Frequently Asked Questions: An Essential Overview

What is the mission of Boston Health Care for the Homeless Program (BHCHP)?

Founded in 1985 as one of the first Health Care for the Homeless programs in the country, Boston Health Care for the Homeless Program (BHCHP) is committed to a singular, powerful mission — to provide or assure access to the highest quality health care for all homeless individuals and families in the greater Boston area.

What services does BHCHP provide?

BHCHP provides primary care, behavioral health care and dental care. Our patients also receive support from case managers who assist them in applying for benefits, identify housing and training opportunities, and coordinate with other service providers. In addition, BHCHP operates a 104-bed medical respite care facility for patients too sick for life in shelter or on the street but not quite sick enough to occupy an acute care hospital room. BHCHP also offers specialized services for patients living with substance use disorders, HIV/AIDS, Hepatitis C, and for patients who identify as transgender.

Don't most of the shelters in Boston operate their own clinics?

No. Most of Boston’s shelters, including Pine Street Inn, St. Francis House, Shattuck at Pine Street Inn, and New England Center for Homeless Veterans rely on BHCHP to provide medical services. BHCHP offers health care at more than 45 locations in the greater Boston area: day programs and soup kitchens, family and domestic violence shelters, overnight and day shelters and hospital-based clinics at Mass General Hospital and Boston Medical Center.

Are the nurses and doctors who work at BHCHP volunteers?

No. In early 1984, a coalition of health care professionals, homeless service providers, and state and city officials came together in Boston to address the unmet medical needs of a growing homeless population. The coalition recognized that traditional health care providers were ill-equipped to respond to the special issues of people living in abject poverty without the safety of a home. Their work envisioned a new model of homeless health services—a model of care that employed interdisciplinary teams of full-time health care providers who could provide the consistency and continuity that so many homeless people lack in their lives.

BHCHP does use volunteers in a number of ways throughout our program, from greeting patients at our clinic sites to running patient activities in our medical respite program. Learn more about individual and group volunteer opportunities.

Why do homeless people need their own health care program?

Homelessness exposes those in crowded shelters to communicable diseases such as tuberculosis and influenza, complicates the management of chronic illnesses such as diabetes, AIDS and asthma, and makes health care harder to access. The obstacles and barriers to health care can be overwhelming for those living in abject poverty without the safety and stability of a home. Health care becomes a distant priority amid the daily search for food, clothing and shelter. Language and transportation barriers prevent access. Mainstream health care too often subjects homeless people to substandard treatment—a result of the complexity of their needs and the stigma associated with homelessness.

BHCHP is unique in its capacity for providing health care to those enduring the turmoil of homelessness. BHCHP’s patients receive care from providers experienced with their medical complexity and respectful of their struggles. Because we provide care in settings where homeless people receive food and shelter, our patients have access to high quality health care that would otherwise be elusive and unattainable.

I thought that the Affordable Care Act required all Americans to have health insurance. Doesn’t this eliminate the need for a program like BHCHP?

While the passage of the ACA in 2010 (and the passage of MA health care reform before that in 2006) requires health insurance coverage for all Americans, there are still some who remain un- or under-insured. While some of our patients lack any coverage, more than 90% of BHCHP’s patients are insured. In fact, BHCHP’s benefit specialists and case managers help patients to enroll in and retain their MassHealth benefits. The availability of health insurance coverage is a critical asset we rely upon in ensuring that our patients can receive the services and treatment they require once they are engaged in primary care and chronic disease management programs.

However, insurance alone is not enough to guarantee easy access to culturally competent, appropriate health care. Financial barriers aside, most homeless individuals are experiencing such extreme tumult and poverty in their lives, on either an episodic or chronic basis, that it is difficult to manage the basic components of obtaining access, such as transportation and keeping scheduled appointments. In the face of day-to-day chaos, homeless individuals and families often must neglect health needs to focus on basic survival.

How many people are homeless in Boston?

During the annual homeless census in 2015, the city of Boston identified more than 7600 people who were homeless on that evening – a 5.6% increase from the previous census.

Counting the number of people who experience homelessness during a given period of time is complicated by the fact that this is not a static, fixed population. People move in and out of homelessness and single point-in-time estimates are poor representations of the magnitude of this problem over a twelve-month period. Moreover, street and shelter counts miss the large numbers of people who are invisibly homeless, such as those who are doubled-up and move about transiently among family and friends. To that end, we estimate that as many as 25,000 individuals are homeless in Boston for some period of time each year. Of that group, BHCHP provides medical care to more than 11,000 individuals in more than 100,000 patient encounters.