Research Study: Medicaid Expansion Reduces Housing Evictions, Improves Health Status

It has long been broadly understood in healthcare that such social determinants of health as housing access and housing stability were and are important, and connected to health status; but recent research has been highlighting in more depth the intricate connections between housing and health.

Indeed, an article published in the September issue of Health Affairs provides new and potentially important insights into this key area. Even its title is very much to the point: “Can Medicaid Expansion Prevent Housing Evictions?” Its authors are Heidi L. Allen, an associate professor in the School of Social Work, Columbia University; Erica Eliason, a doctoral candidate in the School of Social Work, Columbia University; Naomi Zewde, a postdoctoral research scientist at the Center on Poverty and Social Policy, School of Social Work, Columbia University; and Tal Gross, an associate professor in the Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University.

“Medicaid expansion has been shown to reduce medical debt and poverty by alleviating the financial burden of medical care on low-income beneficiaries and their families,” the authors write. “Another of the challenges facing this population is home eviction. The growing rate of home eviction in the United States is drawing the attention of researchers and policy makers. We investigated whether Medicaid coverage plays a role in mitigating the devastating phenomenon of home eviction.”

Indeed, the researchers write, “Eviction can have long-term damaging consequences for the families affected. Prior research suggests that experiencing a housing eviction may lead to poorer physical and mental health outcomes and a considerable worsening of health-related behaviors,” among them, the fact that, “with a legal record of eviction, renters may be forced into a higher-risk rental market in higher-crime, higher-poverty neighborhoods with substandard housing conditions”; the fact that “eviction precipitates acute risk of homelessness, which imparts a well-documented toll on health”; and, fundamentally, “for those receiving health care, forced displacement can interrupt treatment continuity and disrupt patient-provider relationships,4 thus increasing the likelihood of worsened health outcomes.”

Given all these factors, the researchers have found that “Medicaid may mitigate the risk of eviction directly by reducing the cost of medical care and indirectly by protecting earning potential through better health. The strength of the latter effect is moderated in this population by concurrently weak ties to the labor force and a high burden of work-limiting disease and disability. Within this context,” the add, “medical debt or urgent medical needs, acute or chronic (for example, filling prescriptions), may compete with housing obligations when finances are tight. If so, providing otherwise uninsured low-income adults with affordable health care coverage may help prevent eviction.”

Analyzing Medicaid data from California (where, uniquely, the program is known as MediCal), the researchers looked at the California Low Income Health Program (LIHP), also called the Bridge to Reform, which was built on top of a demonstration program in 10 counties, the Health Care Coverage Initiative, which was in effect in 2007-2010.

Analyzing data connected to the LIHP program, the authors state that “We stratified our estimation model of monthly numbers of evictions between counties, using a higher versus a lower share of uninsured residents before the expansion. We stratified counties by the share of residents with incomes below the threshold for Medicaid eligibility (138 percent of the federal poverty level) who were uninsured in 2010.” And, in analyzing the data, the write that “We found that the Medicaid expansion in California led to a significant reduction in the number of evictions occurring in each county.” In fact, they write, “[F]or every thousand new enrollees, there were approximately 22 fewer evictions per year.”

Thus, they note, “This study contributes to an existing body of literature suggesting that one of the principal benefits of Medicaid expansion is related to protection from encumbering medical debt, leading to improved financial well-being. Research has shown that California’s early Medicaid expansion was also associated with a reduction in payday borrowing, which provides further evidence of the financial protection that the expansion provided. In addition, the Oregon Health Insurance Experiment’s randomized trial findings demonstrated an improvement in financial stability and a reduction in catastrophic medical debt among Medicaid recipients. Health care coverage may be keeping households from “falling over the brink,” helping them meet their living expenses as the growing cost of medical care constrains household budgets.”