The Brief

A proposed bill in California’s state Legislature would expand the services street medicine programs can offer unhoused people.

Advocates say the reforms are badly needed — street medics are currently blocked from providing key primary care services such as specialist referrals and access to medical supplies like wheelchairs due to insurance requirements.

Opponents say the expansion would be too expensive — and comes at a time when the state is facing significant budget challenges.

Let’s take a closer look.

What’s the backstory? 

Street medicine programs bring health care straight to people living outside on sidewalks, in riverbeds or under bridges all across California. Physicians typically drive dozens of miles a day and carry backpacks to visit unhoused patients directly in tents, makeshift shelters, vehicles or wherever patients happen to be.

Here in L.A. County, more than 47,000 people live outdoors — the region is home to the largest unsheltered population in the country.

That population faces disproportionate rates of chronic disease, mental health disorders and addiction than the overall population. L.A. County’s unhoused residents die at 4.5 times the rate of the overall population, according to the public health department.

When USC Street Medicine director Brett Feldman started practicing street medicine in Southern California a decade ago, there were just six teams across the state, he said.

Feldman said it was a “radical fringe movement” at the time. Since then, teams like Feldman’s have been welcomed into the mainstream health care system, and today there are more than 70 programs across the state. Over a dozen are based in L.A. County.

A big shift came in 2022, when California’s Department of Health Care Services issued guidance to Medi-Cal health plans, enabling street medicine providers to be reimbursed and designated as primary care providers for unhoused patients.

The following year, the federal centers for Medicare and Medicaid created a new billing code for street medicine, making it reimbursable under Medicare and Medicaid nationwide.

As the co-founder and director of the University of Southern California’s influential street medicine program, Feldman currently oversees six teams who treat about 1,200 patients per year.

But, because state rules for Medicaid managed care health plans require patient care be coordinated through a sole primary care provider, programs like Feldman’s often can’t provide a full-range of care to their unhoused patients.

Katia Cnop of USC Street Medicine approaches a tent of a patient in Los Angeles.

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Aiko Offner

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LAist

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How does insurance coverage for people experiencing homelessness currently work in California?

More than 80% of unhoused Californians have health insurance, according to a 2023 UCSF study. The coverage is mostly provided through Medi-Cal, the state’s Medicaid program, which provides free or subsidized health insurance to disabled and low-income people.

Still, studies show unhoused Angelenos disproportionately rely on emergency rooms and ambulance transports for basic medical care.

Most members of local Medi-Cal plans, like L.A. Care or Health Net, are invited to choose a primary care provider through a package in the mail. That doctor is then tasked with coordinating all their care within the network.

For those who can’t get mail, a primary care doctor is assigned automatically. The vast majority of unhoused Californians — more than 90% according to a state legislative analysis — have never visited their primary care doctor or used their insurance benefits. Still, that physician remains the only one who can order them “medically necessary services,” under current Medicaid rules.

Feldman, with USC’s street medicine program, said he encounters patients daily who he’s unable to help. Under the current rules, he can’t order them X-rays, prescribe a wheelchair or make referrals to a specialist.

“When I see them on the street, I'm not their assigned primary care provider, and I can't order basic things for them,” Feldman said. “Only the person who they're not seeing can order those things.”

Assembly Bill 543, which Feldman helped craft with the bill’s author Assemblymember Mark González, would change that. Co-authors include Assemblymembers Sade Elhawary, John Harabedian, Celeste Rodriguez, Pilar Schiavo and Matt Haney.

“It makes it so that regardless of [primary care provider] assignment, we can order what they need based on their medical necessity,” Feldman said.

The bill passed unanimously through the state Assembly this summer. It’s now scheduled for a state Senate appropriation committee hearing on Aug. 29.

Assemblymember Mark González, center, at a press conference in Los Angeles with Mayor Karen Bass and a Congressional delegation on June 13, 2025.

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Courtesy Assemblymember Mark González

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Why do advocates say reforms are needed?

Medi-Cal managed care health insurance plans, funded by state taxpayers, get paid at a per-patient per-month rate. That money is paid out regardless of whether patients use the coverage.

The system works for most people on Medi-Cal, Feldman said — patients typically stay away from the doctor when they’re feeling well, keeping costs down. But without reliable access to phones or transportation, unhoused patients struggle to make and keep medical appointments.

There’s a huge gap between the insurance benefits unhoused patients are eligible for and the benefits they’re actually able to use, according to a 2023 street medicine landscape report authored by Feldman.

“There are certain groups, insurance groups, who are creating so many different barriers to being preventative,” said González, the state lawmaker who authored the bill. “You cannot do that if your goal here is to heal people.”

Some Medi-Cal health insurance plans acknowledge the challenges, including L.A. Care, the nation’s largest publicly operated health plan with more than 2 million members.

“We recognize it as a problem,” said Charlie Robinson, senior director of the community health department at L.A. Care. “It’s a very normal circumstance for most members -- you need to go to your PCP first and then they can refer you. But it doesn't fit well with this population.”

L.A. Care covers about 70% of unhoused people in L.A. County on Medi-Cal, the agency estimates.

The health plan says it has found another workaround to the problem, launching its own “field medicine” program last year. That effort partners with street medicine programs and allows those practitioners to become primary care providers within L.A. Care’s network.

Still, the agency is “conceptually aligned” with AB 543, Robinson told LAist.

Yelipsa Madera (L) Michael Gallagos (M) and Brett Feldman (R) are part of the Keck School of Medicine of USC's Street Medicine teams.

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Robert Garrova / LAist

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How much would the new legislation cost taxpayers?

The California Department of Finance is opposing the street medicine bill, citing cost concerns. The state agency, which advises Gov. Gavin Newsom’s office on fiscal policy, wrote in a recent analysis that AB 543 would cost the state tens of millions of dollars each year in new spending that hasn’t been approved through the state’s budget process.

“Efforts to expand the scope of Medi-CAL should be considered as part of the annual budget process,” the agency wrote, arguing against new legislation.

The bill, if approved, would also require new coordination between providers and street medics and new tracking numbers.

The state’s finance department noted that Newsom vetoed similar street medicine legislation in 2021 after it passed unanimously through the California Legislature.

González argues the proposed legislation is proactive and cheaper than unhoused people visiting emergency rooms.

“This is the first line of defense,” González said. “Street medicine is preventative so that we don't clog up those resources.”

For now, street medicine providers say they are absorbing a lot of the costs of doing things that insurance plans are already being paid to do, but aren’t.

José Luis Gonzalez,  medical director at street medicine provider Healthcare in Action, testified before the state senate in support of the bill in June, recalling a patient who could not access their primary care provider.

“ The taxpayers are paying for this gentleman to have insurance,” Gonzalez said. “He has insurance and he can't access it. Us providing the service, we're not even getting paid for this.”

Making his rounds last month, USC’s Feldman spotted his patient Dustin Statler, slouched against a retaining wall in L.A.’s Westlake neighborhood.

Statler, 46, had just been discharged from a hospital emergency room, where he’d received dialysis treatment. He’s been homeless in L.A. for a decade. His kidneys are failing.

Feldman said he was able to provide food and basic medicine, but under current rules, he couldn’t refer Statler to a kidney specialist for routine dialysis appointments. Only Statler’s primary care provider, who Statler had never been to, could make the call, Feldman said. But connecting him with that provider could take months.

“ He needs dialysis three times a week,” Feldman said. “If he waited one to two months for dialysis, he will die.”

Katia Cnop of USC's street medicine program visits with a patient.

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Aiko Offner

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LAist

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What will the Trump administration’s changes to Medicaid mean for California?

AB 543, the proposed state law, would automatically enroll unhoused people into insurance coverage, creating a bigger safety net for changes coming in 2027, according to advocates of the legislation. That’s when the Trump administration says Medicaid recipients will be required to hold jobs in order to get their benefits.

Advocates and some health plans say Trump’s Medicaid changes will result in the vast majority of unsheltered Angelenos losing their coverage.

Trump’s ‘Big Beautiful Bill,’ which announced the Medicaid work requirements, also lists exemptions for certain groups. Those include people with disabilities, substance use disorders or serious medical conditions.

But providers say those could be hard to prove, as some require official diagnoses and other paperwork. Some of that work will fall on street medicine providers.

If street medics can automatically enroll unhoused people into Medicaid, as AB 543 would allow, they may be able to help prevent coverage gaps by certifying people for automatic enrollment in advance.

“We can treat them now, and then it'll give us a runway in order to complete all the paperwork to certify that they have a mental illness and would get permanent insurance,” said Feldman with USC.

Dr. Katia Cnop,  associate medical director of USC Street Medicine, is an addiction specialist. With the upcoming changes to Medicaid, she sees her role changing into one where she has to defend unhoused people’s insurance rights.

She believes those insurance challenges ultimately will land more unhoused people in emergency rooms, leading to longer wait times for the entire community.

“The ER becomes super congested and you go from having a six hour wait time to a 24 hour wait time, and it becomes an impossible situation for anyone,” she said.

This story first appeared on The LA Local.

Since 1977, Richard Santillan has been to every Opening Day game at Dodger Stadium. 

“The tradition goes from my father, to me, to my children and grandchildren. Some of my best memories are with my father and children here at Dodger Stadium,” Santillan told The LA Local, smiling under the shade of palm trees near the entrance to the ballpark Wednesday morning. He was there to protest the team less than 24 hours before Opening Day.

Santillan, like countless other loyal Dodgers fans, is grappling with his fan identity over the team’s decision to accept an invitation to the White House and owner Mark Walter’s ties to ICE detention facilities.

More than 30 people joined Santillan on Wednesday morning for a press conference held near 1000 Vin Scully Drive to convey a message directly to the team. 

“We are demanding the Dodgers stop participating in funding of inhumane treatment of families and do not go to the White House to celebrate with the criminal in chief,” Evelyn Escatiola told the crowd. “Together, we have the power to make a change.”

Escatiola, a former dean of East Los Angeles College and longtime community organizer, urged fans to flex their economic power by “letting the Dodgers know that we do not support repression.”

Jorge “Coqui” Rodriguez, a lifelong Dodgers fan, spoke to the crowd and called on Dodgers ownership to divest from immigration detention centers owned and operated by GEO Group and CoreCivic.

Jorge Coqui H Rodriguez speaks at a press conference outside Dodger Stadium on March 25, 2026, to demand the Dodgers not to visit the White House following their 2025 World Series win.

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J.W. Hendricks

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The LA Local

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In a phone interview a day before the protest, Rodriguez told The LA Local he did not want the Dodgers using his “cheve” or beer money to fund detention centers. 

“They can’t take our parking money, our cacahuate money, our cheve money, our Dodger Dog money and invest those funds into corporations that are imprisoning people. It’s wrong,” Rodriguez said. 

Rodriguez considers the Dodgers one of the most racially diverse teams and said the players need to support fans at a time when heightened immigration enforcement has become more common across L.A.

The team’s 2025’s visit to the White House drew ire from the largely Latino fan base, citing the Trump administration’s ongoing attacks on immigrants. 

In June, the team came under further scrutiny when rumors swirled online that federal immigration agents were using the stadium’s parking, which immigration authorities later denied in statements posted on social media accounts.

The team again came under fire after not releasing a statement on the impacts of ICE raids on its mostly Latino fan base at the height of immigration enforcement last summer. The team later agreed to invest $1 million to support families affected by immigration enforcement.

When he learned the Dodgers were pledging only $1 million to families in need, Rodriguez called the amount a  “slap in the face.” 

“These guys just bought the Lakers for billions of dollars and they give a million dollars to fight for legal services? That’s a joke,” Rodriguez said. “They need to have a moral backbone and not be investing in those companies.”

According to reporting from the Los Angeles Times, former Dodgers pitcher Clayton Kershawsaid last week that he is looking forward to the trip.

“I went when President [Joe] Biden was in office. I’m going to go when President [Donald] Trump is in office,” Kershaw said. “To me, it’s just about getting to go to the White House. You don’t get that opportunity every day, so I’m excited to go.”

The Dodgers have yet to announce when their planned visit will take place. 

Santillan sometimes laments his decision to give up his season tickets in protest of the team. His connection to the stadium and the memories he has made there with family and friends will last a lifetime, he said. On Thursday, he will uphold his tradition and be there for the first pitch of the season, but with a heavy heart.

“It’s a family tradition, but the Dodgers have a lot of work to do,” he said.

A local favorite mom-and-pop bookshop in Eagle Rock is facing displacement due to a steep rent hike. The owners say theirs is just one of several small businesses along Eagle Rock Boulevard struggling to keep up with lease increases.

Over the past 19 years, many in the neighborhood have come to love READ Books for its eclectic collection of used titles and shop dog Florence.

Co-owner Jeremy Kaplan said it’s been a delight to grow with the community over the years.

“Like seeing kids come back in, who were in grade school and now they’re in college,” Kaplan said.

But the building where Kaplan and wife Debbie rent was recently sold, and the rent increased by more than 130% to $2,805 a month, Kaplan said. He told LAist it was an increase his small business simply could not absorb.

Kaplan said he originally was given 30 days notice of the rent increase. After some research, assistance from Councilmember Ysabel Jurado’s office and some pro-bono legal help, Kaplan said he pushed back and got the 90-day notice he’s afforded by state law.

California Senate Bill 1103 requires landlords to give businesses with five or less employees 90 days’ notice for rent increases exceeding 10%, among other protections.

Systems Real Estate, the property management company, did not immediately respond to LAist’s request for comment.

What can small businesses do? 

Nadia Segura, directing attorney of the Small Business Program at pro bono legal aid non-profit Bet Tzedek said California law does not currently allow for rent control for commercial tenancies.

Outside of the protections under SB 1103, Segura said small businesses like READ Books don’t have much other recourse. And even then, commercial landlords are not required to inform their tenants of their protections under the law.

“There’s still a lot of people that don’t know about SB 1103. And then it’s very sad that they tell them they have these rent increases and within a month they have to leave,” Segura said.

She said her group is seeing steep rent hikes like this for commercial tenants across the city.

“We are seeing this even more with the World Cup coming up, the Olympics coming up. And I will say it was very sad to see that also after the wildfires,” Segura said.

Part of Bet Tzedek’s ongoing work is to advocate for small businesses, working with landlords who are increasing rents to see if they are willing to give business owners longer leases that lock in rents.

What’s next 

After READ Books posted about their situation on social media, commenters chimed in to express their outrage and love for the little shop.

While he looks for a new spot, Kaplan says he’s forming a coalition of local businesses and activist groups to see what can be done to help other small businesses facing similar displacement. He wants to address the displacement issue for businesses like his, which have made Eagle Rock the distinctive neighborhood that it is today.

Owl Talk, a longtime Eagle Rock staple selling clothing and accessories in a unit in the same building as READ Books, is facing a “more than double” rent increase, according to a post on their Instagram account.

Kaplan said he’s been in touch with the office of state Assemblywoman Jessica Caloza and wants to explore the possibility of introducing legislation to set up protections for small businesses like his, including rent-control measures or a vacancy tax for landlords. Kaplan said he also reached out to the office of state Sen. Maria Durazo.

By his count, Kaplan said there are about a dozen businesses within surrounding blocks that are at risk of closing their doors or have shuttered due to rent increases or other struggles.

When READ Books was founded during the Great Recession, Kaplan said he knew it was a longshot to open a bookstore at the same time so many were struggling to stay in business.

“It was kind of interesting to be doing something that neighborhoods needed. That was important to me growing up, that was important to my children, that was important to my wife growing up,” Kaplan said.

“And then somebody comes in and says, ‘We’re gonna over double your rent.”

Topline:

Frozen budget: Most of the city’s Bureau of Street Lighting budget comes from an assessment that people who own property illuminated by lights pay on their county property tax bill. The amount people pay depends on the kind of property they own and how much they benefit from lighting. A typical single-family home currently pays $53 annually, and in total, the assessments bring in about $45 million annually for the city to repair and maintain streetlights. Changing the amount the Bureau of Street Lighting gets from the assessment requires a vote among property owners who benefit from the lights.

Ballots: L.A. City Council’s vote gives city staff the green light to prepare and send out those ballots. Miguel Sangalang, who oversees the bureau, said at a committee meeting earlier this month that he expects to send out ballots by April 17. Notices about the ballots will be sent out prior to the ballots themselves.

Near unanimous vote: L.A. City Councilmember Monica Rodriguez was the only “No” vote Tuesday, saying she wanted to see a more current strategic plan for the bureau. Sangalang said the bureau developed a plan in 2022 that lays out how money will be spent. Councilmember Imelda Padilla was absent for the vote.

Vote count: Votes will be weighted according to the assessment amount. Basically, the more you’re asked to pay yearly to maintain streetlights, the more your vote will count. Ballots received before June 2 will be tabulated by the L.A. City Clerk.

How much more money: According to a report, the amount needed in assessments from property owners to meet the repair and maintenance needs of the city’s streetlighting in the next fiscal year is nearly $112 million.

Use of the money: Sangalang said at a March 11 committee meeting that the extra funds would be used to double the number of staff to handle repairs and procure solar streetlights, which don’t face the threat of copper wire theft. That would all potentially reduce the time it takes to repair simple fixes down to a week. Currently, city residents wait for months to see broken streetlights repaired. The assessment would come with a three-year auditing mechanism.