Individuals experiencing homelessness may face barriers to accessing accurate information regarding COVID-19 vaccinations, as well as adequate access to vaccination sites. They are at an increased risk for developing COVID-19 due to lack of access to healthcare, lack of proper sanitation supplies, and inability to socially distance, particularly in congregate settings such as shelters. Additionally, people experiencing homelessness often have underlying medical conditions that make them more susceptible to becoming severely ill if infected with COVID-19. They may also face unique challenges to obtaining COVID-19 vaccinations, including mistrust in medical systems and limited access to traditional healthcare delivery settings. While difficult to quantify explicitly at a federal level, of the approximately 500,000 individuals experiencing homelessness annually, a large portion over the age of 65 qualify for both Medicare and Medicaid. Health plans can play a critical role in providing education around COVID-19 vaccinations to members experiencing homelessness and can also utilize plan resources to support these members in accessing vaccinations.
The CDC has issued interim guidance for health departments surrounding COVID-19 vaccinations for people experiencing homelessness, highlighting several key strategies for supporting vaccinations for this population. Notably, the CDC recommends leveraging relationships with local health departments, utilizing the same infrastructure used for COVID-19 testing to conduct vaccinations, and working with trusted providers and social service programs (including harm reduction services and syringe exchange programs) to administer vaccinations. Additionally, the CDC also recently published a frequently asked questions page for this topic that addresses common inquiries specific to this population.
In addition to national guidance, local organizations are innovating to address barriers to vaccination among individuals experiencing homelessness. Cities are using staff from local health departments, fire rescue, and other public health groups to deploy mobile teams to conduct outreach and administer vaccines for people experiencing homelessness in places where they get food and live. Health plans are also developing creative ways to reach members experiencing homelessness. CalOptima, a county organized health system in Southern California that offers health insurance programs to low-income children, adults, seniors, and people with disability, has taken special interest in promoting COVID-19 vaccinations for members experiencing homelessness. CalOptima developed a vaccination intervention and member incentive strategy to promote vaccinations, which includes two $25 nonmonetary food gift cards for Medi-Cal members experiencing homelessness that received both required doses of the COVID-19 vaccine. CalOptima will also coordinate with community health centers, shelter operators, and other community-based organizations to reach homeless members and promote vaccine access. For more information on using incentives to promote vaccine uptake, the U.S. Department of Housing and Urban Development (HUD) HUD Exchange program released this brief.
 Kaiser Family Foundation. (2021). COVID-19 Risks and Vaccine Access for Individuals Experiencing Homelessness: Key Issues to Consider. Retrieved from https://www.kff.org/medicaid/issue-brief/covid-19-risks-vaccine-access-individuals-experiencing-homelessness-key-issues/.
 Office for the Assistant Secretary for Planning and Evaluation. (2014). A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. Retrieved from https://aspe.hhs.gov/reports/primer-using-medicaid-people-experiencing-chronic-homelessness-tenants-permanent-supportive-housing-0.
 Kaiser Family Foundation. (2021).
 CalOptima. (n.d.). About CalOptima. Retrieved from https://www.caloptima.org/en/About/AboutCalOptima.aspx.
 Gerda, N. (2021, July 10). COVID Vax Food Cards for Homeless People Are Up for Retroactive Approval Tuesday. Voice of OC. Retrieved from https://voiceofoc.org/2021/07/covid-vax-food-cards-for-homeless-people-are-up-for-retroactive-approval-tuesday/.