The Impact of Housing Choice Vouchers on Health and Housing Outcomes - The Housing Choice Voucher (HCV) program is the largest rental assistance initiative in the U.S., providing support to 5 million people annually. These vouchers help families rent homes in the private market, with recipients paying 30% of their income toward rent. As housing costs have risen, vouchers remain essential in alleviating rent burdens. However, despite the program’s importance, research on its causal impacts on health is limited. Conversely, little is known about the reciprocal relationship—how recipients’ health status might affect their success in using HCVs. This is a critical gap considering that just over half of recipients successfully use their voucher. To fill these gaps, we propose a study leveraging the New York City Housing Authority (NYCHA) HCV waitlist. In June 2024, NYCHA randomly selected 200,000 applicant households to be placed on its waitlist, in random order, to receive HCVs over the next several years. This randomized waitlist design offers a rare opportunity to study the causal impact of HCVs on a range of housing and health outcomes. Our study will employ both quantitative and qualitative methods to evaluate how baseline health status shapes voucher use and how voucher receipt affects health (primary) and housing outcomes. We will also explore how HCV use affects health through mediation analyses and qualitative interviews. Aims 1 and 2 use NYCHA HCV waitlist data (including HCV recipients and non-recipients) linked with statewide Medicaid data and other housing-related datasets. Aim 1 will examine the impact of baseline health status on voucher lease-up or success rates. Aim 2 will exploit the randomized waitlist design to estimate the impact of HCVs on housing and health outcomes, both overall and for policy-relevant subgroups. Aim 2a will examine housing outcomes including housing stability and quality. Aim 2b will examine health outcomes including health care utilization (emergency department visits, hospitalizations, outpatient primary and specialty care) and pharmacy claims data across a range of physical and mental health conditions. Mediation analyses will explore how specific housing factors contribute to health outcomes. Aim 3 will assess barriers and facilitators to successful HCV use and explore pathways between HCVs and health using in-depth qualitative interviews with voucher recipients. The proposed study, submitted in response to RFA-NR-25-001, will be carried out by a multidisciplinary investigator team that brings deep expertise from both the health and housing sectors. The investigators will work closely with a Study Advisory Board—including robust plans for meaningfully including and amplifying the voices of people with experience of housing insecurity—to maximize the impact of the research. This unique research will provide actionable evidence for health and housing practitioners in NYC and nationally to help them tailor, implement, and scale interventions to boost HCV success rates and maximize the impact of the voucher program and other housing interventions.
