Association for Public Policy Analysis & Management

The Federal Government’s Housing Choice Voucher (HCV) Program is the predominant housing strategy for low-income and vulnerable families; however, little is known about the effect this program has on the health of those it serves. Like many communities, both Vancouver, Washington and Portland, Oregon face severe affordable housing shortages. Each community has chosen to prioritize specific populations for receipt of housing choice vouchers in order to maximize the potential impact of these vouchers on community health. The Vancouver Housing Authority (VHA) distributes vouchers only to medically complex individuals, as defined by participation in the state’s “health home” program for complex high-utilizers; and homeless families with school-aged children. Home Forward, the housing authority in Portland, prioritizes seniors and people with disabilities.

Our goal is to understand how a policy of prioritizing housing choice vouchers for targeted subpopulations impacts key community health indicators. We will use a randomized controlled trial to assess the impact of these two different prioritization strategies on health care utilization, quality, and cost outcomes. We will additionally explore the impact of VHA’s voucher distribution on self-reported health, social, and socioeconomic outcomes; and objective education outcomes.

The study population consists of all individuals housed or on the waitlist for the HCV program at VHA from October 2015 through May 2017; and all individuals housed or on the waitlist for the HCV program at Home Forward from January 2014 through December 2016. Both sites distribute vouchers to individuals and households on their waitlists by random selection: Home Forward selects approximately 1,000 households for vouchers in a typical year; VHA selects approximately 300 per year.

For both the Home Forward and VHA arms of the study, we will bring together administrative records from our housing agencies and Medicaid claims data. For the VHA study population, we will use two additional sources of data: education data from local school districts, and information from surveys on self-reported housing outcomes, neighborhood quality, health care access, health and health behaviors, socioeconomic challenges, and children’s health, wellbeing, and education outcomes. We will use intent-to-treat and instrumental variable analysis to understand the impact of both selection to receive a voucher (intent-to-treat) and obtaining housing with a voucher (instrumental variable analysis) on our health care, social and socioeconomic, and education outcomes.

Lack of affordable housing has caused a substantial rise in housing instability, which in turn carries serious health and social consequences. The results of this research can help us better understand how communities can allocate existing housing supports in a way that creates the greatest impact on health and the key determinants of health.