Access to health care can be a significant challenge for individuals experiencing homelessness. These individuals often face additional barriers such as lack of transportation, difficulty scheduling appointments and limited access to consistent medical care.1 Homelessness impacted a total of 6,389 individuals in Hawaiʻi in 2024 according to a point-in-time count.2 America’s Health Rankings identified Hawaiʻi as having the most severe housing challenges among all US states and ranked it 49th, the second highest, in housing cost burden in 2023.3,4 On Hawaiʻi Island, a point-in-time count conducted in 2023 recorded 278 sheltered and 725 unsheltered homeless individuals in 2023, 12% of whom were children. To improve access to care and health outcomes for individuals experiencing homelessness, UnitedHealthcare Community Plan of Hawaiʻi is collaborating with Hawaiʻi Island Community Health Center (HICHC) to support its Street Medicine program.
Expanding access to care
Health care barriers on Hawaiʻi Island are complex and widespread. A shortage of primary care providers and specialists can create long wait times. High poverty and underemployment rates make private transportation unaffordable for many, while public transit is limited. Language barriers and cultural differences further hinder access to care. These challenges have a significant impact on people experiencing homelessness, many of whom are unable to access preventive care and rely on emergency departments for their care.
Street Medicine program results
448 patient encounters
110 medical appointments completed
170 individuals enrolled in housing programs
86 new patient registrations
236 follow-up appointments booked
109 prescriptions provided
The Centers for Disease Control and Prevention reports that from 2020 to 2021, people experiencing homelessness visited the emergency department at a rate of 310 visits per 100 persons, more than seven times the rate of the general population.5 Usage of emergency departments for non-urgent care inflates costs and strains the health care system and leaves those experiencing homelessness without proper care coordination. The HICHC Street Medicine Outreach program aims to address both issues, reducing the burden on hospitals while providing comprehensive, accessible care.
Bringing care directly to individuals
HICHC, a federally qualified health center (FQHC), provided outreach to people experiencing homelessness for years before launching a dedicated Street Medicine department in 2023.6 The initiative serves individuals experiencing homelessness across 20 zip codes, spanning 2.5K square miles of Hawaiʻi Island. Mobile health units bring primary care to the streets, shelters and other locations, while outreach teams, composed of patient navigators, nurses and health care providers, work to build trust, identify needs and connect individuals to care. On-the-spot health assessments address acute conditions, provide wound care, vaccinations and facilitate mental health support through HICHC’s behavioral health department. Clinicians from HICHC provide support and consultations via telehealth.
The Street Medicine team goes beyond medical care by connecting individuals to specialty services, community resources and FQHC programs, ensuring a whole-person approach. The program incorporates harm reduction strategies, substance use disorder (SUD) services and naloxone distribution to prevent opioid overdoses. Case management services help individuals navigate social services, housing and employment resources. Health education sessions promote hygiene, nutrition and chronic disease management. Integrated with HICHC’s service model, the program provides access to primary care, behavioral health, insurance enrollment, transportation, patient navigation and continuity of care. It also links individuals to essential health care programs such as women, infants and children (WIC), early childhood development, reproductive health and SUD treatment.
Patient perspective: supporting long-term health
For many, the Street Medicine program is more than just a mobile clinic, it is a critical lifeline. One patient shared their experience of receiving care through the initiative:
"I first met the HICHC Street Medicine Outreach team during one of their regular visits to my area. I was hesitant at first, but their kindness made me feel comfortable enough to accept their help. They offered me a full health screening, and that was when I found out I had Hepatitis C.
Hearing that news was scary and overwhelming, but the team didn’t leave me to face it alone. They connected me with their pharmacy specialist and the Hep C program, making sure I got the medical care I needed right away. They helped me understand my condition, set up my treatment plan and worked with me to get my medication. Whenever I had questions or felt anxious, they were there to listen and support me. I never felt judged, just cared for.
The Street Medicine team kept checking in on me, making sure I was taking my medication and staying on track with my treatment. They answered my questions and eased my worries every step of the way. Thanks to their ongoing support, I am starting to feel better. My health is improving, and I finally feel hopeful about the future."
Operating where individuals live, like encampments, shelters, transitional housing and public spaces, the program is rooted in trauma-informed care. The team builds trust through respectful, patient-centered communication using motivational interviewing techniques. To enhance care coordination, HICHC works with Kona Community Hospital and Hilo Medical Center to develop discharge workflows for patients experiencing homelessness. Additionally, the program streamlines new patient registration and insurance enrollment, helping individuals access Medicaid, Medicare and other coverage options without delay.
Hundreds of patients reached
Recognizing the importance of the Street Medicine program, UnitedHealthcare Community Plan of Hawaiʻi has provided $95K to expand its reach and enhance its services. This investment supports program promotion to connect more individuals with care, maintenance of both mobile units, and resources to meet immediate needs, including food, clothing and transportation vouchers for individuals in crisis.
The results of the Street Medicine program have been far-reaching. Between January and October 2024, the Street Medicine program recorded:
- 448 patient encounters
- 86 new patient registrations
- 110 medical appointments completed
- 236 follow-up appointments booked
- 170 individuals enrolled in housing programs
- 109 prescriptions provided
Learn more from the Street Medicine Outreach team below:
By supporting HICHC’s Street Medicine program, UnitedHealthcare Community Plan of Hawaiʻi is advancing whole-person care for individuals facing housing instability. The program ensures that essential medical, behavioral and social services are accessible for all residents. This initiative exemplifies UnitedHealthcare’s commitment to addressing health disparities and improving health outcomes in Hawaiʻi by meeting people where they are and supporting access to care when and where they need it most.
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Sources
- https://masterspublichealth.com/public-health-care-for-homeless-people/
- https://hhdw.org/na-2024-homeless-point-in-time-counts/
- https://www.americashealthrankings.org/explore/measures/severe_housing_problems/HI
- https://www.americashealthrankings.org/explore/measures/cost_burden/HI
- https://www.cdc.gov/
- Street Medicine Outreach – Hawaiʻi Island Community Health Center
