An estimated 745,652 people in the U.S. were homeless in 2025, including 2,720 in Arkansas, according to the 2025 Annual Homelessness Assessment Report to Congress by the U.S. Department of Housing and Urban Development (HUD). Homelessness severely harms physical and mental health, increasing exposure to illness, injury, substance use, and untreated chronic conditions. The negative consequences of homelessness not only impact the individual but also stress the healthcare system through higher inpatient and emergency department usage and the criminal justice system through higher rates of incarceration.
Homelessness is dynamic, with individuals tending to cycle between housing and homelessness. Given the negative consequences of homelessness, it is helpful to understand the factors associated with exits from and returns to homelessness. A study published online in November by the journal Housing Policy Debate examined factors associated with exits from and returns to homelessness among older adults.
Research Focus and Findings
The researchers conducted a longitudinal study on homelessness by recruiting individuals age 50 and up from Oakland, California. They chose to confine the study to older adults because, they noted, older adults are a growing, yet understudied, subset of the homeless population who experience unique vulnerabilities to homelessness and challenges to regaining housing. The study recruited over 350 individuals between July 2013 and June 2014 and an additional 100 between August 2017 and July 2018. The final sample included 411 individuals who either were available for follow-up visits at six-month intervals or, if they missed a scheduled follow-up visit, could be included because the researchers had data on their housing status. Follow-ups continued for a median of four years.
The study found that factors associated with exiting homelessness included having a case manager in the previous six months and having difficulty performing one of the five activities of daily life (bathing, dressing, eating, toileting, and transferring/mobility). The researchers hypothesized that functional impairment may have led to preferential treatment in housing services. Factors associated with decreased likelihood of exiting homelessness included incarceration, sexual or physical abuse, and experiencing unsheltered homelessness for more than 30 days.
When looking at factors associated with returns to homelessness, the researchers found that receiving some form of rental subsidy more than halved the likelihood of returning to homelessness. They also found that moderate-to-severe amphetamine use and incarceration both increased the likelihood of returning to homelessness.
Insights for Arkansas
The number of people in the U.S. experiencing homelessness in 2025 was the highest ever recorded, according to HUD. Between 2024 and 2025, the number of people in families with children experiencing homelessness increased by more than 15%. HUD also reported that Arkansas had the nation’s second-highest rate of unsheltered, unaccompanied youth on a single night in January 2025; the previous year, Arkansas’s rate was the highest in the nation.
Homeless populations in Arkansas may face increased barriers to accessing medical care as Arkansas implements a federal Medicaid work requirement on January 1, 2027. Homelessness alone is not sufficient to qualify for a medical frailty exemption from the work requirement, which could lead to reduced coverage for the homeless population and an increased financial burden on health systems through uncompensated emergency department visits.
Given the findings in the study that rental subsidies reduce the likelihood of returning to homelessness, as well as other research suggesting that housing support can reduce emergency department usage among the homeless (particularly among those with mental health conditions), Arkansas could consider incorporating rental assistance programs into a Section 1115 Medicaid waiver, a mechanism that allows states to conduct pilot projects that promote the objectives of Medicaid. Several states, including California, Oregon, North Carolina, and Arizona, provide housing support through Section 1115 Medicaid waivers.
