Pulse Check: Surveying the Field in Uncertain Times

Table of Contents

Part of the job description for homeless services systems and providers is to identify creative solutions to pressing challenges. In recent years, the COVID-19 pandemic added an unusual strain, and was soon followed by increased federal efforts to criminalize homelessness and remake the social safety net.

To understand the impacts of these developments, the Alliance began a series of periodic surveys of the homeless services field. These Pulse Check surveys will support efforts to advise practitioners, shape policy, and help communities recognize that they are not alone in their experiences.

While this project will eventually reach all types of experts, the first round of surveys targeted executive leaders and was circulated between November and December of 2025. A sampling of 87 leaders within Continuums of Care (CoCs) and 162 leaders within service provider organizations responded. Given that the homeless services field responded to various developments during and after the survey timeframe, the impact of those events may not be fully reflected in this round of findings. For example, various conversations occurred around appropriations for the U.S. Department of Housing and Urban Development (HUD), the Administration’s efforts to change the criteria to receive HUD homelessness funding, and a lawsuit seeking to prevent those changes.

In general, the surveys paint a picture of a field facing mounting pressures that may negatively impact services and the nation’s efforts to end homelessness. Providers expressed key concerns around funding pressures, criminalization of homelessness, shifts in Medicaid, anticipated impacts of federal policy shifts, and staffing challenges.

About the Survey

The Alliance’s Pulse Check survey reached leaders of service provider organizations in 39 states and the District of Columbia. Respondents were located in a broad range of communities, including major cities (42 percent), small cities (30 percent), suburban areas (12 percent), and rural areas (17 percent). Respondents represented the broad range of homelessness services, encompassing street outreach, emergency shelter, and permanent housing.

The Pulse Check survey also reached CoC leaders in 27 states. To avoid collecting identifying information, respondents were not asked to indicate their community type.

The Alliance will periodically conduct such surveys, reaching service provider and CoC leaders, but also other stakeholders. The goal of the “Pulse Check” survey series is to follow changes in homeless services over time in this current era of policy uncertainties and change.

Funding Pressures

Early in 2025, the President released federal budget recommendations that would have restructured and significantly reduced funding for homeless services. Throughout 2025, providers and organizations engaged in vigorous advocacy efforts to avoid these reductions. Congress finalized appropriations for the U.S. Department of Housing and Urban Development (HUD) in January 2026, significantly avoiding the feared cuts to programs and services through September 2026.

As the federal government prepares to begin the next funding process for FY2027, it is likely that homeless services will once again have a dark cloud hovering over their efforts to house people in need. The Alliance’s Pulse Check survey revealed that even a threat of funding cuts can be destabilizing for organizations and agencies.

"Has your organization reduced or eliminated core services (for example, housing or behaviorial health offerings) due to funding uncertainty?"

While grappling with the pressures of potential funding cuts, homeless services systems and providers were simultaneously managing very real reductions in available resources. In response to the COVID-19 pandemic, Congress had increased investments in a broad range of anti-poverty programs; however, the phase-out of those funding streams in recent years affected communities’ ability to provide a sufficient anti-poverty response, including homeless services.

Criminalizing Homelessness

In June 2024, the U.S. Supreme Court issued its decision in City of Grants Pass v. Johnson. The case has given jurisdictions across the country permission to punish people living unsheltered, even when they have no other shelter options in their community. About a year later, President Trump issued an Executive Order indicating that the Administration would take action to encourage communities to enforce laws prohibiting urban camping and loitering. As a result, efforts to criminalize homelessness have been multiplying throughout the country.

"Since 2024, have you observed increases in certain policies, practices, or enforcement activities in your region that address homelessness through criminal or legal measures? (Select all that apply)"

In responding to the Alliance’s Pulse Check survey, leaders of homeless services organizations reported increased criminalization policies and enforcement in their regions. Organizations indicated that these changes were leading to negative outcomes, including client displacements that disrupt services and increased fear among unhoused people.

Medicaid Shifts

The Affordable Care Act of 2014 significantly expanded health insurance coverage for people experiencing homelessness by allowing single adults to participate in Medicaid. In 2025, Congress passed legislation (dubbed the “One Big Beautiful Bill”) that was expected to halt this progress by removing an estimated 7.5 million people from Medicaid. This legislation erected new hurdles, including work requirements and a requirement to re-prove eligibility every six months (instead of annually). Inability to keep up with constant paperwork and delays in government processing are expected to push many people out of the program.

When asked about this issue in the Alliance survey, 62 percent of service providers expected that many of their clients (31 percent or more) would lose Medicaid coverage. They believed these changes would disrupt access to behavioral health services and increase emergency room visits. They cited major barriers their clients would face to meet work requirements, including physical and mental health challenges, criminal legal system involvement, and limited job opportunities in their communities.

"In what ways would reductions in Medicaid eligibility and coverage affect the services that your organization is able to provide to clients? (Select all that apply)"

Anticipated Impacts of Potential Policy Shifts

Through its FY2026 Budget Proposal and an Executive Order focusing on homelessness, the Trump Administration has pushed for changes to homelessness policy. The Alliance’s survey asked system and service provider leaders about some of these recommendations.

Idea: Forced institutionalization of more unhoused people in mental health hospitals, substance use disorder treatment centers, and jails or prisons.

Most service providers (77 percent) generally said these facilities are “not appropriate” or “very inappropriate” for their clients. Providers further indicated that, in their communities, beds in mental health and substance use disorder treatment facilities are generally unavailable. This bed shortage severely limits options for those who voluntarily seek treatment, but also makes it difficult to force people into treatment.

Idea: Eliminate the Continuum of Care Program, selecting a new avenue for delivering homeless services funding to service providers.

The vast majority of service providers (90 percent) said their CoC’s regional planning and coordination work is “moderately” to “extremely” important to achieving their mission. CoCs have many responsibilities. One of their key priorities is collecting and analyzing data from a community’s service providers, and most service providers believe this role is critically important. Sixty-eight percent say that if CoCs are eliminated and can no longer manage data, it would make it difficult to track outcomes and evaluate program effectiveness. Sixty-four percent indicate that it would be difficult to link clients to resources.

Idea: Change policies targeting specific subpopulations.

The federal government has made efforts to prohibit or burden access to services for transgender people, undocumented immigrants, or people who have a substance use disorder. One potential intention is to strong-arm people into changing who they are or their behavior, with continued homelessness being the penalty for not conforming. System leaders suggest that these policy ideas are unlikely to change their clients’ identity or behaviors. Thus, the policies would effectively deny people assistance and prolong homelessness.

One policy idea would deny homeless services to transgender people, potentially with the goal of forcing those in need to reject their own gender identity. However, when asked about the possible elimination of group protections, 77 percent of service providers said “most transgender clients would not conform to gender norms, prolonging their homelessness.”

If harm reduction policies were eliminated (to force people with substance use disorders to get treatment or be denied services), 83 percent of service providers say that clients would continue to be unsheltered either because 1) they wouldn’t try to comply with required treatment or 2) they would try to comply and fail.

In the case of immigration policies, targeting undocumented individuals could negatively affect many people who are not even members of the target population, as shown in the chart below.

Workforce Concerns

Homeless services workers are often underpaid, contributing to high employee turnover and understaffing due to unfilled positions. Funding cuts (or looming threats of funding cuts) intensify these challenges. Employers may find it difficult to institute living wages and may feel compelled to lay off staff or institute hiring freezes. Uncertainties around these possibilities only compound the problem, causing some employees to leave voluntarily before involuntarily losing their jobs. This type of workforce shrinkage often overburdens remaining workers with greater responsibilities while leaving many people (many of whom have histories of poverty and homelessness) unemployed. Efforts to help people and end homelessness are hindered by these compounding factors.

By the end of 2025, federal funding cuts had yet to become a reality—just a national discussion. This uncertainty was enough for some organizations to start reporting staffing disruptions, including layoffs and hiring freezes. Further, organizations indicated that all types of employees are at risk, but particularly caseworkers who play a significant role in connecting clients to housing and services – a critical role in ending homelessness.

Conclusion

The results of this first Pulse Check survey make clear that homeless services organizations and the people they serve are under increasing strain. Systems and providers are managing fewer resources after the expiration of COVID-19 relief dollars, while fearing that still more budget cuts may be down the road. Clients are feeling the pressure of increasing criminalization policies that displace them from familiar places and disconnect them from services. Many people are likely losing access to healthcare, and therefore will lose treatment for physical and mental health challenges. Homelessness leaders further suggest that other pending policy ideas could effectively deny homeless services to increasing numbers of people, leaving them vulnerable to unsheltered homelessness and/or community punishment.

Despite these dire circumstances, many in the field are daily sorting through challenges and making things work. However, they will need help from every level of government and the private sector to actually reach their goal of ending homelessness.

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