Caleb Zimmerschied Valadez is a freelance writer. He can be reached at calzimval@gmail.com.

What started as a radical fringe movement of medicine more than 30 years ago is now being incorporated into mainstream health care — with the city of Los Angeles at the forefront.

With backpacks and pickup trucks full of medicine and equipment, doctors and other medical providers in LA head out to deliver comprehensive health care directly to people experiencing homelessness. Patients receive care wherever they are, whether that’s in an encampment, on the sidewalk, or under a bridge.

The typical model of healthcare in the U.S. either requires someone seeking medical care to schedule an appointment with their doctor, often a month in advance, or wait until it’s an emergency. Both are luxuries for the many unhoused Californians focused on meeting their immediate needs.

“If they spend the day panhandling because they’re hungry and they want to get food, then that’s going to take priority for them over going to the doctor’s office,” said Brett Feldman, associate professor at Keck School of Medicine of USC and co-founder of the USC Street Medicine program.

Besides the social stigma of being visibly homeless, patients may also be reluctant to leave their belongings behind in their tent or encampment for hours while they seek out care. So instead, street medicine teams remove barriers to care and seek out their patients, specifically those experiencing unsheltered homelessness.

According to Los Angeles Council Member Eunisses Hernandez, a vocal supporter of the program, almost 27,000 people in LA are unsheltered. The city currently has a contract with the Street Medicine team, and her district has contributed discretionary dollars to add a social worker and flexible funding for things like emergency motel stays.

“When we think about our public safety system, we can’t just keep responding to harm and violence and crisis. We have to do work to prevent those crises from happening in the first place,” said Hernandez. “Teams like the USC Street Medicine Team are part of an ecosystem of public safety and harm reduction.”

She believes that in addition to keeping people alive, street medicine programs save cities money and take pressure off housing services and first responders. When a first responder takes someone to a hospital, they’re required to wait with the patient until the hospital takes over. That time adds up. Street medicine teams can reduce the heavy reliance on first responders and related costs.

Street medicine can also create continuity for patients experiencing homelessness. “Unfortunately, in typical crisis management, they have two choices: They determine that it’s not a crisis, in which case they leave the person on the street without taking any other action,” said Feldman. “Or if it is a crisis, they take the person to the hospital, but a few days later they’re back on the street. Either way, that person is still on the street without true follow-up care.”

As for hospital use, the street medicine program has reduced hospital admissions for its patients by 75% and decreased the average hospital stay from 12 to 7.9 days since its inception in 2023. Countywide investments into substance use prevention, treatment, and harm reduction — which would include street medicine — helped lead to a 22% reduction in drug-related overdose deaths in 2024.

The street medicine team also includes a housing support arm. According to Hernandez, housing case managers are often overloaded, with over 20 clients per case manager. Outreach workers may carry loads of up to 50 or more people who require housing assistance.

“A lot of the crises that we’re experiencing in LA are because the rent is too damn high,” she said, “And if people could afford their housing, this wouldn’t be happening.”

When trying to house someone, caseworkers often have trouble keeping track of the people who need help. An unhoused person often changes locations many times before they get housing. Hernandez said that it can take as much as 300 days before someone is placed in permanent housing.

Since they see the patients in their own environments, street medicine teams are much more likely to know where the patient is and can help caseworkers find them before their housing voucher expires. And since the team knows the patient’s health care needs, they continue to see the patients once they are housed.

Under the program, between 30 and 40% of patients are housed within a year of their first “office visit.” Patients treated by the street medicine teams also tend to have better physical and mental health outcomes. They are less likely to continue using drugs and more likely to stay housed.

“The motto is to go to the people and then go where they go,” said Feldman. “We see them on the street, but then we follow them into housing, and it becomes a great support for the housing providers who may be struggling to meet the needs of people with complex medical conditions.”

How it (currently) works

One of the chief appeals of the program is that a large portion of street medicine is billable through Medi-Cal. This means cities don’t have to pay for medical care, enhanced care management, and housing navigation assistance.

Moreover, someone who is eligible for Medi-Cal may wait up to two months to confirm their eligibility for services. But the street medicine team sees the patients immediately, many of whom already meet the wage requirements for Medi-Cal. The street team also helps patients who are eligible for Medi-Cal get signed up.

But that could change. Since starting work on this story, Congressional leaders approved billions in cuts to Medicaid, and by extension, Medi-Cal. The recent tax and spending bill also increased work rules for Medicaid recipients.

“Imposing work requirements on a person still living unsheltered without a shower to prepare for a job interview, laundry facilities to present themselves well, transportation to attend work, or electricity to charge a computer to complete work, all while eating less than a meal a day and trying to survive, will be devastating for the people and most will lose coverage,” said Feldman.

It’s also unclear how these changes would impact AB 543 (González, Mark), a pending bill sponsored by USC Street Medicine program. AB 543 would prohibit care delays based on managed care network assignments and provide patients four to six weeks of care while their Medi-Cal eligibility is verified. Feldman said this change would allow doctors to make an immediate and large impact on patient health. The bill also seeks to create a patient identification and data-sharing network so street medicine teams can more quickly identify patients most in need of care.

If people experiencing unsheltered homelessness lose MediCal coverage, Feldman says programs like his will search for other creative ways to continue to serve the people, such as expanding partnerships with cities to respond to referrals, contribute to housing priorities, and lead outreach efforts with medicine.

The benefits are clear even if the funding is not

For Hernandez, the benefits of the program are clear. The street medicine team’s patients trust them much more than traditional doctors, and they can provide care fast. She hopes that the program doesn’t languish, as the city and county bicker over what responsibilities are the city’s and which are the county’s.

She recalls a patient from Compton she met while on a ride-along with the street medicine team. He had just been hit by a car, and with a broken foot, he couldn’t move. The street medicine team was able to give him an ultrasound and take him to the hospital.

“It can be really hard for many people to trust doctors, but because they’re out there building rapport, their patients really trust [the street medicine team] with some of the scariest things they’re going through,” she said.