Madison Area Care for the Homeless (MACH OneHealth) – now known as Madison Street Medicine – aimed to deliver services that bridge the gap between healthcare and housing systems. With funding support, they were able to expand from a volunteer-run initiative into a staffed nonprofit organization offering a range of programs, including weekly clinics at shelters, mobile medical outreach, housing-focused case management, harm reduction services and Madison’s first city-sanctioned campground for unsheltered individuals.
The Challenge
Despite efforts to address the needs of people experiencing homelessness in Dane County, many health inequities persist. In 2018, more than 3,100 individuals in the county experienced homelessness, with many more dealing with housing insecurity. These individuals face higher rates of chronic health conditions, mental illness, substance use disorders and barriers to accessing care. Even when insured or connected to primary care, many continue to report challenges like lack of transportation and mistrust in the health care system.
Although Dane County has more than 60 service providers through the Homeless Services Consortium and healthcare providers through Healthy Dane, there is a lack of coordination between housing and health care providers that results in gaps in care. For example, housing prioritization often depends on a health diagnosis, yet individuals face barriers in accessing health care services, delaying housing placements. Madison Street Medicine emerged in response to this fragmented system hoping to bridge healthcare and housing through community collaboration.
Project Goals
Madison Street Medicine aimed to improve health outcomes for individuals experiencing homelessness and housing insecurity in Dane County by:
Hiring the organization’s first Executive Director to oversee operations, expand programs and guide strategic partnerships.
Supporting and growing direct service initiatives including:
Foot care clinics that offer preventive care, treatment and basic resources like socks and shoes.
Care Connections, which supports ongoing medical and social care coordination by helping clients attend appointments, secure insurance and navigate services.
Implementing an Electronic Health Record (EHR) system designed for homeless health care.
Integrating MACH’s second Community Health Needs Assessment (CHNA) with the Public Health Madison & Dane County’s efforts to influence system-wide planning.
Advocating for policy changes, such as expanding malpractice coverage under Wisconsin’s Volunteer Health Care Program and promoting upstream, preventive care to reduce emergency department utilization.
Results
With support from the Wisconsin Partnership Program, Madison Area Care for the Homeless (MACH OneHealth) – now known as Madison Street Medicine – went from a small, all-volunteer initiative to a nonprofit organization with 17 staff members and 85 active volunteers, allowing them to significantly expand their presence and impact across Dane County.
As a result of this transformation, the organization was able to establish weekly clinics at the men’s shelter and The Beacon day shelter, launch monthly foot care clinics and expand housing-focused outreach and case management programs. A medical outreach van – converted from a box truck – allowed the team to bring health care and housing services directly to people experiencing unsheltered homelessness. The organization also launched and operated Madison’s first city-sanctioned campground for unhoused individuals, achieving a 70 percent positive exit rate, which is above the national average of 40 percent for similar programs.
Madison Street Medicine was also able to successfully create a customized Electronic Health Record (EHR) system designed for homeless health care settings. In addition, the organization improved its harm reduction services and began operating a public health vending machine stocked with naloxone and test strips. Lastly, Madison Street Medicine provided learning opportunities for AmeriCorps members, student nurses, physician assistant students, MEDiC students and other public health trainees.
Due to the team’s successful efforts, they earned Bronze and Silver Seals from the Wisconsin Association of Free and Charitable Clinics in recognition of their service quality.
Lasting Impact
The work done by Madison Street Medicine left a lasting impact on people experiencing homelessness in Dane County. The city-sanctioned campground developed by the organization became a model of success, demonstrating how a trauma-informed, service-rich approach can lead to strong housing outcomes even for unsheltered individuals. At a time when homelessness in the country increased by 18 percent in a single year, the organization showed how targeted investment and innovative programming could yield scalable solutions.
Beyond direct services, Madison Street Medicine played a key role in shaping local policy and systems change. Its leadership contributed to cross-sector coalitions like the Homeless Services Consortium and the H2: Housing + Healthcare Initiative, influencing how health care providers and housing systems coordinate care.
