The causes of homelessness and determining how best to assist those who find themselves homeless became particularly prominent, visible issues in the 1980s. The concept of homelessness may seem like a straightforward one, with individuals and families who have no place to live falling within the definition. However, the extent of homelessness in this country and how best to address it depend upon how one defines the condition of being homeless. There is no single federal definition of homelessness, although a number of programs, including those overseen by the Department of Housing and Urban Development (HUD), Department of Veterans Affairs (VA), Department of Homeland Security (DHS), and Department of Labor (DOL) use the definition enacted as part of the McKinney-Vento Homeless Assistance Act (P.L. 100-77). The McKinney-Vento Act definition of a homeless individual was recently broadened as part of the Helping Families Save Their Homes Act of 2009 (P.L. 111-22). Previously, a homeless individual was defined as a person who lacks a fixed nighttime residence and whose primary nighttime residence is a supervised public or private shelter designed to provide temporary living accommodations, a facility accommodating persons intended to be institutionalized, or a place not intended to be used as a regular sleeping accommodation for human beings. The new law expanded the definition to include those defined as homeless under other federal programs, in certain circumstances, as well as those who will imminently lose housing. In the 112th Congress, a bill that would further expand the McKinney-Vento Act definition, the Homeless Children and Youth Act of 2011 (H.R. 32), has been approved by the House Financial Services Committee, Subcommittee on Insurance, Housing and Community Opportunity. A number of federal programs in seven different agencies, many originally authorized by the McKinney-Vento Act, serve homeless persons. These include the Education for Homeless Children and Youth program administered by the Department of Education (ED) and the Emergency Food and Shelter program, a Federal Emergency Management Agency (FEMA) program run by the Department of Homeland Security. The Department of Health and Human Services (HHS) administers multiple programs that serve homeless individuals, including Health Care for the Homeless, Projects for Assistance in Transition from Homelessness, and the Runaway and Homeless Youth program. This report describes the federal programs that are targeted to assist those who are homeless; includes recent funding levels; discusses current issues, including homelessness after the economic downturn and federal efforts to end homelessness; and provides information on recent legislation. Among active legislation are bills to reauthorize the Violence Against Women Act, which includes transitional housing for those who are homeless as a result of domestic violence (S. 1925 and H.R. 4970) and legislation that would, among other things, reauthorize the Education for Homeless Children and Youth program (H.R. 3989 and H.R. 3990).

The Patient Protection and Affordable Care Act (ACA) reauthorized new funding for numerous existing discretionary grant and other programs and activities. ACA also created multiple new discretionary grant programs and activities and provided for each an authorization of appropriations. Funding for all of these programs and activities is subject to action by congressional appropriators. This report summarizes all the discretionary spending provisions in ACA that authorized appropriations for grant programs and other activities. A companion product, CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA), summarizes all the mandatory appropriations in the new law. Among the provisions that are intended to strengthen the nation's health care safety net and improve access to care, ACA permanently reauthorized the federal health centers program and the National Health Service Corps (NHSC). The NHSC provides scholarships and student loan repayments to individuals who agree to a period of service as a primary care provider in a federally designated Health Professional Shortage Area. In addition, the new law addressed concerns about the current size, specialty mix, and geographic distribution of the health care workforce. It reauthorized and expanded existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). Title VII supports the education and training of physicians, dentists, physician assistants, and public health workers through grants, scholarships, and loan repayment. ACA created several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provided training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expanded the nursing workforce development programs authorized under PHSA Title VIII to bolster undergraduate and graduate nursing education and training. As part of a comprehensive framework for federal community-based (i.e., public health) prevention activities, including a national strategy and a national education and outreach campaign, ACA authorized several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use). The new law also leveraged a number of mechanisms to improve the quality of health care, including new requirements for quality measure development, collection, analysis, and public reporting; programs to develop and disseminate innovative strategies for improving the quality of health care delivery; and support for care coordination programs such as medical homes, patient navigators, and the co-location of primary health care and mental health services. Additionally, ACA authorized funding for programs to prevent elder abuse, neglect, and exploitation; grants to expand trauma care services and improve regional coordination of emergency services; and demonstration projects to implement alternatives to current tort litigation for resolving medical malpractice claims, among other provisions. The Congressional Budget Office estimated that ACA's discretionary spending provisions, if fully funded by future appropriations acts, would result in appropriations of approximately $106 billion over the 10-year period FY2010-FY2019. Most of that funding would be for programs that existed prior to, and whose funding was reauthorized by, ACA. Few new programs created by ACA received funding in FY2011 or FY2012.

The federal health center program, authorized in Section 330 of the Public Health Service Act, awards grants to support health centers: outpatient primary care facilities that provide care to primarily low-income individuals. The program-administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS)-supports four types of health centers: (1) community health centers; (2) health centers for the homeless; (3) health centers for residents of public housing; and (4) migrant health centers. According to HRSA data, there are over 8,633 unique health center sites (i.e., unique health center facility locations). Facilities must meet a number of requirements to receive a Section 330 grant, but receiving these grants enables health centers to receive services or in-kind benefits from a number of federal programs. Appropriations for the health center program have increased over the past decade, resulting in more centers and more patients served. From FY2000 through FY2012 the health center program's appropriation increased by 48%. Over this same time period, the number of health center sites increased by 59%. The program also received supplemental appropriations through the American Recovery and Reinvestment Act (P.L. 111-5) in FY2009. The program's expansion may continue under the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148, ACA), which permanently authorized the health center program and created the Community Health Center Fund (CHCF) that included a total of $9.5 billion for health center operations to be appropriated in FY2011 through FY2015. However, it is not clear whether these funds will be used to expand the health center program because in FY2011, FY2012, and the FY2013 President's Budget request, these funds were or would be used to augment discretionary appropriation reductions to the health center program. Health centers are required to provide health care to all individuals regardless of their ability to pay and are required to be located in geographic areas that have few health care providers. These requirements make health centers part of the health safety net-providers that serve the uninsured, the underserved, or those enrolled in Medicaid. Data compiled by HRSA demonstrate that health centers serve the intended safety net population as the majority of patients are uninsured or enrolled in Medicaid. Some research also suggests that health centers are a cost effective way of meeting this population's health needs because researchers have found that patients seen at health centers have lower health care costs than those served in other settings. In general, research has found that health centers, among other outcomes, improve health, reduce costs, and provide access to health care for populations that may otherwise not obtain health care. This report provides an overview of the federal health center program including its statutory authority, program requirements, and appropriation levels. The report then describes health centers in general, where they are located, their patient population, and some outcomes associated with health center use. It also describes some federal programs available to assist health center operations including the federally qualified health center (FQHC) designation for Medicare and Medicaid payments. The report then concludes with a brief discussion of issues for Congress such as the potential effects of the ACA on health centers, the health center workforce, and financial considerations for health centers in the context of changing federal and state budgets. Finally, the report has two appendixes that describe (1) FQHC payments for Medicare and Medicaid beneficiaries served at health centers; and (2) programs that are similar to health centers but not authorized in Section 330 of the PHSA.