Light streamed through stained-glass windows in a former church, illuminating long white tables where weary men gathered. Johnny Henderson was glad for the rest. The 71-year-old — who has one arm, heart disease and vision problems — slept on the street the night before.
Henderson is a regular at the St. John Center men’s day shelter. So are a great-grandfather in a wheelchair who has prostate cancer, a 54-year-old with four psychiatric disorders and a 66-year-old with a walker who wears a hospital bracelet warning “fall risk.”
All are potential candidates for permanent, government-subsidized apartments under a “Housing First” approach, a model rooted in the belief that people need a stable place to live before addressing other problems. But the approach that’s been central to federal government policy for more than a decade is disappearing under President Donald Trump’s administration. Housing organizations across the U.S. that depend on federal funds are making changes to comply with new government policies that favor a “Treatment First” approach and short-term “transitional” housing.
Homelessness and Health Risks Remain Significant
Across America, nearly 750,000 people were homeless last year, according to an estimate compiled by the U.S. Department of Housing and Urban Development. That number is down slightly from 2024 but up 31% from 2019.
The portion considered chronically homeless — having a disability and long-term or repeated episodes of homelessness of at least a year — has also risen since 2019. Overall, research shows, roughly half of homeless adults live with a disability, up to two-thirds have mental illness and 2 in 5 have substance use disorder.
In Louisville, outreach specialist Angel Sivado said such statistics are reflected in the people she serves, whose living conditions make it extremely difficult to care for themselves, get to doctors or keep up with medications.
James Myers, 66, who is blind, has congestive heart failure and is undergoing treatment for prostate cancer, said, “I’m tired. I mean, the streets will beat you down, and I think they put a few years on me.” Henderson, meanwhile, said, “I’m going to die sleeping outdoors. But I got nowhere to go.”
Housing First Versus Treatment First
The Housing First idea was pioneered by a New York nonprofit in the 1990s and has been at the heart of federal homelessness policy since 2013. Today, there are roughly 173,000 “permanent supportive housing” beds for chronically homeless people, and 235,000 for other populations, including veterans. These are long-term apartments paired with voluntary services.
Studies have consistently shown that Housing First programs keep people stably housed. Some research says they do so better than other models, including “Treatment First,” which favors mandatory services for addiction and serious mental illness. But findings on health outcomes have been mixed.
Last year, Trump signed an executive order calling for an end to federal support for Housing First policies. His proposed budget for fiscal 2027 calls for eliminating the federal initiative that goes mostly to Housing First programs. The administration favors housing lasting up to two years, during which people would be required to get treatment.
“Housing First has failed our most vulnerable and enabled addiction,” HUD said in an email. “HUD’s proposed reforms seek to address the root causes of homelessness and advance recovery, self-sufficiency, and competition that drives accountability.”
Providers Warn of Consequences From Short-Term Housing
Service providers acknowledge that transitional housing is a good option for some people, such as those getting on their feet after evictions. But they say most chronically homeless people can’t pull their lives together within two years and would likely wind up homeless again.
John Franklin, 58, said transitional housing wouldn’t work for him. He spent nearly 14 years on the streets dealing with severe alcoholism, and it took a long time to adjust to normal life. He now gets by on disability, as a throat cancer survivor with heart failure, and lives in a permanent supportive apartment in suburban Louisville.
“I could not make it,” said Franklin, who shares the apartment with his orange tabby, Moe. “This is my safe haven.”
At St. John’s Sheehan Landing, Phillip Sieveking lives in one of 80 furnished one-bedroom apartments, with access to a clinic, food pantry, meeting rooms and community garden. The former chef has diabetes but didn’t take care of it while homeless. Doctors had to amputate part of one leg. He credits his caseworker with encouraging him to keep up with medical care and navigate systems for disability and food benefits.
In New Jersey, Tatiana Velez has been in permanent supportive housing since 2021 after spending 18 years in prison and later living in abandoned buildings and struggling with opioids.
Federal Funding Changes Force Communities to Adapt
After HUD tried to rework its homelessness grants to fit the administration’s favored policies, a consortium of local governments and advocates for homeless people sued. A federal judge agreed with them, but this month, an appeals court said the administration could move ahead.
Trump’s proposed budget calls for eliminating the $4 billion Continuum of Care program, which in 2024 awarded money to 6,500 projects. At that time, more than 60% went to permanent supportive housing, mostly to continue existing efforts. Just 1% went to transitional housing.
Homelessness organizations are scrambling to alter their housing strategies so they can keep getting federal money. In Louisville, St. Vincent de Paul and Family Health Centers-Phoenix Health Care for the Homeless are looking at converting some permanent supportive housing apartments into transitional units. St. John would only be left with Sheehan Landing after converting its 120 community apartments to transitional housing.
In Corbin, Kentucky, Volunteers of America Mid-States had worked for 18 months with Eastern Kentucky University and others on a permanent supportive housing project that would have included childcare and access to college classes. “That project is now dead,” said CEO Jennifer Hancock.
The result for people like Henderson could mean more time on the streets as they grow older and sicker.
“The lady in the housing office told me, she said, ‘Mr. Henderson, you got a stent in your heart. You got one eye and one arm. Something’s going to have to happen for you.’”
Editorial Fact Check & Key Findings
Key points
- Nearly 750,000 Americans were homeless in the latest HUD estimate.
- Proposed reforms eliminate the $4B Continuum of Care initiative favoring permanent supportive housing.
- Federal appeals court permitted the administration to move forward with grant criteria revisions.
What the evidence shows
HUD and the White House are overhauling federal homelessness programs by phasing out the decade-old Housing First model and prioritizing short-term transitional housing requiring treatment.
Background and limits
Roughly 750,000 people were homeless in the US last year, with chronically homeless individuals facing significant physical and psychiatric disabilities. Service providers warn that short-term limits may return vulnerable individuals to the streets.
Why this matters
The federal policy pivot from unconditional permanent supportive housing to condition-based transitional housing marks the largest federal grant restructure in over a decade.
