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This paper examines the role of literacy within a larger social, political, and economic context. Findings are presented from a qualitative study that examined the experiences of 20 homeless individuals who frequented a shelter in downtown Toronto, Ontario. Many participants interviewed either lacked an Ontario Health Insurance Card, or they expressed little interest in acquiring one. This study seeks to explicate the different forms of literacy (health, technological and organizational literacies) that are both employed and reproduced in institutional settings. Using an institutional ethnographic method of inquiry, this study aims to shed light upon the ways in which literacy (or the lack of literacy) shaped and mitigated the experiences of homeless individuals attempting to gain access to health care.