Medicaid Expansion Helped Reduce Eviction Rates, Housing Insecurity

Medicaid expansion was associated with reductions in county-level eviction judgments and eviction rates, but results varied across states, according to a study published in JAMA Network Open.

In 2020, around one in five households had little confidence that they could make their next rent or mortgage payment. Racial or ethnic minority groups are more likely to struggle with housing insecurity compared to their non-Hispanic White counterparts.

While some policies can provide short-term solutions to eviction threats, permanent policies like Medicaid expansion may be more beneficial.

Expanding Medicaid eligibility would expand access to public insurance, which could help eliminate high costs for private coverage and medical bills. In addition, lower costs for care could lead individuals to increase investment in their own health, thus reducing the time they spend being sick and increasing the time they can spend working. Both these scenarios could lead to fewer financial issues and reduce the risk of eviction.

Researchers used county-year-level eviction judgment data from 2002 to 2018 from the Princeton Eviction Lab and state-level data from the Kaiser Family Foundation to determine if Medicaid expansion was associated with reduced eviction judgment rates.

The sample included a panel of 25,398 county-year observations, corresponding to 774 counties across 26 states that had adopted Medicaid expansion and 720 control counties across 14 states that had not expanded Medicaid.

Researchers looked at eviction rates pre- and post-2014, the year states could expand Medicaid under the Affordable Care Act.

The eviction rate for Medicaid expansion counties decreased from the pre-2014 period to the post-2014 period. Pre-2014, the mean county evictions were 534.78 or 2.25 per 100 renter-occupied households. Post-2014, following Medicaid expansion, the mean fell to 463.67 evictions or 2.02 per 100 renter-occupied households.

Meanwhile, the mean county evictions for the control group increased from 477.22 evictions during the pre-2014 period to 490.22 post-2014.

The study found that Medicaid expansion was associated with reductions in county eviction judgments by 66.49 and reductions in the eviction judgment rates by 0.25.

States that adopted 1115 waivers as part of their expansions had a -0.31 larger reduction in home eviction rates than non-1115 waiver states.

The timing of Medicaid expansion was also relevant to its impact on eviction rates, the study found. For example, states that initiated expansions in 2015 and 2016 experienced fewer benefits associated with Medicaid expansion than states that expanded in 2014.

Counties with a greater share of people 65 and older also experienced less of an impact from Medicaid expansion. In contrast, areas with a larger percentage of low-income uninsured people saw more benefits associated with Medicaid expansion.

Additionally, counties with high eviction rates before Medicaid expansion was implemented had disproportionately larger reductions in eviction rates after Medicaid expansion.

Despite a general correlation between Medicaid expansion and reduced eviction rates, the study did not find any evidence that Medicaid expansion helped minimize evictions for racial and ethnic minority populations.

“The null finding regarding the population share that is non-Hispanic Black, Hispanic, and Asian suggests potential Medicaid enrollment disparities across minority populations, as we would otherwise have expected some potential heterogeneity across this dimension of county population characteristics,” researchers wrote.

While the study findings suggest that expanding Medicaid may help reduce households’ risk of eviction, expansion alone may not be enough to ensure qualified individuals are protected.

For example, racial and ethnic minorities are overrepresented among those eligible for Medicaid but remain uninsured, suggesting they face barriers to obtaining Medicaid coverage.

“As such, additional efforts are needed to ensure that all qualified populations gain access to Medicaid coverage as part of expansion efforts. This recommendation seems particularly potent given that many remaining non-expansion states (particularly those located in the south of the US) have high populations of racial and ethnic minorities,” the study concluded.