Trump’s Retreat From ‘Housing First’ Upends Homeless Programs and the People They Serve
LOUISVILLE, Ky. — Light filtered through stained-glass windows in a former church, falling across long white tables where weary men had gathered for a few hours of rest. Johnny Henderson was grateful for it. The 71-year-old, who has one arm, heart disease and worsening vision, had slept outside the night before.
Henderson is a familiar face at the St. John Center men’s day shelter. So are a wheelchair-using great-grandfather with prostate cancer, a 54-year-old managing four psychiatric disorders and a 66-year-old with a walker whose hospital bracelet warns “fall risk.”
Under the federal “Housing First” model, all of them would be candidates for permanent, government-subsidized apartments. The approach rests on a simple premise: people need a stable place to live before they can address addiction, mental illness or other problems. For more than a decade, it has been central to federal homelessness policy. Under President Donald Trump, it is being dismantled.
The upheaval, housing providers and advocates say, is endangering some of the nation’s most vulnerable people.
“Housing is healthcare,” said Ra’Shann Martin, executive director of St. John Center, which provides outreach and housing in addition to the day shelter. “The longer people stay unhoused, the more fragile they become.”
Across the U.S., nonprofits that depend on federal funds are reluctantly revising their plans to comply with policies that favor a “Treatment First” approach and short-term “transitional” housing. They fear the changes will push people with severe health risks back onto the streets—or keep them there, as Henderson has been.
Planned housing projects have been abandoned in places such as Corbin, Kentucky. Less housing is available for homeless people in Santa Cruz County, California. In Louisville, nonprofits are considering converting permanent apartments into temporary housing, including most of St. John’s 200 units.
Nearly 750,000 people were homeless in the U.S. last year, according to an estimate by the Department of Housing and Urban Development. That is slightly lower than in 2024 but 31% higher than in 2019.
The share considered chronically homeless—people with a disability who have been homeless for at least a year or repeatedly—has also increased since 2019 and now accounts for about a quarter of the total.
Research shows roughly half of homeless adults live with a disability, up to two-thirds have a mental illness and two in five have a substance use disorder. Rates of disability, heart disease and diabetes are two to three times higher than in the general population.
In Louisville, outreach specialist Angel Sivado sees those statistics in the people she serves. Their living conditions make it extremely difficult to care for themselves, get to medical appointments or keep up with medications.
On a recent day, she parked a St. John van near a fast-food restaurant and walked into the woods to visit a couple living in a tent. Later, she and a colleague headed toward encampments just off a highway, shouting “outreach” over the traffic.
One of their main tasks is guiding clients through the process of obtaining housing.
“They’re not just homeless people; they’re people,” Sivado said. “They’re somebody’s son. They’re somebody’s mother. They’re someone’s daughter.”
Sometimes there is a victory. Before going home one evening, Sivado stopped beneath a downtown overpass to see James Myers, 66, who is blind, has congestive heart failure and is being treated for prostate cancer. She told him an apartment should be available soon.
“I’m tired. I mean, the streets will beat you down, and I think they put a few years on me,” said Myers, standing near his broken guitar. “I can’t wait to get off the street.”
Others are not so fortunate. Henderson, the St. John regular, survived a train accident that cost him an arm and led to a yearslong opioid addiction. He has recently dealt with heart disease, an eye problem, spinal surgery and auditory hallucinations.
“I’m going to die sleeping outdoors,” he said, his voice breaking. “But I got nowhere to go.”
Every person’s path to homelessness is different, and so is the question of what solution is “best.” The answer may change depending on whether the goal is reducing overall homelessness, moving people into jobs, saving taxpayer money, improving health—or simply keeping people alive.
Housing First was pioneered by a New York nonprofit in the 1990s and has been at the center 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. The units are long-term apartments paired with voluntary services. Tenants often must contribute 30% of their income after certain expenses toward rent and utilities.
Studies have consistently found that Housing First programs keep people stably housed. Some research says they do so better than alternatives, including Treatment First, which requires 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. His proposed budget for fiscal 2027 would eliminate the federal initiative that mostly funds such programs. The administration favors housing lasting up to two years, during which participants would be required to receive 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.”
Many critics of Housing First do not believe addiction and mental health treatment should be optional.
“That is the biggest difference between Housing First and not Housing First,” said Devon Kurtz, director of public safety policy at the Cicero Institute. Kurtz also worries that permanent supportive housing has become a “one-size-fits-all approach,” including for groups that might be better served by transitional housing.
Service providers acknowledge that transitional housing can help some people, such as those recovering from an eviction. But they say most chronically homeless people cannot rebuild their lives within two years and would likely become homeless again.
“If you want to gradually work on reducing social services that are funded by the federal government, OK,” said Jennifer Clark, CEO and executive director of St. Vincent de Paul Louisville, which offers permanent and transitional housing. “But you cannot make a huge sweeping change and big cuts and take an ax to everything and think that there aren’t going to be consequences for some people who are really in need.”
John Franklin, 58, said transitional housing would not work for him. He spent nearly 14 years on the streets battling severe alcoholism, and it took a long time to adjust to normal life. Now living on disability as a throat cancer survivor with heart failure, he cannot imagine paying for housing entirely on his own or surviving the streets.
“I could not make it,” said Franklin, who shares a permanent supportive apartment in suburban Louisville with his orange tabby, Moe. “This is my safe haven.”
The welcome mat outside Phillip Sieveking’s permanent supportive apartment reads “Home Sweet Home,” a phrase that means a great deal to him after a couple of years on the streets.
Sieveking lives at St. John’s Sheehan Landing, a complex with 80 furnished one-bedroom apartments, a clinic, a food pantry, meeting rooms and a community garden he tends in much of his free time.
The former chef has diabetes but did not manage it while homeless. Doctors had to amputate part of one leg. On a recent morning, he put on his prosthetic, grabbed his crutches and slowly made his way to the garden to check on roses, sunflowers and vegetables.
He credits his caseworker with encouraging him to keep up with medical care and navigate systems for disability and food benefits. He also attends meetings at the complex, including one where residents discuss wellness and sobriety while working on art projects.
“They have helped me, you know, go from being homeless to being a part of society,” said Sieveking, 47. “I feel blessed to be here.”
In New Jersey, Tatiana Velez has lived in permanent supportive housing since 2021, soon after connecting with the Camden Coalition, which serves people with complex health and social needs.
After serving 18 years in prison for robbery, she lived in abandoned buildings and struggled with opioids for a couple of years. Velez had never signed a lease or opened a bank account when, in her late 30s, she learned she was pregnant and decided she was ready to change.
“I didn’t know what it was to have a roof over my head or pay the bills,” said Velez, who receives disability payments for psychological and educational disabilities.
She now shares a first-floor suburban apartment with her 5-year-old daughter and a formerly homeless cat named Snowball. A preschool graduation certificate hangs on the wall.
After HUD tried to rework its homelessness grants to fit the administration’s preferred policies, a consortium of local governments and advocates sued. A federal judge sided with them. But this month, an appeals court said the administration could proceed.
Meanwhile, Trump’s proposed budget calls for eliminating the $4 billion Continuum of Care program, which in 2024 awarded money to 6,500 projects. At the time, more than 60% went to permanent supportive housing, mostly to sustain existing efforts. Just 1% went to transitional housing.
The proposed changes have left homelessness organizations scrambling to adjust their housing strategies so they can continue receiving federal money.
“It’s like psychological warfare the last two years, trying to figure out how to navigate these changes that are looming right over us,” Martin said.
Dr. Robert Ratner, director of housing for health in Santa Cruz County, California, said losing permanent supportive housing funds would worsen problems caused by the end of another federal program: pandemic-era emergency housing vouchers. People set to lose those vouchers are being prioritized for available housing, meaning the county cannot help as many people who are homeless now.
A similar dynamic is unfolding at The Delores Project in Denver, which serves women and transgender and nonbinary people. Program leaders expect people already in permanent housing on their campus to stay because they will not have vouchers to move into the community. That will mean fewer openings for new residents.
In Louisiana, the state housing agency applied to redirect federal money away from rental assistance and toward a 200-bed shelter with strict requirements for participants. Local coalitions in charge of the money rejected the effort, but housing advocates worry it signals what may come next.
Some communities are seeing planned projects canceled. For 18 months, Volunteers of America Mid-States worked with Eastern Kentucky University and others on a permanent supportive housing project in Corbin that would have included child care and access to college classes. “That project is now dead,” said CEO Jennifer Hancock.
Many nonprofit leaders feel pressured to move toward transitional housing. In Louisville, St. Vincent de Paul and Family Health Centers-Phoenix Health Care for the Homeless are examining whether to convert some permanent supportive housing apartments into transitional units. St. John would be left with only Sheehan Landing after converting its 120 community apartments to transitional housing.
For people like Henderson, the result would likely 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.’”
But with “just a little life left,” he said, it may not happen soon enough.
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Mulvihill reported from Oaklyn, New Jersey. Katie Jane Fernelius of Verite News in New Orleans contributed to this story.
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