In 2024, 1,911 rural Missourians were homeless and 828 were unsheltered.
Thirty-two percent of homeless rural Missourians report serious mental illness.
Emergency departments provide primary mental health care for 70% of chronically homeless rural Missourians.
In MO, 101 of 114 counties are rural (MO Department of Health and Senior Services (DHSS) 2025). Rural counties lack an urban center of 50,000 people or more (MO Department of Health and Senior Services (DHSS) 2024). Between 2022 and 2024, the number of rural homeless Missourians increased from 1,571 to 1,911 (0.1% of rural Missourians) (MO Balance of State (BoS) 2022, MO BoS 2024). The number of unsheltered individuals, who live in locations such as cars, parks, or abandoned buildings, increased 59%, from 520 to 828 people (BoS 2022, MO BoS 2024, de Sousa et al. 2023).
Chronic homelessness describes an individual who (de Sousa et al. 2023):
In 2024, 438 people in rural MO were chronically homeless and 308, or 70%, were unsheltered (ICA 2025).
Rural MO counties are grouped into ten service regions known as the Missouri Balance of State (BoS 2024, Figure 1). The homeless population in region 1, south of St. Louis, doubled between 2022 and 2024 (from 200 to 468) and now has the largest homeless population, but the lowest rate of unsheltered individuals (16%). The homeless population in region 10, south of Kansas City, stayed the same in these two years, but has the highest rate of unsheltered individuals (62% of 134 people). Future reporting and regional coordination currently face administrative delays due to a federal pause in funding and litigation (BoS 2025).
Figure 1. Rural MO Homelessness Trends and Mental Health Infrastructure. The 101 rural MO counties are shown divided by their Balance of State regions. Regional callouts list the 2024 total homeless population and the number of unsheltered individuals, followed by the percentage of change for both metrics since 2023. Map made with mapchart.net.
Severe mental illnesses (SMIs) are clinical conditions where the psychological and social abilities needed for daily living are overwhelmed by persistent symptoms (Centers for Disease Control and Prevention (CDC) 2025, Centers for Medicare and Medicaid Services (CMS) 2024). In MO, 6% of the population reports an SMI and 17% report an SUD (MO Department of Mental Health (DMH) 2025). For the rural homeless, 32% report an SMI and 25% report a SUD. (Institute for Community Alliance (ICA) 2025). In unsheltered individuals, 34% report an SMI and 36% report a SUD.
Hospital visits often serve as the primary mental health care for the unsheltered chronically homeless rural Missourians (ICA 2025). Individuals experiencing homelessness use emergency departments for mental health crises at rates 2.5 times higher than the general population with stable housing. This reliance on emergency services is correlated with higher Medicaid expenditures and a 40% increase in 30-day hospital readmissions.
Managing SMI effectively requires coordinated care like medication management and outpatient therapy (DMH 2025). However, a lack of permanent supportive housing, which combines non-time-limited housing and on-site health services, increases reliance on acute healthcare services, like emergency departments or hospitalizations, for mental health care (CMS 2024).
References
Andrilla CHA, Patterson DG, Garberson LA, Coulthard C, Larson EH (2018) Geographic Variation in the Supply of Selected Behavioral Health Providers. American Journal of Preventive Medicine 54(6S3): S199-S207. https://doi.org/10.1016/j.amepre.2018.01.004
Centers for Disease Control and Prevention (2025) About Mental Health. https://www.cdc.gov/mental-health/about/index.html
Centers for Medicare and Medicaid Services (CMS) (2024) CMCS Informational Bulletin: Opportunities for Improving Access to Mental Health and Substance Use Disorder Services for Medicaid and CHIP Enrollees Experiencing Homelessness. https://www.medicaid.gov/federal-policy-guidance/downloads/mh-sud-med-chip-enrol-expncg-hmles.pdf
de Sousa T, Andrichik A, Prestera E, Rush K, Tano C, et al. (2023) The 2023 Annual Homelessness Assessment Report (AHAR) to Congress. U.S. Department of Housing and Urban Development. https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf
Institute for Community Alliances (ICA) (2025) Missouri Point-In-Time Dashboard. https://icalliances.org/mo-pit-dashboard
Landes D, Trammell L, Onanian K (2026) From Collapse to Connection: Designing Infrastructure for a Health System in Crisis – Needs Assessment. Missouri Rural Health Association. https://mrhassociation.org/wp-content/uploads/2026/02/26-Needs-Assessment_lowres.pdf
Kaiser Family Foundation (KFF) (2025) Mental Health Care Health Professional Shortage Areas (HPSAs). https://www.kff.org/other-health/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Missouri Balance of State Continuum of Care (BoS) (2022) 2022 Gaps Analysis Report. https://moboscoc.org/wp-content/uploads/2022/12/Final-2022-MO-BoS-CoC-PITC-Report.pdf
Missouri Balance of State Continuum of Care (BoS) (2024) 2024 Gaps Analysis Report. https://moboscoc.org/resources/data/gaps-analysis/
Missouri Balance of State Continuum of Care (2025) Notice of Funding Information. https://moboscoc.org/resources/nofo/
Missouri Department of Health and Senior Services (DHSS) (2025) Health in Rural Missouri Biennial Report 2024- 2025. https://health.mo.gov/living/families/ruralhealth/pdf/biennial2024-ada.pdf
Missouri Department of Mental Health (DMH) (2025) Annual Data Report on Missouri’s Substance Use and Mental Health – 31st Edition. https://dmh.mo.gov/sites/dmh/files/media/pdf/2026/03/2025-annual-report-part1_2.pdf
