The impact of health shocks on housing instability: Evidence from urban Medicaid enrollees

Abstract

Poor health and unstable housing are closely linked. Most research has focused on how housing shapes health, with little empirical study of whether and how health events can lead to future residential mobility or housing instability. This paper uses high-frequency administrative data on residential location and health among Medicaid enrollees in New York City to test whether adverse health events trigger housing mobility or insecurity, independent of the financial toll of medical bills. Using an event study design, I find that health shocks – or, sudden hospitalizations after two hospital-free years – immediately increase residential mobility (21–35 % relative increase) and the probability of living in shelters or on the street (6–10 % relative increase). These increased rates of mobility and instability persist above expected levels for at least two years. For unplanned or urgent hospital admissions, the impact of health events is even greater. These estimates imply that, in their immediate aftermath, adverse health events could be a tipping point for approximately 80,000 additional moves and 20,000 additional cases of homelessness among the U.S. Medicaid-insured population annually. The effects of health events on residential mobility are smaller for those with subsidized housing, a usual source of outpatient care, higher-quality inpatient care, and social support, suggesting potential areas for policy interventions to break the relationship between health problems and housing outcomes, from both inside and outside of health systems. This work also contributes to our understanding of the long tail of social consequences of adverse health events.