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Community-Based Health Care for the Homeless

Rebecca Voelker
JAMA. 1994;271(19):1469. doi:10.1001/jama.1994.03510430021007.
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IN THE SPRAWLING, urban-and-rural landscape of Arizona's Maricopa County, homeless people wouldn't get far on the $15 000 in local funds allocated this year for a program of integrated services, including medical and psychiatric care.

"We are one of the fastest-growing counties in the country, but we are one of the poorest in funds for indigent health care," says Julie Marshall, administrator of the Maricopa County Health Care for the Homeless program, which serves Phoenix and surrounding areas.

The bulk of the program's $1.1-million annual budget comes from the federal Health Care for the Homeless (HCH) program sponsored by the Health Resources and Services Administration (HRSA), Rockville, Md. Through the Division of Programs for Special Populations within its Bureau of Primary Care, the HRSA doles out $58 million annually to 120 community-based organizations working to provide integrated primary medical care, mental health services, and substance abuse treatment while establishing an


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