For many Californians, the path to better health starts not in a doctor’s office, but at home. Yet for more than 186,000 people living without stable housing, a safe place to sleep is out of reach. Among them, older adults aged 50 and above represent the fastest-growing group experiencing homelessness, with many facing this crisis for the first time later in life.
Behind these numbers are stories of lost income, medical bills, and limited access to care. Black, Latino, and Native American communities are also disproportionately affected, highlighting how housing instability deepens long-standing health inequities across the state.
Medi-Cal’s Expanding Role in Whole-Person Care
California's Medi-Cal program, its Medicaid equivalent, covers more than 15 million residents and is a linchpin in the strategy to link healthcare with housing stability. With CalAIM, the state is rethinking its health care system to emphasize social determinants of health, including food access, transportation, and secure housing. Two major initiatives under CalAIM are helping transform this vision into action such as Enhanced Care Management and Community Supports. Together, these programs shift the focus from treating illness to promoting stability, dignity, and prevention, especially for older adults and individuals with complex needs.
Enhanced Care Management: Guiding Care Beyond the Clinic
Enhanced Care Management provides one-on-one, high-touch coordination for people with significant medical or social challenges. Each member is paired with a lead care manager who acts as a single point of contact, coordinating appointments, medications, and essential services such as food or housing support.
For people facing homelessness or unstable housing, ECM teams meet clients wherever they feel safe, whether at home, a clinic, a shelter, or in the community. Care managers help them: Connect with housing programs or temporary rentals, apply for rental or deposit assistance, prevent eviction through counseling and mediation and build independence and long-term stability This approach ensures that no one falls through the cracks. According to the California Department of Health Care Services, roughly 13 percent of ECM participants are age 65 or older, a number expected to grow as more aging adults seek community-based support.
The Bigger Picture: Healing Starts With Stability
When people have a stable home, they can manage medications, attend checkups, and reconnect with family or community. Without housing, health declines quickly, leading to chronic illness, mental distress, and reliance on emergency care.
By embedding housing services into healthcare delivery, California is reshaping what it means to care for its most vulnerable populations. Programs like ECM, Community Supports, and partnerships with providers demonstrate that the path to recovery begins with something simple but essential: a place to heal.
