Children in Households with Moving to Opportunity Vouchers Had Lower Risks of Hospitalization for Housing-Sensitive Conditions

A paper published in Housing Policy Debate,Using the Moving to Opportunity Experiment to Investigate the Long-Term Impact of Neighborhoods on Healthcare Use by Specific Clinical Conditions and Type of Service,” offers further evidence for the health benefits to children of living in lower-poverty neighborhoods. Children in households that received a voucher during the Moving to Opportunity (MTO) demonstration had subsequent hospital admission rates that were 36% lower for asthma and 30% lower for mental health disorders compared to those whose households did not have an MTO voucher.

HUD’s MTO demonstration, conducted in the 1990s, tested the effect of giving residents of distressed public housing the opportunity to move to low-poverty neighborhoods using vouchers. Families with children were randomly assigned to one of three study conditions: 1) receiving a voucher that could only be used in a low-poverty neighborhood; 2) receiving a traditional voucher; or 3) remaining in public housing (see Memo, 1/19/2016 for more research on MTO).

This paper examines long-term differences in hospitalizations and emergency department (ED) visits for specific clinical conditions, and whether such housing assistance impacted broad categories of healthcare utilization, including psychiatric services, dental services, and transportation services. The authors matched 15,892 MTO participants (4,602 adults and 11,290 children) with hospital and emergency department (ED) administrative data through 2015, as well as Medicaid data for inpatient, ED, and outpatient service utilization. They examined the effect of being assigned to receive a voucher on the number of hospitalizations and ED visits for seven clinical conditions: asthma, acute respiratory infections, mental health, diabetes, obesity, and hypertension. These “housing-sensitive” clinical conditions were selected because they have been identified in previous research as affected by the physical conditions in home environments. The authors combined all voucher recipients (those with traditional vouchers and low-poverty neighborhood vouchers) and treated those selected to remain in public housing as a control group.

Voucher households experienced greater long-term health benefits for children than adults. For those who were adults when entering MTO, rates of hospitalization or ED visits for housing-sensitive conditions were not significantly lower for voucher holders. For children in households with vouchers, however, rates of hospital admissions for asthma were 36% lower than for the control group, and admission for mental health disorders was 30% lower. The lower rate of asthma admissions compared with the control group was concentrated among children younger than age 13 at time of entry into MTO. The authors observe that regular maintenance, such as pest control, can reduce allergen exposures and may decrease asthma symptoms. They point to other research on the connections between home and neighborhood environment, stress, and mental well-being.

There were no differences in hospital admissions for the other selected housing-sensitive conditions or in ED visits for any conditions. Children in voucher households did have lower service utilization rates for a variety of types of healthcare services: 18% lower for psychiatric services, 11% lower for outpatient hospital services, and 20% lower for clinic services.

The authors also examined whether changes in neighborhood poverty were associated with changes in healthcare use. For children, a 10 percentage-point reduction in neighborhood poverty was associated with 25% lower rates of mental health hospitalizations and a decline in clinic services. While the authors call for more work to explore the mechanisms that affect this healthcare use, they infer from this research that expanded mobility assistance would produce modest decreases in healthcare use for these housing-sensitive clinical conditions and services.

The paper is available at: