Can Medicaid Expansion Prevent Housing Evictions?

Allen HL, Eliason E, Zewde N, Gross T
Source: Health Affairs
Publication Year: 2019
Patient Need Addressed: Homelessness/housing
Population Focus: Low income, Medicaid beneficiaries, Vulnerable/disadvantaged
Study Design: Other Study Design
Type of Literature: White
link: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05071
Abstract

Evictions are increasingly recognized as a serious concern facing low-income households. This study evaluated whether expansions of Medicaid can prevent evictions from occurring. We examined data from a privately licensed database of eviction records in fourteen states (286 counties) and used a difference-in-differences research design to compare rates of eviction before and after California’s early Medicaid expansion (51 counties). Early Medicaid expansion in California was associated with a reduction in the number of evictions, with 24.5 fewer evictions per month in each county from a pre-expansion average of 224.7. These results imply that for every thousand new Medicaid enrollees in California, Medicaid expansion was associated with roughly twenty-two fewer evictions per year. Additionally, we found a 2.9-%age-point reduction in evictions per capita associated with early expansion. The effects were concentrated among counties with the highest pre-expansion rates of uninsurance. We conclude that health insurance coverage is associated with improved housing stability.

Insights Results

Overview of article

  • This study investigates whether Medicaid expansion (using California as an example) of eligibility plays a role in mitigating home eviction as prior research indicates housing eviction may lead to poorer physical and mental health outcomes and considerable worsening of health-related behaviors. Medicaid may mitigate the risk of eviction directly by reducing the cost of medical care and indirectly by protecting earning potential through better health

Methods of article

  • To evaluate the effect of California’s early Medicaid expansion on evictions, the study ran a difference-in-differences regression, comparing 51 early expanding counties to 235 control counties
  • Outcomes of interest were the number of evictions in each county-month, the number of evictions per capita, the natural logarithm of the number of evictions, and the number of evictions per rental unit
  • To examine whether results were driven by populations most likely to obtain coverage under the Medicaid expansion, authors stratified the estimation model of monthly numbers of evictions between counties, using a higher versus a lower share of uninsured residents before the expansion

Results

  • The study found that Medicaid expansion in California led to a significant reduction in the rate and number of evictions in each county. As expected, the study found a more pronounced effect of Medicaid expansion on evictions in counties with above-median shares of uninsured residents before expansion
  • Medicaid expansion was associated with a decrease in evictions. Specifically, the study found a more pronounced effect of Medicaid expansion on evictions in counties with above-median shares of uninsured residents before expansion, as measured in 2010, compared to those with below-median shares

Key takeaways/implications

  • Overall, this study suggests that healthcare 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
  • This literature helps inform policy makers of the ramifications of expanding or retracting healthcare coverage on the economic wellbeing of the population at focus (i.e., Medicaid eligible). As such, Medicaid is not only a part of healthcare safety, but may also be considered a key strategy in addressing poverty-related housing instability
  • Limitations to the study include the aggregate nature of the data on insurance status to people’s rental histories/eviction records, issues related to using a commercial evictions database instead of undergoing primary data collection, assumptions underlying the empirical approach (e.g., evictions in California and other states were evolving in parallel), potential impact of changes in the housing market on rates of eviction
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