As of December 2025, several federal policy moves are reshaping how safety-net services are funded and delivered—especially for people experiencing homelessness, very low-income seniors, and caregivers trying to keep loved ones stably housed and insured. Our team at Healing Tampa Bay reviewed current federal documents and credible reporting to help Florida residents understand what’s changing, what risks to expect, and which steps can help you safeguard benefits.
Below is what stands out—and what we recommend taking action on now.
What’s new in homelessness and housing funding
- HUD’s FY2025 Continuum of Care (CoC) funding notice cuts sharply into permanent housing supports:
- According to the National Low Income Housing Coalition (NLIHC), the November 13 CoC Notice of Funding Opportunity (NOFO) makes “drastic, harmful changes,” slashing support for permanent housing programs by more than half, with up to 170,000 people at risk of returning to homelessness if those programs lose funding.
- Reporting from Maine Public says federal assistance for permanent supportive housing (PSH) would be “gutted and capped at 30%,” with funds shifted toward transitional housing and work requirements, and notes HUD will no longer automatically renew existing grants (Maine Public). Maine officials warn of possible lapses because the NOFO is late in the funding cycle.
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California news outlets are tracking similar concerns, with the state contesting the shift as HUD posts notice for $3.9 billion in CoC funding and caps permanent housing/rental aid at 30%—a large change where 87% previously supported long-term housing in some regions (Mercury News).
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The NOFO’s timelines and scoring priorities point to service gaps in 2026:
- NLIHC highlights that applications are due January 14 with anticipated awards on May 1, 2026; about one-third of current CoC awards expire between January and June 2026, creating likely funding gaps even for programs that are ultimately renewed (NLIHC analysis). The National Alliance to End Homelessness warns these delays could cause evictions and interruptions in services.
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The NOFO also changes scoring to prioritize alignment with the President’s executive order “Ending Crime and Disorder on America’s Streets,” including policies like mandated services, camping bans, and work requirements. The NOFO notes HUD may evaluate eligibility of projects that have used harm reduction practices, racial preferences, or non-binary definitions of sex (NLIHC summary).
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Longer-term rulemaking could widen use of work requirements and time limits in housing programs:
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As reported by ProPublica, HUD is advancing a rule that would allow (not require) local housing authorities and some private landlords to impose work requirements up to 40 hours per week and time limits as short as two years in public housing and Section 8 programs. While voluntary for local agencies, it signals a policy direction to watch.
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Who might feel the impact the most:
- Program leaders stress that PSH is critical for chronically homeless people, the elderly, and youth—groups who face high risks if stable housing and intensive services are disrupted (Maine Public). Advocacy groups also warn of harms to disabled residents and veterans if coercive approaches expand while permanent housing shrinks (Michigan League for Public Policy).
Bottom line for Tampa Bay: If national CoC priorities shift away from permanent housing and toward short-term or coercive models, local systems may face service disruptions in mid-2026. Tenants in PSH or long-term supportive programs should prepare for possible administrative changes, recertifications, or program transitions—and keep close contact with their case managers.
Medicaid updates that matter for unhoused and housing-insecure households
- CMS guidance confirms Medicaid can support “health-related social needs” (HRSNs) in some states:
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On December 10, 2024, CMS updated a Medicaid and CHIP Informational Bulletin detailing opportunities to cover clinically appropriate, evidence-based services addressing HRSNs like housing instability and food insecurity, via Section 1115 demonstrations, State Plan Amendments, and 1915 waivers. The bulletin underscores federal support for states using Medicaid to address social determinants of health (CMS report to Congress, p.49).
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Hospitals now code homelessness as a complicating condition:
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Effective August 1, 2023, CMS changed the severity designation for three ICD-10-CM diagnosis codes that describe homelessness from “non-complication” to “complication or comorbidity,” reflecting higher average resource costs for these cases. As social determinants of health codes appear more on claims, this could help align resources with patients’ needs, including people experiencing homelessness (CMS report to Congress).
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What the evidence says about Medicaid and homelessness services:
- A peer-reviewed time-series analysis in two Medicaid expansion states (NJ and PA) found the ACA expansion boosted enrollment among adults using homelessness services: an immediate 7.5 percentage point jump in New Jersey and 8.5 points in Pennsylvania, with the strongest enrollment among people with two or more months of homeless-service use in a year (University of Pittsburgh CP3 study). The authors suggest leveraging shelter and outreach relationships can improve enrollment.
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At the same time, federal evaluation of the Accountable Health Communities model found “navigation alone” did not increase resolution of social needs or connections to services in the first three years, though it may have contributed to fewer emergency department visits (CMS Innovation Center AHC evaluation; summarized in CMS data).
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The larger context: State Medicaid HRSN initiatives face fiscal uncertainty:
- States have increasingly used Medicaid to support housing-related services for high-need groups, but major Medicaid cuts proposed and advanced this year place those efforts at risk, according to reporting by the New York Times. The article documents practical housing stabilization activities financed by Medicaid case management—helping tenants avoid eviction, connect with landlords, and manage conditions that could otherwise lead to homelessness.
What this means for Florida residents: Florida has not expanded Medicaid under the ACA. Still, CMS’s December 2024 bulletin shows a clear federal pathway for states to support HRSN services—if state leaders choose to pursue waivers or other authorities. Households connected to shelters or CoC providers should ask whether care teams can help with Medicaid renewals and whether any state HRSN services are available. Case managers are often the strongest bridge to maintaining coverage.
Telehealth and behavioral health remain essential tools
- CMS continues to support Medicaid telehealth flexibilities:
- CMS produced toolkits to help states expand telehealth in Medicaid and CHIP, and contributes to Telehealth.hhs.gov for providers and patients. These materials emphasize mental and behavioral health, substance use disorder treatment, and considerations for rural and underserved populations (CMS report to Congress, p.49).
Why it matters: If housing services are disrupted in 2026, maintaining access to behavioral health care via telehealth can prevent crises. Keep your phone charged, save your provider’s telehealth link, and ask your clinic about no-cost options for video or audio visits.
Utilities assistance: what we know right now
In the sources reviewed, we did not find new federal policy updates specific to utility-bill assistance programs. We will continue monitoring for developments that could affect energy or water assistance access. Meanwhile, preserving your health coverage and any supportive housing or case management services you have can be key to stabilizing other basic needs.
How these changes could affect seniors, caregivers, and low-income families in Tampa Bay
- For tenants in permanent supportive housing or long-term rental assistance linked to services:
- The CoC NOFO caps permanent housing funding at 30% and prioritizes programs aligned with law-enforcement approaches (Maine Public; NLIHC). Expect possible recertifications, program redesigns, or transitions in mid-2026 due to timing gaps.
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If you receive on-site services (nursing, case management), ask now how your program is planning for the May 2026 award date and potential service continuity.
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For caregivers supporting older adults or people with disabilities:
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Medicaid-funded case management and behavioral health supports have been critical to keep people housed, per multiple accounts in NYT reporting. If a loved one is at risk of lapses, keep appointments and ask providers to note functional needs and housing instability in the medical record—these details can support continuity through care transitions and are increasingly captured via SDOH codes (CMS).
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For unhoused individuals seeking coverage:
- Evidence shows enrollment rises when homelessness-service providers help people apply and stay enrolled (University of Pittsburgh CP3). If you are in contact with a shelter, outreach team, or day center, ask them to help you complete a Medicaid application or renewal and to share any documentation they can provide about your circumstances.
Practical steps we recommend taking right now
Given the policy shifts and timing, the single most important move is to reduce your risk of service interruptions by staying connected to your coverage and your housing program.
- Keep Medicaid active and ready for changes:
- If you have Medicaid, make sure your contact information is current with your state Medicaid agency so you don’t miss renewal notices. CMS’s December 2024 guidance shows that some states can cover HRSN services via waivers—if those become available, being enrolled is step one (CMS bulletin summary).
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If you are working with a shelter or supportive housing provider, ask a case manager to help you respond to any Medicaid mail and upload documents—provider relationships matter for successful enrollment (CP3 study).
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Ask your housing program about continuity planning for 2026:
- Because the CoC application is due January 14 and awards are anticipated May 1, 2026, one-third of current awards expiring Jan–June 2026 may see gaps even if renewed (NLIHC). Request written guidance from your provider about any contingency plans, who to call if services pause, and how rental payments will be handled.
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If you are in PSH, ask whether your lease or your subsidy is directly tied to a grant expiring in early 2026 and whether a transition plan is in place.
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Prepare for documentation requests:
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Keep copies (paper or photos on your phone) of your ID if you have it, health insurance card, Social Security letter, any disability determinations, prescriptions, and a list of providers. Although documentation rules vary by program, having organized information can speed up renewals or transfers if a program changes funding or structure.
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Use telehealth to maintain care:
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If transportation or mobility is a barrier, ask your clinic about telehealth options. CMS has toolkits and resources supporting Medicaid telehealth—including for mental health and substance use treatment—which many providers follow (CMS telehealth resources; Telehealth.hhs.gov).
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If you are worried about changing rules (work requirements, camping bans):
- NLIHC notes the CoC NOFO prioritizes applications that align with the administration’s executive order and law-enforcement approaches (NLIHC). If you have a disability, are a veteran, or care for someone with serious health needs, ask your provider about reasonable accommodations and document any medical limitations that make compliance with new requirements difficult. This helps your care team advocate within changing program rules.
Our perspective
From an on-the-ground outreach view, two realities are colliding:
- The homelessness system appears to be moving away from permanent housing investments, at least in the short term, which could destabilize seniors, disabled people, veterans, and families who rely on supportive housing. The late NOFO timing adds avoidable risk of lapses in 2026 (NLIHC; Maine Public).
- Medicaid remains the most reliable bridge to health and stability we have—especially when providers use case management, behavioral health, and, where available, HRSN-aligned supports. But broader fiscal and policy pressures on Medicaid could limit states’ ability to fund the housing-related services that keep people stably housed (NYT; CMS HRSN guidance).
In this environment, staying insured, keeping up with appointments (including via telehealth), and maintaining active communication with your housing or shelter provider is the best protective strategy. Evidence shows that when homelessness service providers help with Medicaid enrollment, more people get—and keep—coverage (University of Pittsburgh CP3). And CMS’s adjustments to homelessness diagnostic coding and its HRSN guidance, while technical, point to a system that is at least partly recognizing the higher care needs of people experiencing homelessness (CMS).
We will continue tracking federal and state updates on housing, utilities assistance, and Medicaid. If you are in the Tampa Bay area and need help reviewing your coverage or navigating program changes, keep your documents handy and stay in close contact with your case manager or clinic; early action is the surest way to prevent gaps in care or housing.