
Dr. Marcus Lam
Associate Professor
School of Leadership and Education Sciences
Department of Leadership
University of San Diego

Dr. Nathan Grasse
Associate Professor
School of Public Policy & Administration
Carleton University
Funding Health Care for People Experiencing Homelessness: An Examination of Federally Qualified Health Centers’ Funding Streams and Homeless Patients Served (2014–2019)
International Journal of Environmental Research and Public Health, 21(7) | June 2024
Abstract
It is estimated that three million people annually experience homelessness, with about a third of the homeless population being served by Federally Qualified Health Centers (FQHCs). Thus, FQHCs, dependent on government funding for financial viability, are vital to the infrastructure addressing the complex issues facing people experiencing homelessness. This study examines the relationship between various government funding streams and the number of homeless patients served by FQHCs. Data for this study come from three publicly available databases: the Uniform Data System (UDS), the IRS Core files, and the Area Resource File. Fixed-effects models employed examine changes across six years from 2014 to 2019. The results suggest that, on average, an additional homeless patient served increases the expenses of FQHCs more than other patients and that federal funding, specifically Health Care for the Homeless (HCH) funding, is a vital revenue source for FQHCs. We found that the number of homeless patients served is negatively associated with contemporaneous state and local funding but positively associated with substance use and anxiety disorders. Our findings have important implications for the effective management of FQHCs in the long term and for broader public policy supporting these vital elements of the social safety net.
Introduction
Homelessness is an intractable issue that requires interventions at multiple levels. At the macro level, public policies and elected officials are critical to driving government funding and public opinion to bring awareness to the homelessness problem and the subsequent consequences of inaction. At the micro level, interventions by social workers and medical professionals that help homeless persons find shelter and receive health care are critical to short-term survival and care. At the meso level, community-based not-for-profit organizations (NPOs) that employ medical professionals, social workers, and other frontline workers are an often overlooked but essential component of the multi-pronged solution to providing vital health, social, and shelter services to people experiencing homelessness.
Marcus Lam’s research focuses on identifying strategies for the sustainability of health and human service nonprofit organizations. Specifically, his program of research advances two interrelated domains: 1) the effect of organizational and environmental factors on nonprofit sustainable resources and 2) the influence of resources on organizational programs, services, and client outcomes. Prior to joining SOLES, Dr. Lam was on faculty at the Columbia School of Social Work in New York City. Dr. Lam has also served as a senior research associate at the UCLA Center for Civil Society and has published reports on the state of the nonprofit sector in Los Angeles, the state of arts and culture funding in Los Angeles, as well as methodological chapters in the Global Civil Society Yearbook. He has also held fellowship positions with the Nonprofit Finance Fund, Los Angeles Program and EMES European Research Network on social enterprises and the social economy.
Nathan Grasse is an Associate Professor in the Master of Philanthropy and Nonprofit Leadership (MPNL) program at Carleton University. He holds a Bachelor of Science (BS), a Master of Public Administration (MPA), and a PhD in Political Science, all from the University of Wisconsin-Milwaukee, United States. His academic focus primarily revolves around the governance of public-serving organizations, highlighting the connections between governance and financial management. This encompasses a detailed study of revenue structures, the influence of organizational and environmental factors, and how strategic choices impact financial health and other organizational outcomes.
Dr. Grasse’s expertise includes nonprofit finance and financial management, governance and leadership, and strategic management. He emphasizes the critical role of charities in addressing social issues, enhancing representation, and delivering services in communities. Recognizing the challenges these organizations face in financial management and governance, particularly due to a reliance on historical or anecdotal information, his work aims to expand knowledge in these areas. This focus is vital for the effective management of charitable organizations, providing them with more robust frameworks and guidelines to improve their decision-making processes.