On a chilly January morning in Los Angeles, physician assistant Brett Feldman searched for patients among the city’s unhoused population. The winter storm had forced many to seek shelter, making his search even more challenging.
Feldman is part of the street medicine team at USC Keck School of Medicine. This team provides essential healthcare to thousands of homeless individuals, many of whom struggle with chronic conditions, mental health issues, and various other medical problems. These individuals need help more than ever.
Yet, Feldman and other healthcare providers have growing concerns about recent changes to Medi-Cal eligibility, introduced by President Trump’s legislation. The shift could leave over 90% of unhoused individuals in Los Angeles without insurance, drastically limiting their access to necessary care.
Medi-Cal, California’s version of Medicaid, offers health insurance for low-income residents. Starting in 2027, new rules will quiz about 14% of the state’s 14 million recipients, requiring them to prove they are working 80 hours a month or face losing their coverage. The new law also mandates biannual income reviews, complicating compliance for the homeless, who often lack stable access to resources like phones and the internet.
A troubling statistic shows that nearly 2 million people could lose coverage, according to state estimates. Many unhoused individuals face significant barriers, including trauma, addiction, and mental health disorders, hindering their ability to find and maintain employment. Research indicates that those experiencing homelessness live, on average, nearly 20 years less than the general population.
Without health insurance, those who are already struggling are left with limited options. They may forgo medications and medical appointments, leading to worsening health and increased emergency room visits—often the only available healthcare left for some.
Kelly Bruno-Nelson, an executive director at CalOptima, a Medi-Cal plan for many with unstable housing, highlights the looming crisis. “This is going to be a huge issue for the unhoused,” she warns.
While the law includes exemptions for many who can’t work—such as those with severe health problems—claiming these exemptions often requires certification from a doctor. However, access to regular healthcare is dismally low among homeless Californians. A recent study found that only 7% of L.A.’s unhoused population visited a healthcare provider in the past year.
This gap puts many eligible individuals like Samantha Randolph at risk. Living on the streets for over five years and currently seven months pregnant, she finds the requirements particularly daunting. Her health insurance recently expired due to a mailing issue, leaving her without critical support for her upcoming childbirth.
State officials are attempting to automate eligibility checks for Medi-Cal to ease the burden on Californians. However, challenges remain. Volunteers and social workers often have limited means to verify work hours or medical exemptions due to the unpredictability of their patients’ living circumstances.
Dr. Matt Beare of Kern County notes that many homeless individuals fall through the cracks of the system, adding that the stakes are high—potentially impacting lives.
California has invested heavily in street medicine over the last five years, bringing healthcare directly to those in need. These teams deliver not just medical care, but also connect patients with social workers and housing specialists. Yet, the expected loss of Medi-Cal could jeopardize these critical services, causing some street medicine programs to struggle financially.
Experts worry that as Medi-Cal coverage dwindles, homeless individuals’ chances of getting help will diminish significantly. They risk falling into a cycle of emergency care and worsening health. “This population could spiral into a healthcare vortex,” says Gray Miller of Titanium Healthcare, explaining that chronic illnesses can escalate quickly for those without stable support.
Luckily for some, like Samantha, there is a glimmer of hope. After dedicated efforts, she finally received her Medi-Cal approval, unlocking access to vital maternity housing. As Feldman says, “I’m so happy we got Sam inside.”
This story highlights the urgent battle facing California’s unhoused population and the healthcare providers striving to support them amid a rapidly changing landscape.
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Donald Trump,Health Care,homelessness,Medi-Cal,public health
