cabins for people experiencing homelessness. Among their concerns, residents cited “having them right in a community, right in front of houses and schools,” according to NBC San Diego . This is a common sentiment among opponents to various housing and sheltering plans in communities across the country. Can you talk about some of the myths or stereotypes that people appear to hold about folks who are unhoused? Where do these ideas come from and are they close to the reality of what you’ve studied?

A: There are lots of myths. One of the myths is that substance abuse and mental illness are the primary causes of homelessness. That simply isn’t true. All the research suggests that about 25 to 30 percent of people experiencing homelessness have a severe mental illness, and about the same percentage have severe substance use disorders [in 2023, about 30 percent of the people surveyed who were experiencing homelessness reported having a serious mental illness and 24 percent reported conditions related to chronic substance abuse, according to the National Alliance to End Homelessness ].

A second myth is that everybody has moved, in this case to Spring Valley, because San Diego’s a wonderful place to be and people are just arriving there because of the weather and because of services. All of the national research suggests that somewhere between 70 and 80 percent of people experiencing homelessness, their last actual housing situation was in the same community where they’re now experiencing homelessness [ research from the San Diego Regional Task Force on Homelessness notes that 80 percent of people experiencing homelessness said they became homeless in San Diego]. They’re homegrown, they haven’t moved into the area from somewhere else.

Another myth is, “People are lazy, crazy, drunks, druggies” or “They’ve made a bad decision.” That’s sort of the myth of people experiencing homelessness. First of all, there are a lot more people in housing who are “lazy, crazy, drunks, druggies,” and who among us has never made a bad decision? One of the frequent phrases is, “Get a job, bum,” so there’s a myth that all the people experiencing homelessness are not working. In fact, something like 40 to 45 percent of adults experiencing homelessness are working, most of them in full-time jobs, they just are not making enough money to pay the rent [ a 2021 study from the University of Chicago estimated that more than half of people living in homeless shelters and 40 percent of people who were unsheltered were employed]. So, that’s another kind of negative stereotype that is so prevalent. For a lot of us, our only direct connection to people experiencing homelessness is those that we see in public and it’s the guys on the street, holding their cardboard signs at a stoplight or panhandling somewhere or sleeping in a doorway or a business’s front steps. Those folks are a relatively small portion of the total population of people experiencing homelessness, so the vast majority of people experiencing homelessness are people we don’t see. They’re, again, in shelters of one kind or another, they’re in some kind of transitional housing, safe houses of one kind or another. The other thing that nobody realizes is that the HUD definition of homelessness does not include people who are doubled up [sharing housing with other families due to a loss in housing, economic hardship, or domestic violence, according to the National Center for Education Statistics ], families who are doubled up with kids are not considered homeless.

Q: A 2022 report in the Journal of Housing and the Built Environment ( “NIMBYism as a barrier to housing and social mix in San Francisco” ) mentions a potential, if unlikely, counter to NIMBYism in the form of how housing can be framed to residents in a community, by highlighting the public benefits. What could that look like when recommending sheltering options in a particular community? Has there been evidence of this working in favor of these sheltering options?

A: There are some striking examples and the two that I’m most familiar with, interestingly enough, are in Texas. One is the community village in Austin, Texas. They created a real community of something like 500 people [ the Community First! Village ]. Some are in tents, most in tiny homes of one kind or another. They’ve created a retail space there. It really is quite an amazing place and this has all been done in the last three or four years, so that’s an example of what can happen. The other example that I’m familiar with is the city of Houston. What they did was make sure that in the initial coordinated planning effort, all of the relevant parties were involved. So, the police, the fire department, the school people that have been in this community—everybody came together and said, ‘OK, let’s develop a collaborative, coordinated plan to address this issue,’ which is very, very unlike what happens in most communities. Because of that, they have had a significant reduction in homelessness over the last three or four years. It’s really quite amazing, so yes, it can happen.

I think there are a number of benefits. One is if you open up communities like this, then people who are there have a much safer, more secure space in which to live and they are more likely to end up employed, which is going to add to the tax base. Another thing is if you allow it to happen, you can create a real sense of community, which is exactly what has happened in Austin. So, people get to know each other and it’s housed people who are getting to know people who have been formerly unhoused. That’s a very real value to both sides. The other thing is, and this is hard to believe, but it’s in all the research says that this is true: it is economically cheaper to do the right thing than to allow people to continue to live as they currently are. This is because of the cost of medical care, the cost of criminal justice system care, and the cost of monitoring homelessness. It is really about 40 to 50 percent less expensive to provide housing and services than it is to continue to allow people to run up the cost of medical care and the jails and prisons and so on [ the National Alliance to End Homelessness reports that average taxpayer costs to respond to chronic homelessness are reduced by nearly half when there is an investment in permanent supportive housing]. Most people simply don’t understand that. One of the problems is that the initial expense is greater if you start providing housing and services, but over time it evens out and it becomes less expensive than it would be if you did nothing. So, those are all the benefits to a community.

Q: There seems to be an irony in conversations about homelessness and a desire to respond to it, to resolve it, while simultaneously wanting people who are unhoused to be unhoused elsewhere — to ultimately be pushed away from community. From your research and work, what would be some of the most just ways to address this kind of response?

A: In many communities, the overwhelming response to the question, “Should we be doing more to provide assistance to those experiencing homelessness?” is, “Yes, however, don’t do it in my neighborhood.” As you say, appropriately, NIMBYism is unfortunately alive and well. I think there are a number of factors that are involved in this. One is xenophobia, which is basically, ‘We don’t like people who are different from us.’ That’s always been true in our history and it continues to be true. You look at issues about race, about gender, and people who are different from us are “them,” they’re not “us.” Unfortunately, a lot of the people who say they want to do right, but don’t do it here, a lot of their reaction is based on what they see on the streets, but that’s only a small portion of the population. All of the examples of what happens when you provide tiny home villages or safe outdoor spaces, or even safe parking initiatives, is if you do it the right way, the kind of fears that people are dominated by, they don’t materialize. If you provide security, safety is not an issue. If you provide appropriate trash receptacles, there isn’t litter all over, everywhere. If you provide the right kind of health and bathroom facilities, that doesn’t become an issue. If it’s connected to some kind of a feeding program, that’s not an issue. If you actually screen people before getting them into these villages, all of the research suggests that you don’t have the kinds of problems that people are afraid of. How you convince people of that is a very, very difficult problem because, unfortunately, most of the people get their information and inform their attitudes based on fairly negative portrayals on TV and in the news, and those don’t help at all because, by and large, they’re talking about a relatively small portion of the population.

This is one of the things we say in the book, “If this person was your son or daughter, your nephew or your niece, a brother or a sister, you always go to the ends of the earth to make sure that person has the kind of housing they needed.” The thing is that all of the folks experiencing homelessness are, in fact, somebody’s brother, sister, nephew, niece, son, daughter, so why aren’t we prepared to go to the ends of the earth to provide them the kind of housing they need? One of our phrases is, “Everybody is someone’s somebody.” Why can’t we treat them as our brothers and sisters rather than as somebody less than human? I just find that, in some ways, very disheartening, but we’ve got to keep fighting to overcome that.

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Water security is critical for poverty reduction, but billions will remain without water access unless urgent action is taken

WASHINGTON, May 20, 2024 — Access to safe drinking water and sanitation, reliable water-supply for agriculture and industry, and protection against droughts and floods are essential for human and economic development, a World Bank report released on Monday states.

Over the past 20 years, the number of people lacking safe drinking water and basic sanitation has increased by 197 million and 211 million, respectively. Today, over two billion people still lack access to safe drinking water, and 3.5 billion are deprived of safely managed sanitation facilities. Resulting infectious diseases contribute to at least 1.4 million annual deaths and 50% of global malnutrition.

Lack of access to safe water and sanitation is particularly harmful in childhood, Water for Shared Prosperity , a report released at the 10 th World Water Forum in Bali, Indonesia by the World Bank Group and the Government of Indonesia, says. Inadequate and unsafe water affects early childhood development, and time spent fetching water, inadequate sanitation and hygiene and droughts or floods disrupt learning and lead to school dropouts.

Climate change is amplifying water-related risks. Driven by global emissions, developing countries are most affected by climate shocks. Between 2000 and 2021, developing countries experienced more severe droughts and longer lasting floods than advanced economies, with long-term effects on nutrition, school attendance and economic welfare. Developing countries disproportionately rely on water-dependent sectors, particularly agriculture, for employment. Globally, over 800 million people are at high-risk of droughts and twice as many live in flood-risk hotspots.

“To improve livelihoods, significant reforms and investments are needed to provide efficiently managed water and sanitation services to those without access, and to strengthen resilience against hydro-climatic risks,” said World Bank Vice President for East Asia and the Pacific Manuela V. Ferro , who is leading the World Bank team at the World Water Forum.

Water for Shared Prosperity offers specific recommendations on how to improve water security in developing countries: Protecting depleting aquifers and unevenly distributed freshwater resources will require more international cooperation, implementing proven nature-based solutions such as reforestation and investing in water storage infrastructure to prevent run-off and make water available in dry periods.

Policies to upgrade housing, and land use regulations to prevent construction in flood-prone areas can reduce exposure. Early warning systems and insurance can help households and farmers cope with extreme hydro-climatic shocks.

Reforming water tariffs and poorly-targeted subsidies, while ensuring affordability for low-income households, can help maintain and expand services and allocate scarce water resources fairly. Service providers will also need to enhance their operations, reducing water losses and lowering operating costs. Supported by policies that ensure transparency and accountability, the private sector can offer valuable expertise to enhance efficiency and manage complex infrastructure.

A spotlight section of the report examines how Indonesia, the host of this year's triennial World Water Forum, is addressing water security challenges. Indonesia has made significant investments to enhance resilience to climate-related risks, including investments in 61 dams to store water and increase irrigated areas.  A Community-Based Water Supply Program has provided more than 24 million people with improved water facilities. The government has prioritized reducing pollution and environmental degradation in the Citarum River Basin in West Java, and is pioneering treatment of peat water to making it suitable for drinking through the National Urban Water Supply project.

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First Look: Understanding the Governor’s 2024-25 May Revision

May 2024 | By California Budget & Policy Center

• Table of Contents
• Our Statement on the May Revision
• Event registration: Examining the Governor’s 2024-25 May Revision

Introduction

Governor Gavin Newsom released a summary of the May Revision to his proposed 2024-25 California state budget on May 10, projecting a $44.9 billion shortfall, or $27.6 billion shortfall, when taking into account early budget action taken by the legislature in April to reduce the shortfall by $17.3 billion. While many of the details are forthcoming, the governor proposes to close the budget gap through the partial use of reserves, spending cuts, and delays or deferrals of spending authorized in earlier years. While the $201 billion General Fund spending plan would protect many investments made in prior years, it also includes cuts and delays to programs and services that affect the day-to-day lives of Californians, particularly foster youth, Californians with disabilities, immigrant communities, students, and families with young children. Notably, the administration’s strategy demonstrates continued resistance to adopting long-term revenue solutions, putting corporate profits over families. This shortsighted approach exacerbates wealth inequality, stalls progress, and undermines the governor’s vision of a California for all.

WHat is the May Revision?

Released on or before May 14, the May Revision updates the governor’s economic and revenue outlook; adjusts the governor’s proposed expenditures to reflect revised estimates and assumptions; revises, supplements, or withdraws policy initiatives that were included in the  governor’s proposed budget  in January; and outlines adjustments to the minimum funding guarantee for K-14 education required by  Proposition 98 (1988) .

The rapid shift from a budget surplus, as was the case in recent fiscal years, to the budget shortfall we face today, is a lingering effect of the unprecedented COVID-19 pandemic and its impact on the economy. The projected budget shortfall is primarily the result of state revenue collections that the administration now projects are $11 billion lower over the three-year budget window (fiscal years 2022-23 through 2024-25) than was anticipated in the governor’s January proposal. The shortfall reflects the steep stock market decline in 2022 — after significant growth in 2020 and 2021 — that negatively impacted income tax collections from high-income Californians and corporations, as well as the economic dampening effects of the Federal Reserve’s interest rate hikes.

Lower state revenues over the three-year budget window result in automatic adjustments to constitutionally-required funding allocations, including to the state’s main reserve and education reserve accounts, as well as reduced funding for K-12 schools and community colleges.

The governor’s proposed solutions to cover the shortfall would partially draw down on various state reserves . The solutions include using $12 billion enacted through legislative early action in April, however, just $3.1 billion would be used in 2024-25, and $8.9 billion would be shifted to 2025-26. The administration also proposes draining the Safety Net Reserve ($900 million), withdrawing $2.6 billion from the Public School System Stabilization Account for education, and leaving an estimated $22.9 billion for future use.

The administration’s proposals include billions in cuts, delays, and deferrals of critical investments intended to improve the health and well-being of all Californians. Reductions that will disproportionately affect the lives of low-income communities, Californians of color, Californians with disabilities, and families with children include, among others:

• Ongoing cuts to CalWORKs for supportive services, home visiting, and mental health/substance abuse services (despite draining the Safety Net Reserve intended to be used to avoid cuts to CalWORKs) and a one-time cut in employment services,
• Cuts to programs that help address homelessness and provide affordable housing,
• Indefinitely delaying further expanding child care slots, 
• Various reductions in investments in behavioral health, including cuts to infrastructure, housing, workforce, and youth behavioral health initiatives,
• Cuts in ongoing support for public health and one-time investments in the health workforce, 
• Cuts to services for Californians who are undocumented, including ongoing support for the expansion of In-Home Support Services (IHSS) and delayed expansion of the California Food Assistance Program (CFAP),  
• Pulling back investments in transitional kindergarten (T-K) facilities and pre-kindergarten (pre-K) inclusivity of students with disabilities.

The revised budget also continues to utilize a controversial accounting maneuver to shift $8.8 billion in K-12 schools and community college (K-14) costs  — on paper — from 2022-23 to later fiscal years and pay for these delayed expenses using non-K-14 funds. 

The May Revision proposals would protect and maintain some progress made in prior budget years to help improve economic security and opportunities for Californians with low incomes and Californians of color, including expanding full-scope Medi-Cal coverage to all Californians, maintaining investments in cash assistance through the CalEITC, Young Child Tax Credit, and Foster Youth Tax Credit, and temporary rate increases for child care providers.

However, state leaders have the tools and resources to prevent other harmful cuts. By further tapping into the state’s main rainy day fund and permanently reducing tax breaks for profitable corporations, state leaders can ensure corporations pay their fair share and avoid cuts to services that help Californians stay healthy, housed, and put food on the table.

This First Look report outlines key pieces of the May Revision to the 2024-25 California budget proposal, and explores how the governor prioritized spending and determined cuts to balance the budget amid a sizable projected state budget shortfall.

Budget Overview

Economic Outlook : Revised Budget Projects Moderate Job and Wage Growth Revenue : Revised Budget Reflects Additional $11 Billion Downgrade in Revenue Outlook Tax Policy : Modified Tax Proposals Include Temporary Business Tax Break Limitations Reserves : May Revision Includes Withdrawal of Reserve Funds, Proposes New Fund to House “Excess Revenue”

Coverage, Affordability & Access : Governor Upholds Medi-Cal Expansion, Amends MCO Tax, Proposes Harmful Cuts Health Workforce: Revised Budget Severely Cuts Health Care Workforce Development Behavioral Health : Behavioral Health Initiatives Mostly Sustained, But New Cuts Proposed Public Health : Cuts to Public Health Leave Californians Vulnerable to Future Threats

Homelessness & Housing

Homelessness : May Revision Reduces Limited Funding for Homelessness Housing : May Revision Proposes Deeper Cuts for Affordable Housing

Economic Security

Overview: May Revision Proposes Alarming Cuts to Vital Safety Nets Refundable Tax Credits : Revised Budget Maintains Tax Credits for Californians with Low Incomes Refundable Tax Credits: Revised Budget Does Not Implement Workers’ Tax Credit Slated for 2024 CalWORKs : May Revision Proposes Additional Cuts to Critical CalWORKs Support Services Food Assistance : Governor Proposes Cuts and Delays to Previous Food Assistance Commitments Child Care : Governor Maintains Temporary Rate Increase, Pauses Slot Expansion Californians with Disabilities : Governor Protects SSI/SSP but Cuts Key Services for People with Disabilities Immigrant Californians : Proposal Eliminates and Delays Vital Services for Immigrant Californians, Maintains Cut to Legal Services Domestic Violence : Governor Does Not Provide Needed Support to Domestic Violence Survivors

Early Learning & Pre-K : Transitional Kindergarten Expansion Continues While Facilities are Cut Proposition 98 : K-14 Education’s Minimum Funding Level Drops Due to Lower Revenue Estimates K-12 Education : Budget Proposal Relies on Reserves to Support K-12 School Funding Formula Community Colleges : Revised Budget Increases Reserve Withdrawals for Community Colleges Funding CSU/UC : Revised Proposal Maintains Deferrals for the CSU and UC Systems Student Financial Aid : May Revision Abandons Commitments to Expand Student Financial Aid

Justice System

State Corrections : May Revision Calls for Deactivating Prison Housing Units, but Not Prison Closures Retail Theft : Revised Budget Continues to Provide Over $100 Million to Address Retail Theft Proposition 47 Investments : Revised Budget Estimates Proposition 47 Savings of $95 Million for Local Investments

Workforce & Climate Change

Other/General Workforce : Governor Proposes Additional Cuts to Several Workforce Programs Climate Change : Revised Budget Proposes Further Cuts to Prior Environment Commitments

virtual event

How does the governor’s administration navigate and prioritize spending in the face of a challenging fiscal landscape?

Join us for this free, virtual event on May 22.

Revised Budget Projects Moderate Job and Wage Growth

The administration’s economic outlook projects trends in major economic indicators that affect state tax collections and revenues in the budget. The revised outlook projects steady, but slowing national economic growth into next year, with California job gains expected to remain relatively weak through 2025. The number of nonfarm jobs in the state is forecast to increase by just 0.1% in 2024 and 0.4% in 2025, following a stronger increase of 0.9% in 2023 and 1.5% in 2019, just before the pandemic. California’s unemployment rate is projected to remain relatively higher in the near term as well: 5.2% in 2024 and 5.3% in 2025, up from 4.7% in 2023 and 4.1% in 2019. Wages and incomes are also expected to grow more slowly this year and next than just prior to and coming out of the pandemic downturn. The revised budget does not project a recession in the near term, but does note that if inflation remains elevated, the Federal Reserve could maintain higher interest rates which could slow economic activity by more than projected. 

While the administration’s outlook is useful for understanding how economic conditions might impact budget revenues, it’s also important to consider how economic conditions are affecting Californians with low incomes, who count on programs and services funded by the budget. In March 2024, the majority of California households with incomes under $25,000 (55%) reported having difficulty paying for basic needs like food, housing, and medical expenses, according to the most recent US Census Pulse survey. Black, Latinx, and other Californians of color, as well as households with children were more likely to struggle paying for basic expenses. The Census data from March also show that 42% of Black households with children and 32% of Latinx households with children did not have enough to eat , compared to 15% of white households with children. Among all households with children, about one-quarter (24%) had insufficient food. In addition, the latest Census data show that California continues to have the highest poverty rate of the 50 states based on the Supplemental Poverty Measure, which provides a more accurate picture of poverty by accounting for differences in the cost of housing across communities. Housing costs in California typically exceed costs in the rest of the nation, and rents have risen sharply in many parts of the state in recent years making it difficult for Californians with low incomes to afford housing .

Revised Budget Reflects Additional $12.5 Billion Downgrade in Revenue Outlook

The governor’s revised proposal is based on an updated revenue estimate for the three-year budget window spanning fiscal years 2022-23 through 2024-25. After lower-than-expected tax collections since the governor’s January proposal, the administration now expects General Fund revenues to be about $12.5 billion lower over that window than the January estimate. This is before taking into account loans and transfers, the governor’s revenue proposals, and other budget solutions ( see Tax Proposals section ).

The administration continues to have a more optimistic revenue outlook than the Legislative Analyst’s Office, which recently projected that the three-year total of the “Big Three” General Fund revenues sources — personal income taxes, corporate taxes, and sales taxes, which together make up the majority of General Fund revenues — could be around $19 billion lower than the governor’s January projection.

After accounting for automatic spending changes resulting from the lower revenue estimate, the governor estimates that the downgraded revenue outlook results in a $7 billion addition to the three-year state deficit the governor identified in January. 

The administration expects state revenue growth to generally return to the pre-pandemic pattern after the dramatic spike in revenues during the pandemic as the stock market surged and then subsequently corrected.

Modified Tax Proposals Include Temporary Business Tax Break Limitations

In January, the governor proposed a modest package of revenue solutions that included limiting the extent to which businesses can use prior-year losses to offset their taxable profits (“Net Operating Loss carryforwards”), eliminating oil and gas tax subsidies, and other minor tax changes. These revenue proposals made up less than 1% of the total budget solutions proposed in January.

The May Revision modifies the January revenue-related proposals by:

• Replacing the previous Net Operating Loss proposal with temporary business tax benefit limits.
• Clarifying existing law for how some multinational corporations calculate their taxable income in California.

The updated proposal would suspend the use of Net Operating Losses for businesses with state income above $1 million, and limit total business tax credits that a business can use in a single year to $5 million. The tax credit limit would exclude Low-Income Housing Tax Credits as well as Pass-Through Entity Elective tax credits. These limitations would be in effect for up to three years, beginning with the 2025 tax year, and could be eliminated if the administration determines that the revenue situation has improved sufficiently by the 2025-26 May Revision. The administration estimates these limitations would raise revenues by $900 million in 2024-25 and $5.5 billion in 2025-26.

The administration expects this proposal to raise $216 million in the budget window.

While temporary limitations on businesses’ ability to reduce their state income taxes help to address the deficit in the short-term, the governor’s revised proposal does little to increase state revenues on an ongoing basis and misses key opportunities to make the state’s tax system more fair. Policymakers should consider permanent limitations on business tax credits — as some states already do — to ensure that businesses are not paying next to nothing in state income taxes when they turn large profits. State leaders should also explore other options to permanently increase state revenues by making the corporate tax system more fair and eliminating or reforming other costly and inequitable tax breaks , which are not regularly considered as part of the budget process.

May Revision Includes Withdrawal of Reserve Funds, Proposes New Fund to House “Excess Revenue”

California has a number of state reserve accounts that set aside funds intended to be used for a “rainy day” when economic conditions worsen and state revenues decline. Some reserves are established in the state’s Constitution to require deposits and restrict withdrawals, and some are at the discretion of state policymakers.  

California voters approved Proposition 2 in November 2014 , amending the California Constitution to revise the rules for the state’s Budget Stabilization Account (BSA) , commonly referred to as the rainy day fund. Prop. 2 requires an annual set-aside equal to 1.5% of estimated General Fund revenues. An additional set-aside is required when capital gains revenues in a given year exceed 8% of General Fund tax revenues. For 15 years — from 2015-16 to 2029-30 — half of these funds must be deposited into the rainy day fund, and the other half is to be used to reduce certain state liabilities (also known as “budgetary debt”).

Prop. 2 also established a new state budget reserve for K-12 schools and community colleges called the Public School System Stabilization Account (PSSSA) . The PSSSA requires that when certain conditions are met, the state must deposit a portion of General Fund revenues into this reserve as part of California’s Prop. 98 funding guarantee ( see Prop. 98 section ). In order to access the funds in the BSA and PSSSA, the governor must declare a budget emergency — an action that is not included in the May Revision or in the early budget action agreed to by the governor and Legislature in April, but will be necessary to access these funds.

The BSA and the PSSSA are not California’s only reserve funds. The 2018-19 budget agreement created the Safety Net Reserve Fund , which holds funds intended to be used to maintain benefits and services for CalWORKs and Medi-Cal participants in the event of an economic downturn. Additionally, the state has a Special Fund for Economic Uncertainties (SFEU) — a reserve fund that accounts for unallocated General Fund dollars and that gives state leaders total discretion as to when and how they can use the available funds.

The current-year (2023-24) budget, enacted in mid-2023, projected $22.3 billion in the BSA; $10.8 billion in the PSSSA; $900 million in the Safety Net Reserve; and $3.8 billion in the SFEU. However, revenue adjustments in the current year result in updated 2023-24 projections in the governor’s proposed budget — $22.6 billion in the BSA; $2.6 billion in the PSSSA; $900 million in the Safety Net Reserve; and a shortfall of $843 million in the SFEU, which fluctuates throughout the year based on changes in revenues.

In April 2024, the governor and legislative leaders agreed to an early action budget package to partially address the state’s budget shortfall that included drawing down $12 billion from the BSA, a proposal that was also included in the governor’s January budget proposal.

The May Revision:

• Includes the $12 billion withdrawal from the BSA, but spreads the withdrawal over the next two fiscal years — utilizing only $3.1 billion in 2024-25 and shifting $8.9 billion to 2025-26. 
• Withdraws all $900 million from the Safety Net Reserve, despite also proposing significant cuts to the CalWORKs program, a program the reserve is designed to protect ( see CalWORKs section ).
• Withdraws $5.8 billion from the PSSSA in 2023-24 and the remaining $2.6 billion in 2024-25.
• Projects a 2024-25 year-end SFEU balance of $3.4 billion.

In total, the May Revision proposes to withdraw less from the state’s rainy day funds for 2024-25 than the governor’s January proposal, despite the fact that the administration projects that the budget shortfall has increased since January. Taking into account the remaining reserves in the BSA and the SFEU, the governor’s May Revision projects total remaining reserves of $22.9 billion at the end of 2024-25, compared to $18.4 billion in the governor’s January proposal. 

Given that the administration’s approach to resolving the state budget shortfall includes an array of harmful cuts to vital programs and services that help Californians with low incomes, communities of color, and Californians with disabilities, state leaders appear to have additional room to responsibly draw upon reserves to protect those programs and also leave funds available to address future fiscal uncertainties.

New Fund to Capture “Excess Revenue”

The May Revision also signaled the administration’s intent to enact legislation to enable state leaders to save more during future upswings in revenue by requiring the state to set aside a portion of anticipated “surplus” funds — funds that exceed a yet-to-be-determined standard for historical trends. The administration notes that the funds would not be able to be committed until revenues have been realized. 

While the specifics of the governor’s proposal are not yet available, any efforts to set aside additional funds would likely interact with other constitutional requirements that affect state spending and reserves, including Prop. 4 (1979; the “Gann Limit”), Prop. 98 (1988), and Prop. 2 (2014). For instance, the administration notes that amendments would be needed to Prop. 2 to allow for increased deposits to the BSA. Any amendments to the constitutional provisions, however, would need to be approved by California voters.

State Budget Reserves Explained

See our report, California’s State Budget Reserves Explained , to learn more about the savings accounts policymakers can use to support Californians in times of budget shortfalls.

Governor Upholds Medi-Cal Expansion, Amends MCO Tax, Proposes Harmful Cuts

Access to health care is necessary for everyone to be healthy and thrive. About 14.5 million Californians with modest incomes — nearly half of whom are Latinx — are projected to receive free or low-cost health care through Medi-Cal (California’s Medicaid program) in 2024-25. Another 1.8 million Californians purchase health coverage through Covered California, the state’s health insurance marketplace. 

The May Revision maintains recent Medi-Cal expansions, but pulls back on other health care investments that were established in prior years. Specifically, the revised budget:

• Maintains the expansion of Medi-Cal eligibility to undocumented adults ages 26 to 49, but cuts $94.7 million to eliminate In-Home Supportive Services (IHSS) for all undocumented Californians.
• Cuts $280 million for Equity and Practice Transformation Payments to Providers.
• Cuts $62 million from the Health Care Affordability Reserve Fund intended to reduce cost-sharing in Covered California.
• Eliminates the Indian Health Grant Program.
• Freezes funding levels for county administration of Medi-Cal eligibility.
• Eliminates acupuncture as an optional Medi-Cal benefit for adults.
• Eliminates $2 million in ongoing General Fund for free clinics.
• Does not provide funding to reform the Medi-Cal Share of Cost program.
• Does not provide funding to implement continuous coverage for children from birth to age five.

These services help Californians with low incomes who are over the age of 65, blind, and/or disabled live with dignity in their own homes. Under this revised spending plan, about 14,000 Californians would lose access to IHSS solely due to their immigration status. This proposal is both harmful and xenophobic, potentially pushing immigrant families deeper into poverty. These cuts could also lead to increased state spending on nursing home care in the long run. State leaders should not compromise home care for thousands of Californians simply due to their immigration status.

These grants to certain Medi-Cal providers were intended to improve quality, health equity, behavioral health integration, and primary care infrastructure. The May Revision maintains $70 million General Fund expenditures included in the 2022 Budget Act.

These funds are critical for Californians who are uninsured and struggling to purchase coverage as well as for those who are insured but can’t afford to access the care they need.

This aims to improve the health status of American Indians living in urban, rural, and reservation or rancheria​ communities throughout California. The May Revision proposes to reduce $23 million annually beginning in 2024-25 to eliminate this program.

This reflects a reduction of $20.4 million in 2024-25 and ongoing. This reduction occurs at a time when counties are processing a high volume of renewals and many Californians are losing Medi-Cal coverage .

The estimated reduced General Fund cost for this cut is $5.4 million in 2024-25 and $13.1 million ongoing. Acupuncture is performed to prevent, modify or alleviate severe, persistent chronic pain resulting from a medical condition.

This provides primary care, preventive health care, and additional health services to medically underserved Californians.

This would alleviate financial burdens for many older adults and people with disabilities. Under the current Medi-Cal Share of Cost program, which forces many Californians to choose between paying for their health care, rent, food, or other basic needs. This reform was passed in the 2022 Budget Act but was subject to future appropriation. 

California was one of the first states to pass a policy that would ensure that children under age five can keep their Medi-Cal coverage without administrative renewals. Funding is needed to start the necessary steps to implement this policy change.

The May Revise also amends the Managed Care Organization (MCO) tax revenue and expenditure proposal. The MCO tax is a provider tax imposed by states on health care services that essentially reduces, or offsets, state General Fund spending on Medi-Cal. The federal government approved the initial MCO tax proposal last year. In January, the administration proposed to increase the MCO tax and the May Revision proposes an additional amendment to the MCO tax to include health plan Medicare revenue, resulting in an additional $689.9 million in reduced General Fund costs in 2024-25, $950 million in 2025-26, and $1.3 billion in 2026-27. These changes would be subject to federal approval. Overall, the May Revision includes $9.7 billion in MCO tax funds over multiple years to support the Medi-Cal program. However, rather than using $6.7 billion of this amount to continue Medi-Cal provider rate increases, as originally planned, these funds will be used to offset General Fund spending. 

The May Revise does protect some health care investments that were established in prior years. Specifically, the budget:

• Sustains the ambitious Medi-Cal reform effort known as CalAIM (California Advancing and Innovating Medi-Cal).
• Maintains one-time $200 million ($100 million General Fund) in 2024-25 to support access to reproductive health services.
• Maintains commitment to eliminate the Medi-Cal asset test for seniors and people with a disability.

This was originally introduced in 2019. The main goal of this initiative is to better support millions of Californians enrolled in Medi-Cal — particularly those experiencing homelessness, children with complex medical conditions, children and youth in foster care, Californians involved with the justice system, and older adults — who often have to navigate multiple complex delivery systems to receive health-related services. Initial components of CalAIM launched in the beginning of 2022 and the remaining components will go live over the next several years.

The administration plans to develop a federal demonstration waiver that would support access to family planning services for Medi-Cal enrollees as well as strengthen the state’s reproductive health safety net. Access to reproductive health services, including contraceptive care, sexually transmitted infection prevention and treatment, obstetrical care, and abortion services, have a profound impact on the lives of women and pregnant people.

Specifically, the revised budget includes $112.2 million total funds ($56.1 million General Fund) in 2023-24 and $227.2 million total funds ($113.6 million General Fund) in 2024-25 for the elimination of the Medi-Cal asset test which became effective on January 1, 2024.

Lastly, the May Revision includes directed payments to children’s hospitals and public hospitals. This includes an annual allocation of $230 million to support children’s hospitals, with half of these funds provided by the federal government and the remaining half sourced from the Medi-Cal Provider Payment Reserve Fund. 

Revised Budget Severely Cuts Health Care Workforce Development

Access to health care services is important for everyone’s health and well-being. The state’s workforce must meet the needs of Californians to achieve equitable access to timely and culturally competent health services. While state policymakers have made considerable investments in recent years to bolster the health workforce, investments in various health workforce areas still fall short. 

Despite the clear need to invest in the health workforce, the May Revision cuts over $1 billion over multiple years. This includes:

• $854.6 million General Fund across five years for various health care workforce initiatives.
• $189.4 million Mental Health Services Act Fund for behavioral health workforce programs.

This includes community health workers, nursing, social work, primary care education and training, and efforts to increase the number of underrepresented individuals in health professions. The May Revision proposes to cut $300.9 million in 2023‑24, $302.7 million in 2024-25, $216 million in 2025‑26, $19 million in 2026-27, and $16 million in 2027‑28 for these initiatives.

These cuts impact the social work initiative, addiction psychiatry fellowships, university and college grants for behavioral health professionals, expanding Master of Social Work slots, and the local psychiatry behavioral health program overseen by the Health Care Access and Information Department.

The May Revision also modifies previous plans to enhance Medi-Cal provider participation under the Managed Care Organization (MCO) tax proposal. While the revised budget maintains $727 million to increase provider rates for primary care, maternity care (including doulas), and non-specialty mental health services, it reallocates $6.7 billion previously intended for other health areas, including primary and specialty care in Medi-Cal, abortion and family planning access, clinics, and the Medi-Cal workforce pool. This redirection of funds towards existing Medi-Cal services is sensible in a budget deficit, but it raises concerns about the impact on timely access to health care services.

The health care workforce and access to health care services are intrinsically linked. If people cannot find a health care provider in their area or face extended wait times for an appointment, they do not have meaningful access to health care. State policymakers must continue to build a health care workforce that not only meets the needs of Californians but also mirrors the state’s diverse population in terms of race, ethnicity, sability, gender identity, and sexual orientation. Doing so will require sustained, ongoing investments, not cuts.

Behavioral Health Initiatives Mostly Sustained, But New Cuts Proposed

Millions of Californians who cope with behavioral health conditions — mental illness or substance use disorders — rely on services and supports that are primarily provided by California’s 58 counties. Improving California’s behavioral health system is critical to ensuring access to these services for all Californians, regardless of race, age, gender identity, sexual orientation, or county of residence. 

In recent years, state policymakers have launched various initiatives to transform California’s behavioral health system with the goal of improving access. Proposition 1 , the most recent of these initiatives, was approved earlier this year. Prop. 1 is a two-part measure that 1) amends California’s Mental Health Services Act and 2) creates a $6.38 billion general obligation bond to fund behavioral health treatment and residential facilities as well as supportive housing for veterans and Californians with behavioral health needs.

The May Revise includes some initial funding to begin Prop. 1 implementation, including:

• $126.9 million for the Department of Health Care Services in 2024-25.
• $85 million ($50 million General Fund) for county behavioral health departments.

Of this amount, $16.9 million is from the General Fund, $28.2 million is from the Behavioral Health Services Act Fund, $31.6 million is from the Opioid Settlement Fund, $10.4 million is from the Behavioral Health Infrastructure Bond Act, and $39.8 million is from the federal government.

This provides mental health and substance use disorder services to Californians through Medi-Cal and other programs.

In the governor’s January budget proposal and the revised budget proposal, the administration maintains funding to continue behavioral health initiatives that state leaders launched in recent years. For instance, the revised budget sustains the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration , which aims to improve mental health services for Medi-Cal members. The administration assumes that implementation of BH-CONNECT will begin on January 1, 2025. Major reforms to the Medi-Cal program as well as the level of federal funding provided must be negotiated with the federal government through the Medicaid waiver process. As such, implementation will depend on the availability of funding and federal approval.

However, the revised budget also proposes a series of cuts and delays to other behavioral health initiatives. Specifically, the revised budget:

• Eliminates $450.7 million one-time from the last round of the Behavioral Health Continuum Infrastructure (BHCIP) Program.
• Reduces funding and modifies the Children and Youth Behavioral Health Initiative.
• Cuts $132.5 million in 2024-25 and $207.5 million in 2025-26 for the Behavioral Health Bridge Housing Program.
• Cuts $126.6 million ongoing General Fund for CalWORKs mental health and substance abuse services, effectively eliminating this service.
• Cuts $61 million General Fund in 2024-25 and ongoing for the Naloxone Distribution Project and Medication Assisted Treatment.
• Includes $27.2 million General Fund in 2023-24 and $37.8 million General Fund in 2024-25 for Community Assistance, Recovery, and Empowerment (CARE) Act.

This program provides competitive grants to expand the community continuum of behavioral health treatment resources. The May Revision proposes to reduce BHCIP funding by $70 million General Fund in 2024-25 and $380.7 million General Fund in 2025-26. While BHCIP will receive Prop. 1 bond funds, these funds are inadequate to address the overarching need for state investments. ( See homelessness section. )

The spending reductions — $72.3 million in 2023-24, $348.6 million in 2024-25, and $5 million in 2025-26 — impact school-linked health partnerships, various grant programs, a public education campaign, and a youth suicide reporting and crisis response pilot program. Of this amount, the administration notes that $140 million General Fund proposed in 2024-25 to support a platform is no longer needed. The revised budget does maintain $9.5 million ($4.1 million General Fund) in 2024-25 to establish a Wellness Coach benefit in Medi-Cal, which the administration proposed in January. Effective January 1, 2025, these coaches will offer wellness education, screening, support coordination, and crisis management services to children and youth in schools and other behavioral health settings.

This program aims to address the immediate housing and treatment needs of people with serious behavioral health conditions who are also experiencing unsheltered homelessness. The administration notes that $90 million in Behavioral Health Services Act funding would be provided in 2025-26, resulting in a net reduction of $117.5 million for that year. ( See homelessness section. )

California has led the way in expanding CalWORKs support services, recognizing families often need additional support, like mental health and substance use treatment, to improve their well-being and address barriers to work. ( See CalWORKs section. )

Naloxone is a life-saving medicine that reverses an opioid overdose and Medication Assisted Treatment is treatment for a substance use disorder that includes medications along with counseling and other support.

This is a plan to establish court-ordered treatment for people experiencing both homelessness and serious behavioral health challenges. The revised budget adjusts estimated county funding to align with recent trends in utilization. 

Investing in the state’s behavioral health system is crucial for supporting Californians who are coping with mental health conditions or substance use disorders. State leaders should continue to invest in the behavioral health system and address the behavioral health workforce shortage. Policymakers can also invest in efforts to make sure that the behavioral health workforce better reflects the diversity of all Californians, including their gender identities and sexual orientations.

Cuts to Public Health Leave Californians Vulnerable to Future Threats

Everyone should have the opportunity to be healthy and thrive. The California Department of Public Health as well as local public health departments are vital in protecting and promoting Californians’ health and well-being. From improving living conditions to promoting healthy lifestyles to responding to infectious disease emergencies, public health workers are essential.

Despite this important responsibility, funding has not kept pace with the cost of responding to ongoing and emerging health threats. Many Californians suffered during the COVID-19 pandemic due to the state’s lack of preparedness. Communities of color experienced higher rates of illness and death due to historic and ongoing structural racism that deny many communities the opportunity to be healthy and thrive. Structural racism continues to underscore the need to address the root cause of health disparities through public health initiatives. 

In an alarming move, the governor’s revised budget proposes significant cuts to public health investments that were established in previous years. Specifically, the May Revision eliminates $52.5 million in 2023-24 and $300 million ongoing General Fund thereafter to improve public health infrastructure at the state and local level. Under this revised spending plan, local health jurisdictions would no longer continue to receive a minimum base allocation to support workforce expansion, data collection and integration, and partnerships with health care delivery systems and community-based organizations. At the state level, these cuts will reduce the capacity to assess and respond to current and emerging public health threats and will weaken key functions such as emergency preparedness and public health communications.

These cuts to public health capacities are short-sighted and harmful. After years of underinvestment in public health, these dollars provided much-needed infrastructure support. Given that public health emergencies and climate change disasters often disproportionately impact people with low incomes and communities of color, these cuts undo progress to advance health equity. State leaders should ensure that counties and cities have the capacity to address ongoing and future public health threats.

May Revision Reduces Limited Funding for Homelessness

Having a place to call home is core to living with dignity and health. Yet homeless service providers served over 330,000 Californians experiencing homelessness last year, underscoring both the need and increased capacity of the state’s response systems. Homelessness providers and localities are serving more individuals and families than ever before partially due to previous one-time state funding investments that provided critical resources for homelessness prevention and resolution services. Despite this, the May Revision proposes no new resources and reduces previous allocations, effectively leaving no significant state funding to address homelessness in 2024-25 or beyond. 

The May Revision proposes to eliminate $260 million in supplemental grant funds for the  Homeless Housing, Assistance and Prevention (HHAP) Grant Program in 2025-26, but maintains the last round of funding in 2023-24. HHAP is critical as it provides local jurisdictions with flexible funds to address homelessness in their communities in a variety of ways, ranging from rental and operating subsidies to acquiring shelter, interim and permanent housing beds, and street outreach, among other uses. The May Revision also changes previously proposed funding delays into funding cuts for various homelessness programs that serve diverse populations.

These funding reductions include:

• A reduction of $132.5 million in 2024-25 and $207.5 million in 2025-26 for the Behavioral Health Bridge Housing Program.
• A reduction of $80 million General Fund for the Bringing Families Home Program.
• A reduction of $65 million General Fund for the Home Safe Program.
• A reduction of $50 million General Fund for the Housing and Disability Advocacy Program.

This leaves  $132.5 million General Fund in 2024-25 and $117.5 million ($90 million Mental Health Services Fund and $27.5 million General Fund) in 2025-26. These funds help provide immediate housing for people experiencing homelessness who have a serious mental illness or substance use disorder ( see Behavioral Health section ).

Appropriated in the 2022 Budget Act, which serves families involved in the child welfare system.

Appropriated in the 2022 Budget Act, which supports the safety and housing stability of individuals involved in Adult Protective Services.

Appropriated in the 2022 Budget Act, which assists people experiencing or at risk of homelessness to connect with disability benefits and housing supports.

Also notable is the increased reduction of $450.7 million one-time from the last round of the Behavioral Health Continuum Infrastructure Program (BHCIP), leaving $30 million one-time General Fund in 2024-25. This program provides competitive grants to expand the community continuum of behavioral health treatment resources ranging from wellness centers to psychiatric care facilities. BHCIP will be receiving $4.4 billion in bond funds through Proposition 1 , which voters approved in March 2024. The Department of Health Care Services is anticipated to open funding applications this summer and begin granting competitive awards by the fall ( see Behavioral Health section ). Prop 1. also restructures funds from the Mental Health Services Act, which exists separately from the state budget. It now requires counties to redirect 30% of these funds for housing interventions for people experiencing or at risk of homelessness with behavioral health conditions. However, these funds are inadequate to address the overarching need for state investments, as they focus solely on a specific subset of unhoused Californians.

May Revision Proposes Deeper Cuts for Affordable Housing

All Californians deserve a safe, stable, and affordable place to call home. However, many are blocked from this opportunity due to California’s affordable housing shortage and accompanying high housing costs. Renters, people with low incomes, Black and Latinx Californians, and undocumented Californians are especially likely to struggle to afford their homes . Yet despite noting California’s serious housing affordability challenges, the May Revision proposes deeper funding reductions and scarce new investments to affordable housing programs.

The administration now proposes $1.7 billion in General Fund reductions for various programs that support affordable housing development and homeownership . The May Revision reductions build on those in the January proposed budget . These include:

• An additional reduction of $236.5 million General Fund for the Foreclosure Intervention Housing Preservation Program in 2023-24 , bringing the total reduction to $474 million, which will eliminate the program.
• An additional reduction of $75 million General Fund for the Multifamily Housing Program , bringing the total reduction to $325 million General Fund, eliminating state funding in 2023-24.
• A newly proposed reduction of $127.5 million General Fund for the Adaptive Reuse Program , with $87.5 million from the 2023 Budget Act and $40 million from the 2022 Budget Act, which will eliminate the program. 
• An additional reduction of $35 million General Fund for the Infill Infrastructure Grant Program , with $25 million from 2023 Budget Act and $10 million from the 2022 Budget Act, eliminating state funding in 2023-24.
• An additional reduction of $26.3 million General Fund for the Veterans Housing and Homelessness Prevention Program from the 2022 Budget Act. The January proposed budget already fully reduced allocated state funds for this program in 2023-24.

The May Revision does reinstate an additional $500 million for state Low Income Housing Tax Credits – as has been done since 2019 – which help promote and finance affordable housing development. The administration also highlights Proposition 1 , approved by voters in March, as providing some funding for supportive housing programs. Prop. 1 provides roughly $2 billion in bond funds for the development of permanent supportive housing units specifically for Californians experiencing or at risk of homelessness with behavioral health needs (see Homelessness and Behavioral Health sections). Over half of these funds are designated for veterans. The Department of Housing and Community Development is anticipated to open applications for this funding at the end of 2024. However, these funds are specifically for supportive housing units and fall short in providing the diverse critical investments needed to continue meaningful, affordable housing development in California.

state budget terms defined

What’s the difference between a trailer bill and policy bill? A deficit and an operating deficit? And what exactly is a “Budget Bill Jr.?” Our Glossary of State Budget Terms answers that and more.

May Revision Proposes Alarming Cuts to Vital Safety Nets

While California has made significant investments in its social safety net in recent years, millions of people in communities across the state are still struggling to make ends meet as the cost of living continues to outpace incomes. Poverty, particularly among children and people of color, is on the rise. Despite this, the governor’s proposed budget includes very concerning cuts to vital safety net programs that may have devastating consequences for California families with the greatest needs. Cuts to the Department of Social Services, which administers the state’s safety net programs, total nearly $2 billion in the 2024-2025 fiscal year alone. These cuts target key investments in CalWORKs, food assistance, and child care. The budget proposal outright eliminates several critical support services for CalWORKs families, significantly reduces funding for program administration, and drains the dedicated reserves that were designed to protect the program from cuts.

Additionally, the proposal delays a long-awaited program expansion of food assistance to undocumented older adults and defunds a pilot to increase CalFresh benefits. In delaying and eliminating these vital services, which were small stepping stones to larger expansions that would close gaps in food insecurity across the state, the proposal would take California a step backward. In the child care space, the governor indefinitely delays his promised slot expansion despite the growing unmet need. Other cuts in this space would affect programs that serve foster youth and people with disabilities. 

California’s future largely depends on children whose entire lives will be shaped by the extent to which our state invests in their education, health, and well-being. But children cannot thrive unless their families thrive. Despite the budget shortfall, California’s leaders have a responsibility to ensure that our state’s children and families have the opportunity to reach their full potential.

Revised Budget Maintains Tax Credits for Californians with Low Incomes

California’s Earned Income Tax Credit (CalEITC), Young Child Tax Credit, and Foster Youth Tax Credit are refundable state income tax credits that provide tax refunds or reductions in state taxes owed to millions of Californians with low incomes, boosting their incomes and helping them to pay for basic needs like food. These credits also help to promote racial and gender equity by targeting cash to Californians of color, immigrants, and women who are frequently blocked from economic opportunities and forced into low-paying jobs that fail to provide economic security .

The administration maintains these tax credits in the revised budget while also continuing to cut funding for free tax preparation assistance, education, and outreach,  in half to $10 million in 2024-25, as proposed in January. These funds support community based organizations (CBOs) in their efforts to educate community members about state and federal refundable tax credits, connect eligible tax filers to free tax preparation services and assist tax filers in applying for or renewing Individual Taxpayer Identification Numbers, which some Californians must have in order to claim tax credits. Cutting this funding will reduce the capacity of CBOs to provide these services.

Revised Budget Does Not Implement Workers’ Tax Credit Slated for 2024

The 2022-23 budget included a new refundable tax credit for workers slated to become available in tax year 2024 if the Department of Finance determined that sufficient General Fund resources were available to support it. This credit was intended to help cover the cost of being a member of a labor union, particularly among workers with lower incomes who are typically excluded from an existing tax deduction for certain business expenses, including union dues. The administration does not include this new tax credit in the revised 2024-25 budget given the multi-year budget shortfall.

May Revision Proposes Additional Cuts to Critical CalWORKs Support Services

The California Work Opportunity and Responsibility to Kids (CalWORKs) program is a critical component of California’s safety net for families with low incomes. The program helps over 650,000 children and their families, who are predominantly people of color, with modest cash grants, employment assistance, and critical supportive services. The governor’s May Revision proposes deeply concerning cuts to CalWORKs administrative and program funding in addition to the significant cuts proposed in January.

The newly proposed cuts include:

• A one-time reduction of $272 million in 2024-25 for employment services under the single allocation funding.
• An ongoing reduction of $126.6 million for Mental Health and Substance Abuse Services, effectively eliminating this service. 
• An ongoing reduction of $47.1 million for the Home Visiting Program, which is designed to support positive health, development, and well-being of CalWORKs families with children under 2.

This amounts to a total cut of $445.7 million. Adding on to the cuts proposed in January , which totaled about $293 million in FY 24-25, this brings the total to about $739 million in cuts to CalWORKs, two-thirds of which would be ongoing. For many years, California has led the way in expanding CalWORKs support services, recognizing families have diverse needs and often need additional support to address barriers to work and improve their well-being. Taking programs away that offer mental health support, crisis intervention (Family Stabilization Program), and parenting support (Home Visiting Program), which research has shown can reduce or prevent the effects of adverse experiences for children, could jeopardize families’ ability to meet all program requirements and maintain access to their grants. Families not meeting strict program requirements will be at risk of punitive sanctions, which will only push them deeper into poverty. 

In addition to the proposed cuts, the governor’s budget does not include funding to redirect collected child support payments from the state back to former CalWORKs parents. For formerly assisted families, outstanding child support debt that is collected does not go to the families but rather goes to the state, county, and federal governments as “reimbursement” for the costs associated with the CalWORKs program.  Under this change , which was supposed to go into effect in April 2024, these families would have received an estimated annual total pass-through of $187 million annually.

Additionally, the governor proposes drawing down the full $900 million in the Safety Net Reserve, which was created to maintain existing CalWORKs and Medi-Cal benefits and services during an economic downturn ( see Reserves section ). While the governor does not propose cutting cash grants, given the projections of a sustained deficit in upcoming years, fully drawing down the reserve will leave CalWORKs vulnerable to additional cuts, similar to what occurred during the Great Recession . Closing the budget shortfall at the expense of families with low incomes is a short-sighted approach that could have detrimental effects on California’s economy and families facing the greatest needs.

Governor Proposes Cuts and Delays to Previous Food Assistance Commitments

All Californians should be able to put enough food on the table without having to go without other basic needs. But about 1 in 11 California households — and 1 in 8 California households with children — sometimes or often didn’t have enough to eat in March 2024, according to recent US Census Household Pulse data. In recent years, households have been hit with both rising food prices as well as the expiration of enhanced pandemic-era food benefits . 

CalFresh — California’s version of the federally funded Supplemental Nutrition Assistance Program (SNAP) — provides modest food assistance benefits to about 5.4 million Californians . The California Food Assistance Program (CFAP) is a state-funded program providing food benefits to certain non-citizens who are excluded from receiving federal  benefits, but undocumented immigrants are still excluded from CFAP benefits. The 2021-22 budget agreement included a plan to expand CFAP to Californians aged 55 and older who are excluded solely due to their immigration status. The expansion is currently set to begin in October 2025.

While the governor’s January budget proposal generally maintained prior commitments to  improve and expand the state’s food assistance programs, the May Revision proposes cuts and delays that would reverse or pause recent progress, including:

• Delaying the CFAP to include undocumented adults age 55 and older until 2027-28.
• Eliminating funding for the CalFresh Minimum Nutrition Benefit Pilot Program.
• Eliminating the Work Incentive Nutrition Supplement Program (WINS) beginning in 2025-26.

This means those older adults will continue to be excluded from vital food benefits for the next several years. The administration also has not put forth any plans to end this exclusion for undocumented Californians under age 55, even while 45% of undocumented Californians with low incomes are affected by food insecurity.

The 2023-24 budget created this pilot program and included $15 million one-time funding for 2024-25 to provide a state supplement to increase the minimum benefit for selected households to $50 for one year. This pilot program was a small step in acknowledging the inadequacy of the current minimum benefit of $23.

WINS is a $10 supplemental food benefit for some working CalFresh households. The Legislative Analyst’s Office estimates that eliminating the program would reduce food benefits for around 125,000 households . The program is funded through CalWORKs but is only available for households not receiving regular CalWORKs benefits. The program was created with the primary goal of improving the CalWORKs Work Participation Rate (WPR), and it appears the proposal to eliminate WINS is a response to a recent federal law that would require the state to increase the supplement in order for it to continue helping the state achieve its WPR target, which could cost the state an additional $40 million each year. However, this elimination represents a loss of benefits for those households that rely on the additional assistance to keep food on the table, and the administration does not propose any relief for families to offset that loss.

Additionally, the budget does not include funding to implement Cal Grant reform, which would allow more college students to access CalFresh benefits ( see Financial Aid section ). The 2022 budget included a plan for Cal Grant reform, but it was subject to sufficient funds being available in 2024, so this was one of several “trigger” proposals included 2022 that will not be moving forward this year. Finally, the budget includes $63 million in additional funding to implement the universal school meals program to account for an expected increase in the number of meals to be provided and a cost-of-living increase ( see K-12 Education section ). The $63 million is in addition to the increase included in the January proposal.

Governor Maintains Temporary Rate Increase, Pauses Slot Expansion

Thousands of families in California rely on subsidized child care and development programs administered by the California Department of Social Services (CDSS) as a critical resource for supporting their families to grow and thrive. While the state has made improvements to California’s child care system — most recently through reforming family fees and committing to an alternative methodology for child care provider reimbursements — the system is still falling short for many families and child care providers. For example, as of 2022, only one in nine children eligible for subsidized child care received services, despite growing demand. Moreover, the state released data this year showing that 73% of family child care providers do not pay themselves a salary. The administration therefore has an opportunity to advance progress toward creating an equitable child care system that meets the needs of all families and reflects the integral role of child care providers.

The governor’s revised budget:

• Pauses planned child care slot expansion at 119,000 new spaces.
• Maintains commitment to one-time funding for temporary subsidy rate increases but lacks a detailed plan for meeting federal deadlines to implement an alternative rate structure.
• Cuts funding for foster youth child care programs and support services.
• Includes $972 million in cost shifts to help ensure that unspent federal relief dollars are not reverted.

  In 2021-22, the governor committed to adding approximately 200,000 new child care slots by 2026-27. As of 2023-24, approximately 146,000 new slots were funded. Expansion was paused in 2023-24, and the state is still in the process of rolling out all intended new slots. Specifically, only about 119,000 new slots have been added. The revised 2024-25 budget paused slot expansion at this 119,000  “until fiscal conditions allow for resuming the expansion.” These proposed actions result in a reduction of $489 million in 2024-25 and $951 million in 2025-26 for subsidized child care slots. The April 24, 2024 Assembly Budget Subcommittee No. 2 on Human Services and Assembly Budget Subcommittee No. 3 on Education Finance discussed the possibility of creating a “reversion account” that would keep unspent funds for slot expansion within child care. This reversion account to maintain unspent dollars within child care is not included in the 2024-25 revised budget.

The 2023-24 budget provided a total of nearly $1.4 billion in one-time funds for temporary rate increases for providers reimbursed through the California Department of Social Services (CDSS). The 2024-25 proposed budget maintains this one-time funding. This one-time funding is set to expire July 1, 2025, which is also the federal deadline determining the new rate structure, per the alternative methodology currently being developed. If the new provider rates are not determined by this deadline, they will revert back to the 2018 regional market rate or standard reimbursement rate. The administration remains committed to developing a single rate structure and alternative methodology for child care reimbursements. However, given the need for spending associated with the alternative methodology to be included in the 2025-26 budget process and Child Care Provider United union negotiations, the lack of a detailed plan (i.e., confirming a timeline for when state agencies produce cost estimates) makes the state more vulnerable to missing the federal deadline.

The Emergency Child Care Bridge Program for Foster Children (Bridge Program) is administered through CDSS. The Bridge Program provides time limited vouchers for child care and child care navigator services for foster care system families and parenting foster youth. The revised budget reduces funding for the Bridge Program, reflecting a reduction of $34.8 million in 2024-25 and $34.8 million in 2025-26. Additionally, the revised budget maintains proposed cuts to the Family Urgent Response System (FURS) by $30.1 million. FURS is a hotline for current or former foster youth and their caregivers to call and get immediate help for any issue they may be experiencing. 

The Legislative Analyst’s Office (LAO) estimates that the state currently has $450 million of COVID-19 federal relief funds that may go unspent (set to expire September 30, 2024). Moreover, as of March 2024, the state had a Proposition 64 child care carryover balance of $296 million. The 2024-25 proposed budget plans to utilize all or a portion of these funds (among others) to offset General Fund costs for child care. Specifically, $596.8 will be shifted for 2023-24 and $375.5 will be shifted for 2024-25. This approach likely aligns with the LAO’s recommendation to minimize federal reversion of COVID-19 relief funds.

Governor Protects SSI/SSP but Cuts Key Services for People with Disabilities

All Californians should be included, supported, and treated with dignity in their communities, regardless of disability status. In California, people with disabilities can access several essential programs and services to manage their needs. The governor’s revised budget maintains a recent increase to the largest cash assistance program serving low-income Californians with disabilities, but builds on January’s proposed cuts and reduces support for key programs serving this population.

Specifically, the governor’s budget:

• Protects the recent grant increase to the State Supplementary Payment (SSP) program.

The Supplemental Security Income (SSI) and SSP programs together provide grants to over 1 million older adults with low incomes and people with disabilities to help them pay for housing, food, and other necessities. In recent years, state policymakers have made significant investments to increase SSP grants, however, the total grant levels remain below federal poverty levels. After deep cuts to the program during the Great Recession, grants cannot keep up with rising housing costs, making it difficult for low-income people with disabilities to make ends meet.

The governor’s January proposal included:

• Delaying, by one year, a scheduled raise for workers who care for people with intellectual and developmental disabilities.
• A funding delay for the Preschool Inclusion Grant program.

The governor proposes to implement this wage increase for around 150,000 workers on July 1, 2025 — one year later than anticipated. This delay would allow the state to avoid $613 million in new state costs in the 2024-25 fiscal year, with these costs instead reflected in the 2025-26 budget. More than 460,000 Californians with intellectual and developmental disabilities — including children receiving early intervention services — are expected to receive supports and services in 2024-25. Delaying pay increases for workers who provide these services could exacerbate staffing shortages across the disability system. This, in turn, would make it more challenging for individuals with disabilities and their families to receive the services that the Lanterman Act requires the state to provide.

The January budget proposal included a delay of $10 million General Fund for this program, which had been delayed to 2024-25 in previous years. This delay essentially postpones its implementation to 2026-27. The Preschool Inclusion Grant program was created in the 2022-23 budget with the goal of supporting preschool programs to include more children with developmental disabilities. This program and proposed reductions are different from the enrollment requirements as part of the California State Preschool Program (see “preschool inclusivity” bullet below).

The May Revision maintains these delays in funding and also:

• Eliminates the In-Home Supportive Services (IHSS) expansion coverage to undocumented Californians of all ages by cutting $94.7 million ongoing.
• Cuts the planned expansion of preschool inclusivity.
• Cuts $65 million for the Home Safe Program.
• Cuts $50 million for the Housing and Disability Advocacy Program.
• Cuts $44.8 million for Adult Protective Services (APS).
• Does not include funding to reform the Medi-Cal Share of Cost program.

IHSS is a key health care program that helps older adults with low incomes and people with disabilities live safely and with dignity in their own homes. Under the revised spending plan, about 14,000 Californians would lose access to IHSS solely due to their immigration status ( see the Coverage, Affordability & Access section ) .

Currently, at least 5% of California State Preschool Program enrollment must be for students with disabilities. The administration had planned to increase this proportion to at least 10% by 2026-27. However, the 2024-25 proposed budget cuts funding for this increase, reflecting a one-time General Fund savings of $47.9 million in 2025-26 and $97.9 million General Fund ongoing starting in 2026-27 ( see the Early Learning section ) . 

A ppropriated in the 2022 Budget Act, which supports the safety and housing stability of individuals involved in Adult Protective Services ( see the Homelessness section ) .

Appropriated in the 2022 Budget Act, which assists people experiencing or at risk of homelessness connect with disability benefits and housing supports ( see the Homelessness section ) .

This provides abuse intervention and support services to older adults and dependent adults who are unable to meet their own needs. This cut targets a recent expansion effort to address California’s growing aging population, which may limit the program’s reach, particularly for more complex cases.

This would alleviate financial burdens for many older adults and people with disabilities. Under the current Medi-Cal Share of Cost program, many Californians have to live at the maintenance need level in exchange for Medi-Cal services, which forces many to choose between paying for their health care, rent, food, or other basic needs ( see the Coverage, Affordability & Access section ) .

Proposal Eliminates and Delays Vital Services for Immigrant Californians, Maintains Cut to Legal Services

Immigrants are an integral part of California’s communities. They are not just part of the state’s mighty economic engine as taxpayers, entrepreneurs, and members of the workforce — they enrich our cultural identity as the Golden State. They are students, teachers, artists, chefs, religious leaders, colleagues, neighbors, and family members. 

California has the largest share of immigrant residents of any state. Over half of all California workers are immigrants or children of immigrants, and nearly 2 million Californians are undocumented, according to recent estimates .

State leaders have made notable progress in recent years working toward a California for all, where all people have access to economic opportunity and essential services, regardless of immigration status. Extending full-scope Medi-Cal eligibility to undocumented Californians is one significant example of this, and the governor’s May Revision maintains the final and most recent step in this expansion, extending coverage to adults ages 26 to 49. However, the revised budget takes a step backwards by eliminating or delaying other vital services for undocumented Californians that other Californians can access. Specifically, the revised budget:

• Permanently eliminates In-Home Supportive Services (IHSS) for all undocumented Californians.
• Delays expanding the California Food Assistance Program (CFAP) to undocumented adults age 55 or older, as promised in last year’s budget.

These services help Californians with low incomes who are over the age of 65, blind, and/or disabled live with dignity in their own homes. This harmful and xenophobic cut will cause about 14,000 Californians to lose access to IHSS solely due to their immigration status, potentially pushing them deeper into poverty ( see Health Coverage section ).

Instead of beginning in October 2025, these vital food benefits will be delayed until 2027, denying hundreds of thousands of older Californians access to assistance at a time when 45% of undocumented Californians with low incomes are affected by food insecurity ( see Economic Security section ).

The revised budget also maintains the governor’s January budget proposal to cut immigration legal services, which are a lifeline for immigrant families. Specifically, the May Revision:

• Continues to permanently cut funding for the Temporary Protected Status (TPS) Services program , eliminating $10 million General Fund in 2023-24 and each year thereafter, zeroing out all resources for this program. 
• Continues to permanently cut funding for the California State University Legal Services program by $5.2 million General Fund in 2023-24 and each year thereafter.

Cutting support for immigrant legal services is harmful. These services are crucial for helping immigrants stabilize their lives and remain in their communities. Immigration legal services can help put immigrants on a pathway to stability , particularly for those without status. Without access to legal services, immigrants can face greater risks of deportation and family separation, which can lead to financial hardship for families and adverse health outcomes . Given that newly arriving immigrants have the potential to grow the economy and contribute to state and local coffers, supporting them is a strategic investment in our collective future. 

The governor’s May Revision also reduces $29 million for the Rapid Response program in 2024-25, which helps sustain humanitarian support to individuals and families seeking safety at the California-Mexico border in partnership with local providers. This reversion in funds comes out of the $79.4 million General Fund reappropriated for the Rapid Response program from the 2021-22 and 2022-23 budget acts to 2023-24 as part of the early action budget deal approved by policymakers in April. The revised budget proposes no additional state funding for this program in 2024-25 despite the glaring need for continued investment . 

Eliminating and delaying vital services to Californians simply due to their immigration status would have a significant negative impact on immigrant communities and our collective prosperity and is a short-sighted approach to closing the state’s budget shortfall.

Governor Does Not Provide Needed Support to Domestic Violence Survivors

Every Californian deserves to live in a world where they feel safe. However, millions of Californians experience domestic and sexual violence every year — women, transgender, and non-binary Californians, and some women of color are most likely to experience this type of violence. 

Domestic and sexual violence prevention programs are proven ways to stop the violence from occurring in the first place by taking a proactive approach and seeking to shift culture on racial and gender inequities. Since 2018, state policymakers have provided small, one-time grants for prevention programs, administered by the California Governor’s Office of Emergency Services. Besides funding for prevention services, the state also receives federal funding through the Victims of Crime Act (VOCA) to help provide essential services to survivors of crime, including survivors of domestic violence. These funds help provide survivors with critical services like emergency shelter, counseling, and financial assistance. 

However, cuts to VOCA at the federal level are resulting in roughly a 45% cut to state grants for organizations that support survivors of crime, decimating the funding of many of these organizations who rely entirely on VOCA funding to provide these critical services. Additionally, the last round of prevention grants will run out at the end of 2024 . Prevention efforts take time, and organizations doing this critical work cannot commit to long term programming without permanent, ongoing funding.

In the May Revision, the governor:

• Does not provide funding to fill the gap in crime victim services funding.
• Does not provide continued funding for domestic violence prevention.
• Eliminates all funding for the cash assistance program for survivors.

In 2021-2022, the state stepped in and provided $100 million in one-time funding to backfill federal VOCA funding gaps. However, since 2019, funding has fallen far short of levels needed to maintain the services local organizations provide to more than 816,000 victims of crime. At the current funding levels, programs will have experienced a 67% cut in funding since 2019. While organizations are being forced to pause critical services to survivors of crime, the state continues to spend billions of dollars on prisons. The state could safely close up to five state prisons, which would result in savings of around $1 billion per year – some of which could be used to help support crime survivors ( see State Corrections section ).

While the 2023-24 budget extended state funding for domestic and sexual violence prevention grants, the governor does not propose any additional funding for new grants in the 2024-25 fiscal year, leaving many organizations uncertain as to how they will continue providing crucial services without funding.

In 2022-23, the state appropriated $50 million to establish the Flexible Assistance for Survivors (FAS) grant program. These dollars were meant to provide grants to community-based organizations to provide flexible assistance such as relocation, care costs, or other basic needs to survivors of crime. In January, the governor proposed delaying the $47.5 million program until 2025-26. However, the May Revision removes all state funding for the program, eliminating another support for survivors of crime.

While the governor has failed to include funding to support survivors of domestic and sexual violence among other crimes, a bipartisan group of Assemblymembers have issued an emergency budget request to address the VOCA funding shortfalls, recognizing the importance of protecting the state’s most vulnerable individuals. 

GUIDE TO THE STATE BUDGET PROCESS

See our report  Guide to the California State Budget Process  to learn more about the state budget and budget process.

Transitional Kindergarten Expansion Continues While Facilities are Cut

The California Department of Education (CDE) hosts two early learning and care programs: Transitional Kindergarten (TK) and the California State Preschool Program (CSPP). CSPP provides preschool to children ages 3 and 4 for families with low to moderate incomes. TK serves 4-year-olds, and eligibility is based on age alone in public schools and is not dependent on family income. Given the overlap with the child care and development programs administered through the California Department of Social Services, CSPP is included in recent family fee and rate reform wins (see Child Care section). However, as Universal TK continues to roll out and CDSS child care and development programs face cuts and delays, the administration has the opportunity to ensure that all early learning and care programs have the resources they need to prioritize family needs and early educator well-being. 

• Continues to fund the implementation of Universal TK expansion.
• Maintains CSPP slots and temporary reimbursement rate increases.
• Cuts the planned $550 million investment in preschool, TK, and full-day kindergarten facilities.

The initial year one expansion took effect during fiscal year 2022-23 and covered children whose fifth birthdays fell between September 2 and February 2 (the previous cut-off was December 2). The year two 2023-24 expansion provided eligibility to children who turn 5 between September 2 and April 2. The year three 2024-25 expansion will extend eligibility to children who turn 5 from April 2 to June 2. The revised budget includes $550 million from the General Fund for this year three expansion. As Universal TK continues to roll out, TK programmatic delays from 2023-24 are still relevant. Specifically, the following are delayed until 2025-26: 1) the reduction in TK classroom ratios to 1:10 and 2) the deadline for TK teachers to earn 24 units (or equivalent), a child development permit, or an early childhood education specialist credential.

The revised budget includes $1.4 billion in 2024-25 to maintain projected CSPP enrollment. As shared in the Child Care section , the 2023-24 enacted budget included one-time funding for temporary reimbursement rate increases and a commitment to developing an alternative methodology for provider rates. While this increase was negotiated by Child Care Providers United (CCPU) – representing home-based providers – the per-child temporary rate increase also applies to CSPP providers. Thus, the one-time funding promised for CSPP provider temporary rate increases is proposed to be maintained for 2024-25. Specifically, the revised budget includes $53.7 million from the General Fund to support reimbursement rate increases. Moreover, if the state does not determine the new rate structure by July 1, 2025, CSPP providers will also have their rates reverted to the 2018 standard reimbursement rate.

Facilities investments are intended to help build new school facilities or retrofit existing buildings in order to provide appropriate spaces for preschool, TK, and full-day kindergarten. The 2023-24 enacted budget reflected $550 million in 2024-25 to support this facilities program. This funding was delayed to 2025-26 in the January budget proposal. However, due to the projected budget shortfall, the dollars that were delayed to 2025-26 are now cut. The administration suggests that preschool, TK, and full-day kindergarten facilities could be added to an education bond proposal.

K-14 Education’s Minimum Funding Level Drops Due to Lower Revenue Estimates

Approved by voters in 1988, Proposition 98 constitutionally guarantees a minimum level of annual funding for K-12 schools, community colleges, and the state preschool program. The governor’s May Revision assumes a 2024-25 Prop. 98 funding level of $109.1 billion for K-14 education. Because the Prop. 98 guarantee tends to reflect changes in state General Fund revenues and estimates of General Fund revenue in the May Revision are lower than estimates in the January budget proposal, the governor’s revised spending plan assumes a decrease in the Prop. 98 guarantee in 2023-24 and 2022-23. Specifically, the May Revision assumes a 2023-24 Prop. 98 funding level of $102.6 billion, $3 billion lower than the $105.6 billion funding level assumed in the governor’s January budget proposal. The 2022-23 Prop. 98 funding level of $97.5 billion is roughly $800 million below the $98.3 billion funding level assumed in January, but it is $9.8 billion below the level assumed in the 2023-24 budget agreement – the largest decline in an estimated Prop. 98 guarantee for a prior-year since Prop. 98 was adopted. 

To address this unprecedented drop in the 2022-23 Prop. 98 guarantee, the governor’s May Revision proposes using the same complex accounting maneuver as the one he proposed in January: the revised budget plan attributes $8.8 billion in reduced Prop. 98 spending to the 2022-23 fiscal year, which would help reduce state General Fund spending to the lower revised Prop. 98 minimum funding level. However, the revised spending plan would not take away the $8.8 billion from K-12 schools and community colleges — dollars they received for 2022-23 that have largely been spent. Instead, the governor proposes to shift the $8.8 billion in K-14 education costs — on paper — from 2022-23 to later fiscal years and pay for these delayed expenses using non-Prop. 98 funds. 

The May Revision also reflects withdrawals of $5.8 billion in 2023-24 and $2.6 billion in 2024-25 from the Public School System Stabilization Account (PSSSA) – the state budget reserve for K-12 schools and community colleges ( see Reserves section ). Because the revised 2023-24 PSSSA balance of $2.6 billion is not projected to exceed 3% of the total K-12 share of the Prop. 98 minimum funding level in 2023-24, current law would allow K-12 school districts to maintain more than 10% of their budgets in local reserves in 2024-25.

Budget Proposal Relies on Reserves to Support K-12 School Funding Formula

The largest share of Prop. 98 funding goes to California’s school districts, charter schools, and county offices of education (COEs), which provide instruction to 5.9 million students in grades kindergarten through 12. The governor’s May Revision maintains the proposal made in his January budget to withdraw funds from the Public School System Stabilization Account (PSSSA) – the state budget reserve for K-12 schools and community colleges – to support the Local Control Funding Formula (LCFF), the state’s main K-12 education funding formula. Specifically, the governor’s revised spending plan:

• Allocates $7.5 billion from the PSSSA to support ongoing LCFF costs.
• Increases one-time funding for green school buses by roughly $395 million, for a total of approximately $895 million.
• Reduces K-12 school facilities funding by $375 million.
• Provides funding for a 1.07% COLA for non-LCFF programs and the LCFF Equity Multiplier.
• Increases funding for universal school meals by $63.3 million.
• Maintains $25 million in ongoing funding for literacy screening training.

The LCFF provides school districts, charter schools, and COEs a base grant per student, adjusted to reflect the number of students at various grade levels, as well as additional grants for the costs of educating English learners, students from low-income families, and foster youth. The May Revision includes a 1.07% cost-of-living adjustment (COLA) for the LCFF. To pay for the additional ongoing costs, the proposal would withdraw $5.3 billion from the PSSSA to fund the LCFF in 2023-24 and $2.2 billion to fund the LCFF in 2024-25.

The May Revision sustains a commitment made in the 2023-24 budget agreement to support the greening of school bus fleets through programs operated by the California Air Resources Board and the California Energy Commission in 2024-25. The governor’s proposal would increase 2024-25 funding for green school buses above the $500 million included in his January budget, but would reduce funding committed to the program to $105 million in 2025-26.

The 2022-23 budget agreement included an intention to allocate $875 million in one-time, non-Prop. 98 General Fund spending for the School Facility Program (SFP) to support K-12 facilities construction in 2024-25. The Legislature’s “early action” package approved the governor’s January budget proposal to reduce the 2024-25 SFP allocation by $500 million. The May Revision proposes to eliminate the remaining $375 million in 2024-25 SFP funding.

The governor’s January budget proposal included $65 million to fund a 0.76% COLA for the LCFF Equity Multiplier , established as part of the 2023-24 budget agreement, and for several categorical programs that remain outside of the LCFF, including special education, child nutrition, and American Indian Education Centers. The May Revision would increase ongoing funding to support these COLAs in 2024-25.

California established a Universal Meals Program in the 2022-23 school year that provides two free meals per day to any public K-12 student regardless of income eligibility. The governor’s January budget proposed $122.2 million to fully fund the program in 2024-25, and the May Revision proposes to increase this funding to pay for growth in the projected number of meals served and a COLA ( see Food Assistance section ) .

The 2023-24 budget agreement included a requirement for school districts to begin screening students in kindergarten through 2nd grade for risk of reading difficulties by the 2025-26 school year. The May Revision sustains the governor’s January budget proposal to provide funding to administer these literacy screenings.

Revised Budget Increases Reserve Withdrawals for Community Colleges Funding

A portion of Proposition 98 funding provides support for California’s Community Colleges (CCCs), the largest postsecondary education system in the country, which serves high percentages of students of color and students with low incomes. CCCs prepare more than 1.8 million students to transfer to four-year institutions or to obtain training and employment skills. 

The 2024-25 revised spending plan increases withdrawal amounts from the Prop. 98 reserve for CCC apportionments and provides additional resources to fund an increase in the cost-of-living adjustment (COLA). 

Specifically, the governor’s revised budget includes:

• Reserve withdrawals totaling $914.1 million from state budget reserves for CCC apportionments.
• A 1.07% COLA for apportionments and other programs.

The governor proposes a withdrawal of $381.6 million from the Prop. 98 reserve (also known as the Public School System Stabilization Account or PSSSA) ( see Reserves section ) in 2023-24 and $532.6 million in 2024-25 for the Student Centered Funding Formula (SCFF).

This includes $100.2 million ongoing Prop. 98 dollars for the SCFF. The revised spending plan also provides ongoing Prop. 98 resources to provide the same percentage COLA to other CCC categorical programs and the Adult Education Program.

Revised Proposal Maintains Deferrals for the CSU and UC Systems

California supports two public four-year higher education institutions: the California State University (CSU) and the University of California (UC). The CSU provides undergraduate and graduate education to nearly 460,000 students at 23 campuses, and the UC provides undergraduate, graduate, and professional education to more than 290,000 students across 10 campuses. 

The governor’s revised budget includes additional cuts to higher education and maintains funding deferrals for both of the state’s public university systems. 

The January proposal included:

• A deferral of $240 million General Fund dollars from 2024-25 to 2025-26 for the CSU.
• Deferrals totaling $259 million General Fund dollars from 2024-25 to 2025-26 for the UC.
• A reduction of $494 million in General Fund dollars for the California Student Housing Revolving Loan Fund Program.

These dollars were meant to fulfill multi-year funding increases as part of the CSU compact. Under this proposal, the governor intends to restore this funding commitment in 2025-26, along with the scheduled base increase for the fourth year of the agreements. Additionally, the administration would also provide a one-time payment of $240 million in 2025-26 as part of the deferral.

This includes a deferral of $228 million for base increase as part of the multi-year compact with the UC and $31 million to support the UC in increasing the number of resident undergraduate students. In 2025-26, the governor intends to restore the $228 million on top of the increase scheduled for the fourth year of this compact and provide a total of$62 million for resident undergraduate enrollment, reflecting the deferred amount and that year’s increase for this purpose. The administration would also provide one-time payments of $228 million and $31 million to compensate for the deferrals in 2024-25 of the same amount.

The proposal pulls back $194 million in 2023-24 and $300 million in 2024-25. This program provides interest-free loans to campuses for new student housing projects.

The May Revision maintains these proposals and also include the following cuts in higher education:

• An ongoing reduction of nearly $14 million General Fund for the Proposition 56 General Fund backfill that supports Graduate Medical Education programs at the UC. 
• An ongoing cut of $13 million General Fund for the UC Labor Centers. This funding provides support for economic research and labor education across various UC campuses. 
• A reduction of $485 million General Fund of unspent one-time dollars for the Learning-Aligned Employment Program. The program provides resources for students at public colleges and universities to earn money while learning in a field related to their educational and career interests ( see Workforce section ).
• A $60 million General Fund cut for the Golden State Teacher Grant Program. This program provides awards to students in professional preparation programs and who are working toward a teaching credential. 

May Revision Abandons Commitments to Expand Student Financial Aid

The budget shortfall and proposed solutions significantly impacts access to financial aid opportunities for California students. The May Revision does not include funding for the anticipated reform to the Cal Grant program and reduces funding for the Middle Class Scholarship (MCS). 

Specifically, the revised spending plan:

• Does not trigger the Cal Grant Reform Act.
• Walks back expansion of the MCS.

Given the multi-year shortfall, the revised spending plan does not include funding for the Cal Grant Reform Act, which was included in the 2022-23 budget, and the governor does not propose any budgetary actions to phase in the program. Trailer bill language as part of the 2022-23 budget stated that the reform would become operative if General Fund dollars “over multi-year forecasts” are available beginning in 2024-25. The Cal Grant is California’s financial aid program for low-income students pursuing postsecondary education in the state. These grants support students by providing financial assistance so they can afford the costs of college attendance, including meeting their basic needs such as housing, food, transportation, and child care. The Cal Grant Reform Act would reach thousands of new students who were previously not eligible and would also allow more students to qualify for CalFresh food assistance, freeing up resources for institutions to support students with other non-tuition costs.

The May Revision proposes an ongoing cut to the MCS of $510 million . The revised spending plan also includes an additional spending reduction of more than $20 million, reflecting revised program estimates. These two actions reduce total spending for the program down to $100 million ongoing, reflecting an 88% drop from the 2023-24 total funding level. The May Revision also maintains the January proposal to abandon a planned one-time investment of $289 million that was included as part of the 2023-24 budget. The state created the MCS program in 2013-14 to provide partial tuition coverage to CSU and UC students who were not eligible for Cal Grants. The program was revamped in 2022-23 by increasing funding and implementing new rules. Due to these changes, a broader group of students received the awards. Eligible students include those who qualify based on income (maximum household income is $217,000), low-income students who qualify through other requirements, and community college students in bachelor’s degree programs.

Overall, these budget choices have consequences for college affordability, degree attainment, and overall student well-being. Students pursuing postsecondary education confront significant hardship to afford basic necessities , and they are often forced to make difficult decisions that impact their college experience and degree completion .

May Revision Calls for Deactivating Prison Housing Units, but Not Prison Closures

More than 93,000 adults who have been convicted of a felony offense are serving their sentences at the state level , down from a peak of 173,600 in 2007. This sizable drop in incarceration is largely due to justice system reforms adopted since the late 2000s, including Proposition 47 , which California voters passed with nearly 60% support in 2014 . Despite this substantial progress, American Indian, Black, and Latinx Californians are disproportionately represented in state prisons — a racial disparity that reflects racist practices in the justice system as well as structural disadvantages faced by communities of color.

Among all incarcerated adults, most — about 90,000 — are housed in state prisons designed to hold roughly 75,500 people. This overcrowding equals 119% of the prison system’s “design capacity,” which is below the prison population cap — 137.5% of design capacity — established by a 2009 federal court order. California also houses around 3,000 people in facilities that are not subject to the cap, including fire camps, in-state “contract beds,” and community-based facilities that provide rehabilitative services.

• Calls for deactivating 46 housing units across 13 state prisons, for ongoing annual state savings of around $80 million.
• Fails to advance a plan to close state prisons.
• Proposes deep cuts to the Adult Reentry Grant (ARG) program.

The housing units proposed for deactivation contain roughly 4,600 beds. However, the state prison system currently operates with about 15,000 empty beds . Moreover, closing housing blocks rather than entire prisons saves the state less money because ongoing operational and staffing costs are higher when prisons remain open. For example, while the governor’s proposal would reduce state costs by around $80 million per year, the state would save around $200 million per year for every prison it closes. Given California’s challenging fiscal outlook, state leaders should be exploring ways to significantly reduce spending on prisons in order to ensure the wise use of state tax dollars and maximize state savings.

In recent years, California has ended the use of private prisons and shut down three state prisons. State leaders can — and should — go further. In fact, due to the large number of empty prison beds, the state could safely close up to five additional prisons, according to the Legislative Analyst’s Office . Closing five more state prisons would save around $1 billion per year — dollars that could be redirected to help incarcerated individuals successfully transition back to their communities as well as support crime survivors, reduce poverty, increase housing stability, and address substance use and mental health issues. Unfortunately, the May Revision fails to advance a plan to close more prisons, with the governor instead focusing on deactivating selected prison housing units for far less state savings.

Community-based organizations use ARG funds to help formerly incarcerated people successfully transition back to their communities. In January, the governor proposed to cut $7.8 million in unspent ARG funds from 2022-23 as well as to delay $57 million in ARG funds budgeted for 2024-25 to the next three fiscal years (2025-26 to 2027-28 — providing $19 million per year). The May Revision maintains the $7.8 million cut and also proposes two significant reductions: 1) eliminate (rather than delay) the $57 million budgeted for 2024-25 and 2) cut $54.1 million in ARG funds budgeted for 2023-24. The governor’s proposal represents a major step back from recent efforts to ensure that people released from prison are prepared to successfully reenter their communities.

Revised Budget Continues to Provide Over $100 Million to Address Retail Theft

Retail theft  is defined in several ways  in California law:

• Shoplifting
• Commercial burglary
• Organized retail theft

Shoplifting occurs when the value of stolen goods is $950 or less (petty theft) — a limit set by Proposition 47 of 2014 . Shoplifting is generally a misdemeanor, but may be charged as a misdemeanor or a felony if the defendant was previously convicted of certain severe crimes or is required to register as a sex offender.

Commercial burglary covers higher-value retail theft (grand theft) and can be charged as a misdemeanor or a felony.

Organized retail theft , a specific type of theft created by the Legislature in 2018 , is punishable as a misdemeanor or a felony.

Robbery , a felony, occurs when force or a threat of force is involved. “Smash and grab” incidents are prominent examples of robberies affecting retail businesses.

Retail theft rose following the isolation and social breakdown caused by the COVID-19 pandemic. In California, commercial burglary and robbery rates continued to exceed their pre-pandemic (2019) levels as of 2022, the most recent year for which statewide data are available. In contrast, California’s statewide shoplifting rate remains below the 2019 level despite a recent increase.

In January, Governor Newsom proposed to provide $119 million in 2024-25 to address organized retail theft and other crimes. This was the same amount of General Fund support provided in the current fiscal year (2023-24) despite the large budget shortfall the state is facing.

The May Revision modestly reduces the total funding level from $119 million to $115.4 million. This reflects a $3.6 million cut to the Vertical Prosecution Grant Program, which would see its funding reduced from $10 million to $6.4 million in 2024-25. The governor does not propose cuts in 2024-25 to other components of his organized retail theft package, which includes $85 million for local law enforcement agencies and $24 million for state-level task forces and prosecution teams.

Revised Budget Estimates Proposition 47 Savings of $95 Million for Local Investments

Overwhelmingly approved by voters in 2014, Prop. 47 reduced penalties for six nonviolent drug and property crimes from felonies to misdemeanors. Consequently, state prison generally is no longer a sentencing option for these crimes. Instead, individuals convicted of a Prop. 47 offense serve their sentence in county jail and/or receive probation.

By decreasing state-level incarceration, Prop. 47 reduced the cost of the prison system relative to the expected cost if Prop. 47 had not been approved by voters. The Department of Finance is required to annually calculate these state savings, which are deposited into the Safe Neighborhoods and Schools Fund and used as follows:

• 65% for behavioral health services — which includes mental health services and substance use treatment — as well as diversion programs for individuals who have been arrested, charged, or convicted of crimes. These funds are distributed as competitive grants administered by the Board of State and Community Corrections.
• 25% for K-12 school programs to support vulnerable youth. These funds are distributed as competitive grants administered by the California Department of Education.
• 10% to trauma recovery services for crime victims. These funds are distributed as competitive grants administered by the California Victim Compensation Board.

As of the 2023 Budget Act, the state has allocated roughly $720 million in savings attributable to Prop. 47 — funds that have been invested in local programs that support healing and keep communities safe. For example, a recent evaluation shows that people who received Prop. 47-funded behavioral health services and/or participated in diversion programs were much less likely to be convicted of a new crime. Specifically, individuals enrolled in these programs had a recidivism rate of just 15.3% — two to three times lower than is typical for people who have served prison sentences (recidivism rates range from 35% to 45% for these individuals).

The May Revision estimates that Prop. 47 has generated an additional $94.8 million in state savings due to reduced state-level incarceration. These dollars will be allocated through the 2024 Budget Act, increasing Prop. 47’s total investment in California’s communities to more than $800 million since these savings were first allocated through the 2016 Budget Act.

Governor Proposes Additional Cuts to Several Workforce Programs

The revised budget proposes to cut spending on several workforce development programs to help address the multi-year budget problem. ( See Health Workforce section. ) Specific cuts include:

• $50 million General Fund in 2024-25 and 2025-26 to California Jobs First (formerly called the Community Economic Resilience Fund).
• $20 million General Fund in 2024-25 to the California Youth Leadership Corp
• $20 million General Fund in 2025-26 to the Apprenticeship Innovation Fund at the Department of Industrial Relations.
• $10 million General Fund ongoing for the Women in Construction Unit at the Department of Industrial Relations.
• $10 million General Fund in 2025-26 for the Department of Industrial Relations’ California Youth Apprenticeship Program.

This program is an inter-agency partnership that supports strategies to diversify local economies and develop sustainable industries that create high-quality, broadly accessible jobs.

This is an initiative of the Workforce Development Agency, certain community colleges, and non-profit organizations that prepares historically marginalized youth to become community organizers and change agents in their local communities.

This is in addition to the $40 million General Fund delay in 2024-25 that was included in the governor’s January budget.

This aims to increase opportunities in the construction industry for women, non-binary, and underserved communities.

This provides apprenticeships for youth ages 16 to 24. This cut is in addition to the $25 million General Fund spending delay in 2024-25 that was included in the governor’s January budget.

In addition, the revised budget cuts $485 million General Fund in unspent one-time funds for the Learning-Aligned Employment Program in 2022-23. This program places eligible students at public colleges and universities in employment opportunities related to their area of study or career objectives. ( See higher education sections .)

Revised Budget Proposes Further Cuts to Prior Environment Commitments

Californians across the state have increasingly seen the effects of climate change through devastating fires, droughts, and floods, but communities of color and low-income communities are often hit hardest by these catastrophes due to historical and ongoing displacement and underinvestment. Additionally, these communities are more likely to be exposed to environmental pollutants for the same reasons. 

Significant investments in climate resilience were made through recent years’ budgets. Most of the commitments were one-time investments intended to be made across several years, so there are significant unspent funds remaining. In January, the governor proposed budget solutions that included $2.9 billion in reductions and $1.9 billion in delays of climate investments committed in previous budget agreements. Several of these proposals were included, or partially included in the early action agreement between the governor and the Legislature.

The May Revision proposes around $1 billion in additional reductions to climate and environment programs for 2022-23 as well as further reductions to planned spending beyond the current budget window. Reductions are proposed in areas including but not limited to clean energy and transportation, water and drought resilience, and wildfire resilience.

Significant new reductions that may disproportionately impact low-income and under-resourced communities include:

• $399 million for the Active Transportation Program across 2025-26 and 2026-27 ($300 million in 2025-26 and $99 million in 2026-27).
• $268.5 million for the Cleanup in Vulnerable Communities Initiative ($136 million in 2023-24, $85 million in 2025-26, and $47.5 million in 2026-27).
• $140 million for the Equitable Building Decarbonization program across 2024-25 and 2025-26 ($53 million in 2024-25 and $87 million in 2025-26).

This program supports walking and biking options with the goals of improving safety and mobility and reducing greenhouse gas emissions. The Transportation Commission notes that 85% of funds committed have gone to projects benefiting disadvantaged communities.

The initiative was created in 2021 and committed $500 million across four years to clean up hazardous waste sites in communities subject to environmental hazards.

This program provides funds for 1) energy retrofits for low and moderate income households and 2) incentives for the adoption of energy efficient technologies, at least half of which must benefit under-resourced communities. This appears to be in addition to the $286 million proposed reduction across several years included in the January proposal.

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Webinar: Examining Governor Newsom’s May Revision

Join us on Wednesday, May 22, at 11 a.m. as Budget Center experts explore how the governor responds to fiscal challenges and provide an overview of the state budget process.

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• About Adverse Childhood Experiences
• Risk and Protective Factors
• Program: Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action
• Adverse childhood experiences can have long-term impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include: 1

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with: 1

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination. 2 3 4 5 6

Quick facts and stats

ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs. 7

Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs. 1

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live. 5 6 ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work. 7

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. 8

ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. 9 Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide. 1 10 11 12 13 14 15 16 17

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress. Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning. 18

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. 18 These effects can also be passed on to their own children. 19 20 21 Some children may face further exposure to toxic stress from historical and ongoing traumas. These historical and ongoing traumas refer to experiences of racial discrimination or the impacts of poverty resulting from limited educational and economic opportunities. 1 6

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We all have a role to play.

• Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005. DOI: http://dx.doi.org/10.15585/mmwr.mm6844e1 .
• Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Science Direct. 2022; 22:7; 1105-1114. DOI: https://doi.org/10.1016/j.acap.2022.04.010 .
• Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood M. Risk Behaviors and Experiences Among Youth Experiencing Homelessness—Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts. Journal of Community Health. 2022; 47: 324-333.
• Experiencing discrimination: Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health | Annual Review of Public Health ( annualreviews.org).
• Sedlak A, Mettenburg J, Basena M, et al. Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Executive Summary. Washington, DC: U.S. Department of Health an Human Services, Administration for Children and Families.; 2010.
• Font S, Maguire-Jack K. Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse Negl. 2016;51:390-399.
• Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2 .
• Bellis, MA, et al. Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences Across Europe and North America: A Systematic Review and Meta-Analysis. Lancet Public Health 2019.
• Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 | MMWR
• Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7.
• Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N. Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstetrics & Gynecology . 2021;138(5):770-776. https://doi.org/10.1097/AOG.0000000000004570 .
• Sulaiman S, Premji SS, Tavangar F, et al. Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review. Matern Child Health J . 2021;25(10):1581-1594. https://doi.org/10.1007/s10995-021-03176-6 .
• Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. Journal of Pediatric Psychology . 2021;46(7):801-813. https://doi.org/10.1093/jpepsy/jsab027 .
• Mersky JP, Lee CP. Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC pregnancy and childbirth. 2019;19(1). https://doi.org/10.1186/s12884-019-2560-8.
• Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. No youth left behind to human trafficking: Exploring profiles of risk. American journal of orthopsychiatry. 2019;89(6):704.
• Diamond-Welch B, Kosloski AE. Adverse childhood experiences and propensity to participate in the commercialized sex market. Child Abuse & Neglect. 2020 Jun 1;104:104468.
• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
• Narayan AJ, Kalstabakken AW, Labella MH, Nerenberg LS, Monn AR, Masten AS. Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction. Am J Orthopsych. 2017;87(1):3. https://doi.org/10.1037/ort0000133.
• Schofield TJ, Donnellan MB, Merrick MT, Ports KA, Klevens J, Leeb R. Intergenerational continuity in adverse childhood experiences and rural community environments. Am J Public Health. 2018;108(9):1148-1152. https://doi.org/10.2105/AJPH.2018.304598.
• Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. J Adolesc Health. 2013;53(4 Suppl):S32-38. https://doi.org/10.1016/j.jadohealth.2013.05.004 .

Adverse Childhood Experiences (ACEs)

ACEs can have a tremendous impact on lifelong health and opportunity. CDC works to understand ACEs and prevent them.

States With the Largest Homeless Populations

One state accounted for close to a third of the nation’s homeless population, according to an annual report.

States With the Most Homeless People

Melina Mara | The Washington Post via Getty Images

California alone accounted for nearly 30% of all homelessness in America, based on 2023 estimates of the Annual Homelessness Assessment Report to Congress.

The estimated number of people experiencing homelessness in America surged to about 653,000 in 2023, the highest level on record since reporting began in 2007.

That’s according to the latest release of the Annual Homelessness Assessment Report to Congress from the U.S. Department of Housing and Urban Development. The report found that on a single night in January of 2023, at least 653,104 people were experiencing homelessness in the U.S., a more than 12% increase from 2020.

The “point-in-time” data from the report can come from volunteers, who typically canvas communities each January to survey homeless populations, as well as partnerships with local outreach staff, shelters and service providers.

Though COVID-era concerns may have led to an undercount in 2022, the latest figures also mark a 12% year-over-year increase. In the wake of the data’s release, the report’s project director, Meghan Henry , said the recent rise “reflects a perfect storm of economic instability in the wake of COVID, a relentlessly unaffordable housing market, and the sunsetting of programs that really provided concrete supports for people.”

Nationwide, the 2023 point-in-time count shows that approximately 0.2% of the U.S. population was homeless. However, numbers and rates varied by state, along with the prevalence of different types of homelessness.

These Are the 10 States With the Most Homeless People:

• California (181,399)
• New York (103,200)
• Florida (30,756)
• Washington (28,036)
• Texas (27,377)
• Oregon (20,142)
• Massachusetts (19,141)
• Colorado (14,439)
• Arizona (14,237)
• Pennsylvania (12,556)

California alone accounted for nearly 30% of all homelessness in America, based on the 2023 estimates. Yet standardized by population, the states with the highest rates of homelessness were New York (5.2 people experiencing homelessness per 1,000 residents), Vermont (5.1), Oregon (4.8) and California (4.6).

Meanwhile, Wyoming, North Dakota and Mississippi had the smallest numbers of homeless people, with fewer than 1,000 statewide. Adjusted for state population, Mississippi (0.33), Alabama (0.65) and Louisiana (0.69) had the lowest rates of homelessness.

These Are the 10 States With the Least Homeless People:

• Wyoming (532)
• North Dakota (784)
• Mississippi (982)
• Delaware (1,245)
• South Dakota (1,282)
• West Virginia (1,416)
• Rhode Island (1,810)
• Montana (2,178)
• Idaho (2,298)
• New Hampshire (2,441)

Do Warmer Climates See More Homelessness?

Climate can contribute to where homeless people live, and unsheltered populations appear to be larger in warmer states. The sheltered population, meanwhile, consistently makes up a larger share of the nation’s overall homeless population. In 2023, about 6 in 10 people experiencing homelessness were sheltered, meaning they resided in an emergency shelter, traditional housing or safe haven program.

In 2023, states in the West and South had the highest rates of unsheltered homelessness, including California (68%), Oregon (65%) and Florida (50%). About 95% of the homeless populations in Vermont and New York were sheltered.

A case that could reshape how municipalities deal with unsheltered homelessness went before  the U.S. Supreme Court in April.

Is Homelessness Getting Worse?

Since pre-pandemic estimates in 2020, the homeless population has grown in the vast majority of states. Vermont has seen the starkest increase in homelessness since 2020, with its homeless population nearly tripling, while Maine saw its homeless population more than double.

Between 2020 and 2023, the prevalence of homelessness increased across all race and ethnicity groups, but most notably climbed for the Asian (+52%) and Hispanic populations (+38%). And while homelessness among veterans was the only broad category that saw improvement – declining by 4.5% over the pandemic – chronic homelessness increased, with such patterns affecting about 1 in 3 individuals experiencing homelessness in 2023.

“Homelessness is an experience and it’s one that’s incredibly fluid. So people don’t become homeless and stay homeless until they’re not anymore,” Henry told U.S. News in an interview. “It is this sort of in and out of homelessness.”

What Populations Are Most At-Risk of Experiencing Homelessness?

Data has shown that people of color , people with a criminal conviction and those who have been involved with the foster care system are all more likely to experience homelessness than other groups. Nationwide, Black and Indigenous people continue to be overrepresented among populations experiencing homelessness. And 6 of every 10 people experiencing homelessness in 2023 were men or boys, the 2023 data shows.

The most recent release of the annual point-in-time count also revealed that 1 in 5 people experiencing homelessness in 2023 were 55 or older.

Elderly homelessness “is something that we've been seeing increase in the shelter population over the last few years,” Henry says. “It isn’t that people are just aging into being elderly and homeless. We also know that people are becoming homeless for the first time when they’re already over 65. … It’s certainly very tragic.”

What Causes Homelessness?

The main cause of homelessness in America is a lack of affordable housing, according to the U.S. Conference of Mayors . While many attribute homelessness to mental health issues or substance abuse, researchers have pointed to housing market conditions as a greater driver.

Affordable housing shortages, alongside high inflation, have pushed many out of their homes . And only around 1 in 4 people eligible for federal rental assistance reportedly receive it .

What’s Being Done to Combat Homelessness in the U.S.?

National policies, when they’re implemented at the local level, can have a large effect on homelessness, Henry says.

“The Bush administration put a ton of resources toward ending chronic homelessness, and during that time period, that population declined nationally,” she says. “Similarly, Obama then put a lot of resources toward veterans, and that population dropped.”

In December 2022, the Biden administration released a “housing first” strategic plan to reduce the homeless population by 25% by 2025. The approach calls for boosting permanent and affordable housing options, along with health care, job training and education assistance programs.

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Tags: Department of Housing and Urban Development , weather , housing , poverty

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COVID-19 and people experiencing homelessness: challenges and mitigation strategies

• Individuals experiencing homelessness are at increased risk of infection with severe acute respiratory syndrome coronavirus 2 owing to their lack of safe housing and are also at higher risk of severe coronavirus disease 2019 (COVID-19), given the high prevalence of risk factors in homeless populations.
• People experiencing homelessness often find it difficult to adhere to public health directives such as physical distancing, isolation and quarantine because of shelter conditions and other challenges.
• Several cities and regions have taken measures to provide spaces for people experiencing homelessness, to ensure physical distancing, isolation or quarantine; however, service providers must focus on building relationships and rapport, and take a trauma-informed approach to care, to persuade individuals to follow advice.
• Closure of regular services may put people experiencing homelessness at risk of other harms, such as those related to unsafe substance use and intimate partner violence.
• The COVID-19 pandemic has highlighted the importance of housing as a social determinant of health and raises the question of whether current approaches to addressing homelessness should be re-evaluated.

Infectious disease epidemics and pandemics have a disproportionate impact on people experiencing poverty, marginalization, stigmatization and discrimination. 1 – 3 Amid the current coronavirus disease 2019 (COVID-19) pandemic, this disparity is particularly relevant for individuals who experience homelessness. Homeless shelters are an ideal environment for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of shared living spaces, crowding, difficulty achieving physical distancing and high population turnover. 4 People who are homeless also have a high prevalence of chronic health conditions that increase the risk of poor outcomes if they develop COVID-19. 5

We discuss the unique effects of COVID-19 on those experiencing homelessness, specific challenges to be addressed and strategies to mitigate disease spread within the homeless population, focusing on emerging trends in North America from the perspective of equity-informed action. We highlight interventions and adaptations that may lessen the adverse impact of the COVID-19 pandemic on people experiencing homelessness.

How has COVID-19 affected the homeless population and its service providers?

Homeless individuals are at increased risk of infection with SARS-CoV-2 owing to their lack of safe housing and conditions in shelter and drop-in facilities. 1 , 6 In a shelter population, spread of SARS-CoV-2 may be rapid and the detection of illness delayed because of limited access to health care and social services. 7 , 8 The risk of severe COVID-19 is increased for people experiencing homelessness owing to the high prevalence of medical comorbidities including heart disease, respiratory conditions, liver disease and high rates of smoking in homeless populations. 9 – 11 An increasing proportion of people experiencing homelessness are older than 65 years, a factor that also exacerbates the risk of developing severe COVID-19. 12

Given these factors, modelling of the potential effect of SARS-CoV-2 among the US homeless population showed a potential peak infection rate of 40%, with an estimated 4.3% of individuals who experience homelessness likely to require admission to hospital. 6 Among 408 individuals experiencing homelessness who were in shelters in Boston, Massachusetts, 36% tested positive for SARS-CoV-2. 13 Rapid transmission has also been reported among staff at shelters, with 1 study showing that 30% of staff working in a Boston shelter tested positive for COVID-19. 14 Projected COVID-19 mortality rates among individuals experiencing homelessness range from 0.3% to 1.9%, which is higher than population averages. 6

Staff and organizations that provide services for people experiencing homelessness have identified the following particular problems: lack of timely and ongoing public health communications, difficulties in maintaining adequate infection control measures because of limitations in staffing and physical facilities, lack of sufficient personal protective equipment, and challenges to achieving effective screening of clients. 1 Furthermore, the obvious difficulty of maintaining self-isolation or quarantine in shelters or drop-in sites makes it essential to plan early and proactively to create isolation sites for people experiencing homelessness. 1

What changes to the homeless services sector may reduce the spread of COVID-19?

A framework created by the Canadian Network for Health and Housing for People Experiencing Homelessness notes 6 essential pillars in response to this pandemic: enhanced screening methods, sentinel surveillance, coordination of health and shelter systems, COVID-19 risk stratification, isolation shelters for persons under investigation and cohorting SARS-CoV-2-positive cases for community-based shelter care. 15 Given that homeless people represent a group that is particularly vulnerable to COVID-19, it is prudent to offer homeless people priority testing for SARS-CoV-2.

In keeping with general public health recommendations to prevent the spread of SARS-CoV-2, shelters, meal programs and other organizations that serve individuals experiencing homelessness must create conditions that enable physical distancing. Opening new shelter spaces and increasing spacing between beds has the potential to reduce the risk of spread of SARS-CoV-2. 7 , 16 Additional strategies to allow for physical distancing in shelters and drop-in sites include moving individuals who experience homelessness into hotels and motels, which has been implemented by government and shelter personnel in locations such as Montréal, Calgary, Los Angeles and the Region of Peel in Ontario. 17 – 20 Such efforts require commitment to additional funding and human resources.

Seattle reportedly created 1893 new spaces in shelter services to address the unique needs of individuals experiencing homelessness, 16 including increased number of beds in emergency shelters (95 beds), access to areas for physical distancing (709 expansion spaces), areas for isolation or quarantine (432 beds) and areas designed for recovery (612 beds). 16 A dedicated site for individuals with COVID-19 and experiencing homelessness was created in the Region of Peel and in Toronto, Canada, to allow for isolation along with health and social support care. 7 , 20

What special challenges arise in the management of people who are suspected of having or confirmed to have COVID-19?

Intersecting factors such as mental illness, substance use, involvement in sex work and distrust of service providers may contribute substantially to difficulties faced by individuals in engaging with pandemic-specific protocols. 4 , Additional challenges include limited access to health or social services. 4 Screening and treatment services such as primary care clinics may have been less accessible for individuals experiencing homelessness. The transient nature of homeless populations adds further complexities with respect to contact tracing to contain the spread of SARS-CoV-2 and reduce community transmission. 4 Additionally, the limited availability of services relative to the needs of the population poses major constraints on control efforts, as inadequate resources (e.g., space and personal protective equipment) make enforcing public health protocols extremely difficult at many shelters. 7 , 8

Individuals experiencing homelessness who do not adhere to advice to self-isolate or quarantine pose a particular challenge. When individuals with SARS-CoV-2 re-enter the community, risk of disease transmission is high. Absent legal and restrictive measures to address this issue, health and social homeless service providers must focus on building relationships and rapport, and take a trauma-informed approach to care, to persuade individuals to follow advice.

As discussed, individuals experiencing homelessness are likely to be at high risk for clinically severe COVID-19 yet are also unlikely to have engaged in any advance care planning. However, as a result of alienation from the health care system, many individuals experiencing homelessness may resist transfer to hospital if their condition deteriorates. Work is under way to establish consistent protocols for advance care planning for homeless people before admission to COVID-19 sites. Clinicians caring for this population should be trained and equipped to provide pandemic palliative care, including compassionate and trauma-informed end-of-life care. 21

How might physical distancing and isolation interventions negatively affect individuals experiencing homelessness?

Physical distancing has substantial negative implications for individuals who are homeless or precariously housed. Abrupt closure of drop-in services and community centres, and resulting disruption in social relationships and support, may lead to deterioration in mental health for many. Similarly, reduced access to public spaces such as libraries, community centres and malls, and a reduction in resources such as peer counselling services, disproportionately affect individuals experiencing homelessness.

Among individuals who are experiencing homelessness and have substance use disorders, the added stress imposed by the closures of related services may contribute to increased alcohol or drug use and high rates of substance-related morbidity or mortality. 22 , 23 For individuals who are opioid dependent, experiences of physical distancing and the resulting limited supply of opioid products may increase risks of overdose because of intermittent use and loss of drug tolerance. Reduced access to supervised consumption services increases risk of harms associated with unsafe drug use, including acquisition of blood-borne infections such as HIV and hepatitis C. 23

For many individuals who experience homelessness, sources of income include activities such as panhandling or sex work. Among women, girls and gender-diverse people, engaging in sex work or survival sex is often necessary to maintain shelter or to avoid intimate partner violence. 24 With physical distancing in place, individuals may have a reduced ability to engage in these activities and therefore may suffer substantial loss of income. Furthermore, homeless women and gender-diverse people may be at increased risk of experiencing intimate partner violence during the pandemic.

Individuals who experience homelessness are also likely to face criminalization of their daily life. For example, it is difficult, if not impossible, for homeless individuals to avoid infractions of physical distancing orders when they line up to enter a shelter or meal program or when they sit on a park bench. Homeless people in both Canada and the US have reportedly received fines ranging from $500 to $10 000 for such violations, 25 which is highly problematic. 25

How can COVID-19 care for individuals who experience homelessness be made more equitable?

As described above, interventions that are designed to house, isolate and treat people experiencing homelessness can begin to address the challenges, yet gaps remain. Programs and policies for addressing COVID-19 should be developed with and by Indigenous organizations to ensure that stigmatization, racism and ongoing colonialization experienced by Indigenous people is not compounded by public health approaches to the pandemic and that the unique needs of Indigenous people experiencing homelessness are met.

Health, social and government agencies must collaborate in a coordinated approach when developing and implementing services within the homeless sector. Funding is needed to ensure adequate supply of resources such as personal protective equipment, to enhance shelter space and to ensure harm reduction approaches in isolation and quarantine facilities for individuals experiencing homelessness. The latter includes providing managed alcohol programs, overdose prevention support and access to opioid antagonist therapy or safer supply.

Finally, as the pandemic wanes and is ultimately controlled, governments and service providers should take the opportunity to overhaul the way that people experiencing homelessness are treated and sheltered, and to transition to approaches that focus on long-term recovery through permanent housing and supports. 8 , 25 The feasibility of the latter approach will be influenced by ongoing shifts in the housing market, public priorities and government budgets as a result of the COVID-19 pandemic.

COVID-19 and associated public health control measures pose particular challenges and increased risks of harm for people experiencing homelessness. Measures have been implemented across the US and Canada to increase capacity to allow safe physical distancing for homeless people, including arranging temporary housing, enlarging shelter spaces and creating isolation sites for homeless people with COVID-19. However, the diverse needs of various subgroups of people experiencing homelessness must be considered to ensure implementation of effective and equity-focused interventions. The COVID-19 pandemic has highlighted the importance of housing as a social determinant of health and raises the question of whether current approaches to addressing homelessness should be re-evaluated.

Competing interests: Stephen Hwang and Naheed Dosani receive sessional payments from Inner City Health Associates for providing and directing medical care for people experiencing homelessness in Toronto. No other competing interests were declared.

This article has been peer reviewed.

Contributors: All of the authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.