Which metropolitan regions use regional Continuum of Care models and how has that affected homelessness outcomes?
Executive summary
Regional Continuum of Care (CoC) structures — where metropolitan areas or multi-jurisdictional regions coordinate HUD CoC planning and funding across city, county, or multi-county boundaries — are in active use in multiple U.S. metro regions including Boston, Los Angeles (multiple CoCs across the county and cities), Nashville-Davidson County, Massachusetts’ Balance-of-State region, and the Bay Area’s multi-county CoCs [1] [2] [3] [4] [5]. Evidence from federal and regional reporting shows CoCs shape funding flows, data collection, and planning, and when federal rules or funding change the downstream effect can be large — threatening permanent housing capacity and reversing local reductions in unsheltered homelessness — but rigorous causal proof that regional CoC structure alone produces better outcomes is limited in the public record [6] [5] [2] [7].
1. Which metropolitan regions use regional CoC models — who coordinates what
Large metropolitan governments and multi‑county regions routinely operate CoCs as regional planning bodies: Boston’s CoC is coordinated by the Mayor’s Office of Housing and includes dedicated boards and consumer councils for citywide application to HUD (Boston CoC) [1]. Greater Los Angeles is covered by multiple CoCs that together serve Los Angeles City, Los Angeles County, Long Beach, Glendale and Pasadena, each coordinating funding and services across municipal boundaries within the metro area [2]. Nashville operates a metropolitan Nashville‑Davidson County Continuum of Care with the Office of Homeless Services designated as the Collaborative Applicant and HMIS/Coordinated Entry lead [3] [8]. Massachusetts uses a Balance‑of‑State CoC to coordinate across many jurisdictions where no single city CoC exists, reflecting a regional approach to proposal submission and planning [4]. California’s Bay Area is represented in analyses as a set of nine counties whose CoC funding and priorities have region‑wide implications [5] [9]. HUD’s national CoC program framework undergirds all these local/regional bodies and establishes the expectations for coordination and funding competition [10] [6].
2. How regional CoCs affect funding flows and program priorities
Regional CoCs centralize the competitive CoC application process and rank projects for HUD funding, which concentrates power to set local priorities — for example Boston’s citywide application submission and ranking process is run through the Mayor’s office and CoC board [1]. Changes or disruptions in HUD’s Notice of Funding Opportunity (NOFO) can produce immediate regional budgetary shocks because CoCs manage bulk federal allocations; analysts warned that shifts in NOFO priorities could create a Bay Area funding gap of hundreds of millions and eliminate thousands of permanent housing beds regionwide [5]. National reporting notes HUD distributes billions to CoCs (e.g., $3.6 billion noted for FY2024), reinforcing that CoCs are the primary vehicle for federal homeless assistance funding [6].
3. Outcomes reported where regional CoCs are active — improvements and vulnerabilities
Where regions have deliberately invested and coordinated through CoCs, jurisdictions report measurable local improvements: state reporting celebrates a 9% drop in unsheltered homelessness in California and highlights large grants to local CoCs to sustain interim and permanent services across LA and other CoCs [2]. At the same time, watchdogs and research show rising overall homelessness nationally (an 18% increase in one recent national count) and caution that CoC funding instability can quickly erase local gains by reducing permanent housing placements — the strategy Congress and HUD have historically considered most effective at reducing homelessness [11] [5]. Evaluations have also questioned whether CoCs alone have produced clearly detectable system‑wide results in all places, noting mixed evidence on the Continuum model’s efficacy in isolation from housing supply, local policy, and funding levels [7].
4. Tradeoffs, hidden agendas, and limits of the evidence
Regional CoCs give local actors the capacity to coordinate services, collect HMIS data, and set priorities, but they also concentrate decision‑making and make regions vulnerable to federal policy shifts and competitive ranking dynamics that can favor certain program types over others [1] [6] [12]. Advocacy groups and policy analysts have an implicit agenda to protect CoC funding and permanent housing investments; their modeling shows large negative impacts if federal priorities change, while federal HUD notices reflect shifting administrative priorities that can reallocate funds [5] [6]. Importantly, the available reporting links regional CoC organization to better coordination and to exposure to federal funding volatility, but does not provide controlled causal studies proving that being a regional CoC by itself yields better homelessness outcomes independent of funding levels, local housing supply, or complementary state policy [7] [12].