June 3, 2026-- Major health events increase the risk of housing instability and homelessness among Medicaid enrollees, according to a new study at Columbia University Mailman School of Public Health. These findings shed new light on the complex, bidirectional relationship between health and housing. The research examined housing outcomes following serious health events by tracking reported address changes over four years before and after a sudden hospitalization.
While decades of research have focused on how housing conditions shape health, until now there has been little attention paid to the reverse relationship: how adverse health events themselves can destabilize housing. The results are published in the Journal of Health Economics .
"Most prior work has focused on housing as a social determinant of health," said Kacie Dragan, PhD, assistant professor of Health Policy and Management at Columbia Mailman School. "Our paper provides new evidence that the relationship also runs in the other direction. Major health crises are key tipping points for residential mobility and housing instability, including homelessness."
Dragan analyzed high-frequency health and residential address data from New York City Medicaid enrollees between 2010 and 2019 to establish clear timing in the sequence of hospitalizations and moves. The study included all enrollees who experienced a sudden hospitalization between 2012 and 2017 and compared them to a matched group without a sudden hospitalization.
"Our analysis focused on a broad population living in one of the nation's tightest urban housing markets, while also examining what features of health and housing systems may protect low-income residents from instability," noted Dragan.
The study found that adverse health events were followed by a 21–35 percent increase in quarterly residential moves, a 40–56 percent increase in housing instability (multiple moves in rapid succession), and a 6–10 percent increase in the risk of entering homelessness, including shelters or street homelessness. Effects were even larger when analyses were limited to urgent hospital admissions. When scaled nationally, this could mean that health events are the tipping point for 80,000 additional moves and 20,000 additional cases of homelessness in the U.S. Medicaid-insured population each year.
Overall, 237,199 Medicaid enrollees experienced a health shock. The study population was demographically diverse, and enrollees were hospitalized for a wide range of conditions, including diabetes complications, strokes, heart attacks, injuries, asthma, pneumonia, and mental health emergencies.
"Understanding the drivers of housing instability remains a major policy priority. Much of the existing research has focused on narrow definitions of homelessness — like shelter use — or only on formal evictions.
Our paper looks at a range of housing instability outcomes following major health events," said Dragan. "It offers evidence for how health systems might use their existing capabilities to support patients at risk of instability — either by preventing disruptive health events in the first place or facilitating rapid support services during health crises to interrupt the long tail of social consequences that can follow."
Potential pilot programs and policy interventions informed by these findings could include:
- Medical-legal partnerships during inpatient stays to address health-related eviction or employment issues;
- Assistance applying for paid leave, subsidized housing, emergency rental assistance, or disability accommodations before discharge; and
- Interventions that improve access to regular outpatient care before a health crisis, like community health workers.
"More broadly, improving the quality of care available to low-income patients — including access to highly effective treatments for depression, diabetes, HIV, hepatitis, and opioid use disorder, as well as preventive services like PrEP — may help reduce housing instability simply by lowering the risk of severe health crises in the first place," Dragan added.
The findings underscore the importance of reducing health disparities in order to improve other aspects of people's well-being, beyond clinical outcomes typically measured. By focusing on Medicaid enrollees with comprehensive insurance coverage and minimal cost-sharing, the study also highlights that insurance coverage alone is insufficient to protect patients from the broader social consequences of illness.
"People experiencing serious illness are uniquely vulnerable to housing instability and residential displacement, suggesting that efforts to improve healthcare access and quality may also serve as important housing stabilization strategies," said Dragan.
The study was supported by the Agency for Healthcare Research and Quality (T32HS000055), the National Institute of Mental Health (T32MH019733), Harvard Radcliffe Institute, and The Horowitz Foundation for Social Policy.
The author reports no conflicts of interest.
Columbia University Mailman School of Public Health
