Rental Assistance

Table of contents

Impact Assessment

The findings below synthesize the results of rental assistance to support housing stabilization across the following three domains of measurement:

Healthcare Cost, Utilization & Value: There is insufficient evidence of the impacts of rental assistance on healthcare cost, utilization, and value. An observational study found no significant effects of housing choice vouchers on emergency department use for asthma among children but did find an effect for public or multifamily housing use of the emergency department. Another study reported no significant changes in healthcare use among housing deposit recipients compared to case management alone. However, one study suggested that renters receiving assistance spent less on healthcare annually than unassisted renters with low-income. More high-quality systematic reviews and/or large randomized controlled trials (RCTs) are needed to confirm the program’s impact on healthcare utilization. While the impact of housing assistance/stable housing on healthcare cost, utilization, and value for people who are pregnant is positive, with an RCT demonstrating significant reductions in neonatal intensive care unit (NICU) utilization, further research is warranted.
Health: There is insufficient evidence for the impacts of rental assistance on health outcomes, with effects varying by health condition. Positive effects include reductions in anxiety, depression, and psychological distress, as well as less likelihood of undiagnosed diabetes among recipients of rental assistance compared to people on the waitlist. However, some studies showed no significant changes in outcomes such as asthma attacks or identified associations between rental assistance and higher prevalence of obesity in some populations. Mental health outcomes were also mixed, with improvements during interventions, yet one case experienced increased anxiety post-intervention. Subgroup analyses revealed variability, with individuals aged 45–64 experiencing greater effects compared to younger age groups for conditions like undiagnosed diabetes. Longitudinal monitoring, subgroup analyses by demographic factors, and further research, such as systematic reviews on targeted health conditions, are needed to clarify these outcomes. For pregnant people, a sub-population of the studies reviewed found the effect on health has been studied, and while rental assistance has shown some promise, there have been no statistically significant findings.‍
Social: There is sufficient evidence for the impacts of rental assistance on stable housing and food access, though gaps remain in other social outcomes. Observational studies with comparison groups found that rental assistance improved housing stability, reducing the likelihood of being behind on rent and increasing rent payment rates. Recipients also experienced improved food security and increased consumption of fruits and vegetables. A pre-post analysis highlighted additional benefits, such as higher household incomes and social investments like education and skills building. However, an RCT indicated that financial benefits faded over time, with no significant impacts on eviction filings or homelessness system use. Other observational studies associated rental assistance with increased smoking and obesity but no changes in body mass index (BMI), alcohol consumption, or physical activity. While evidence is strong for housing-related benefits, further high-quality research is needed to clarify impacts on broader social outcomes. RCT evidence has shown that housing stabilization for people who are pregnant leads to a higher likelihood of housing at 18-months and having spent fewer days in shelters.

Background of the Need / Need Impact on Health

There is growing consensus that access to safe and affordable housing is a key health determinant. Housing can impact health based on accessibility, affordability, stability, quality, safety, and surroundings.

Housing Stability

Affordable housing in the United States (U.S.) has become increasingly difficult to access. In 2023, 51.8% of all American renters spent at least 30% of their income on rent[1]. In 2020, one in five U.S. households reported challenges with being able to afford their rent or mortgage payment and, therefore, were identified as housing insecure[2]. Up to 3.6 million eviction cases were filed annually between 2000 and 2018 [3],[4]. Individuals are more likely to be evicted if they identify as Black or Hispanic/Latino, women, or low-income[5]. The housing affordability crisis is compounded by a steep rise in the cost of rent while the increase in renters’ earnings lag[6]. A U.S. Conference of Mayors survey found seven of 10 Americans are concerned about housing costs and its affordability[7].

In the past three years, the median monthly rental price has increased by 18% and the median purchase price for housing has increased by 21% leading to increased homelessness[8]. The U.S. Department of Housing and Urban Development (HUD) identifies “a person who lacks a fixed, regular and adequate nighttime residence” as experiencing homelessness[9]. According to the National Alliance to End Homelessness, a January 2023 count identified a record-high of 653,104 people experiencing homelessness (a 12.1% increase since 2022) across the U.S., with more than 50% of those individuals experiencing unsheltered homelessness. About 61% of people experiencing homelessness identify as men, while homelessness among those who identify as women is growing rapidly by over 20% between 2022 to 2023. Since 2015, transgender individuals have experienced a 217% increase in homelessness[10].

The two factors that pose the greatest risk for homelessness are being severely housing cost-burdened and living in “doubled-up” overcrowded homes, also known as ‘couch surfing.’ Additional risks include an individual that identifies as LGBTQ+, being a survivor of intimate partner violence, exiting the criminal justice system, being a youth aging out of foster care, as well as ongoing mental health and substance use disorders[11]. Individuals in these groups may face discrimination and safety issues that make accessing both housing and sustainable employment difficult.

Housing Quality and Impact on Health

The health effects of housing instability and homelessness include adverse physical and mental health outcomes, chronic disease, and injury. There is a significant association between eviction rates and any cause of mortality with the strongest association in counties with higher proportions of Black and women residents[12]. Black, American Indian/Alaska Native, and Hispanic/Latino communities disproportionately live in households that are rent-burdened and of low housing quality while experiencing some of the greatest health disparities[13].

Housing of poor quality can directly impact health via exposure to things like lead, mold, asbestos, or poor air quality[14]. Additionally, exposure to extreme indoor temperatures, overcrowding, or lack of proper fire safety requirements (e.g., smoke and carbon monoxide alarms) can be deleterious to health. Poor housing conditions have a disproportionately adverse impact on children, older adults, people with physical disabilities, and individuals of low socioeconomic status. Housing quality also includes neighborhood factors such as incidence of violence, environmental conditions, access to transportation, and availability of other social services and supports.

Specific health impacts of housing instability and homelessness in people who are pregnant

It is unclear how many individuals who are pregnant are experiencing housing insecurity; however, the Health Resources and Services Administration (HRSA) estimates that between 6% to 22% of people experiencing homelessness may be pregnant[15]. A more recent estimate based on a systematic review of the literature estimates that between 4% and 9% these individuals may be pregnant[16]. One analysis found that the rate of unhoused pregnant patients increased 72% between 2016 and 2020[17].

Housing instability and homelessness are associated with poorer health outcomes including less or poor prenatal care, higher rates of mortality, preterm birth, low birth weight, NICU admissions, behavioral health conditions, and obstetrical complications, including hypertensive disorders, iron deficiency, and antepartum hemorrhage[18],[19],[20],[21],[22],[23],[24]. In one study, rates of low birth weight, NICU stays, and extended hospital stays after delivery occurred in people experiencing housing-insecurity at twice the rate of the people who are housing-secure[25]. Another study also identified a number of impacts on healthcare utilization and costs including longer hospital stays after childbirth, more emergency room visits, and more readmissions[26].

Background on the Intervention

The studies described in this assessment include a range of emergency housing rental assistance programs, including rental subsidies (paid directly to a landlord), flexible funding or money that could be used for rent or other housing needs (e.g., furniture), utilities assistance, and some ancillary supports (e.g., job coaching). Emergency rental assistance is typically a temporary solution to prevent or address homelessness.

Healthcare organizations’ partnerships and investments around housing assistance may fill a critical gap[27]. More permanent solutions for affordable housing including housing vouchers, subsidized housing, and public housing, may not be available in the community where a person lives and works or may have long wait lists[28]. Temporary Assistance for Needy Families which provides cash assistance to individuals who are pregnant and their families who are earning lower incomes provides variable benefit amounts by state and is consistently too low to support the cost of rent. For example, in July 2022, the maximum benefit amount for a single parent with a child in Arkansas was $162 per month[29]. The Emergency Rental Assistance Program created in response to the COVID pandemic provided significant support to low-income families, however one analysis found that only 24% of families eligible and in need of federal rental assistance received that benefit[30]. For many families, the cost of heating or cooling their home can further burden a household’s economic resources. The Low-Income Home Emergency Assistance Program (LIHEAP) is a federal program that helps low-income households pay for heating or cooling their homes. LIHEAP funds are distributed to organizations that have significant flexibility as to how they administer funds. Recipients are only allowed to receive support once per year and the organizations often run out of funds before meeting the need in the community[31]. Compelling data indicates that rental subsidies can both support rehousing and prevent homelessness[32].

In its Health-Related Social Needs Services Framework, the Centers for Medicare and Medicaid Services identified federal authorities that would enable states to offer housing supports (including housing transition and navigation, on-time moving costs, etc.), first month’s rent, short-term pre-procedure and post-hospitalization housing, and utility assistance. States would need to elect to offer this support through a waiver (such as an 1115 waiver) or through Managed Care authorities[33].

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Additional Research and Tools

Table of contents

Airgood-Obrycki (2022)

Renters in the U.S. who either received Emergency Rental Assistance (ERA) or applied for ERA and were still waiting for approval. The sample includes 10,300 cash renters, those who are using cash deposits. These people with low-incomes who receive HUD funds, pooled from the Household Pulse Survey conducted between August 2021, and April 2022. Of this sample, 56% received ERA and 44% were applicants awaiting approval.

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Receipt of ERA, which provided financial support for rent and utilities during the COVID-19 pandemic to mitigate hardships, prevent evictions, and improve well-being. Renters who received ERA were compared to those who applied but were awaiting approval, serving as a control group.

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Observational study with a comparison group. The study used logistic regression and propensity score matching to analyze eight binary outcomes related to housing stability, financial well-being, and mental health.

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Health: Recipients of ERA had a 7% lower likelihood of reporting poor mental health (e.g., anxiety, depression, or little interest in activities) compared to applicants. ERA recipients were more likely to experience improvements in mental health due to reduced financial and housing stress.

Social: ERA recipients were 36% less likely to be behind on rent than applicants. For those behind on rent, ERA recipients were 14-20% less likely to think eviction was likely or to be three or more months behind on payments. ERA receipt improved renters’ financial well-being: 13% lower likelihood of difficulty meeting expenses, 11-percentage point lower likelihood of borrowing from friends or family, nine-percentage point lower likelihood of experiencing food insecurity, and six-percentage point lower likelihood of tapping savings/assets.

Antonakos & Colabianchi (2019)

1,374 participants aged between 18 to 62 who were the head of the household and had not received rental assistance for four years prior to baseline.

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Treatment group participants received four categories of rental assistance: public housing; other subsidized housing including low-income housing tax credit; tenant-based housing (primarily vouchers); and Farmers Home, State-assisted housing assistance.

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Observational study with a comparison group. A pooled cross-sectional design with propensity score matching to estimate the influence of rental assistance on each health indicator at two, four, and six years after baseline. Data sources included survey data from the Panel Study of Income Dynamics—a nationally representative panel study of U.S. individuals, geospatial data, data on rental assistance, and HUD income limit data. There were 116 treatment group participants and 1,258 in the comparison group.

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Health: Using average treatment effect on treated, it was found rental assistance was associated with increased smoking and obesity two years after baseline, but did not influence BMI, alcohol use, or physical activity.

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Bogle et al. (2024)

135 households in Austin, Texas, experiencing housing instability, primarily from high poverty neighborhoods.

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Direct cash transfers were disbursed to households to alleviate housing instability and provide financial stability. Participants received $1,000 per month for one year starting in September 2022. Participants had full discretion over how to spend the funds on resources that may include rent or other essential items. The intervention was implemented in partnership with the City of Austin, UpTogether, and 10 community-based organizations.

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Pre-post analysis. The study evaluated changes within the same group of participants over time, using surveys at baseline, six months into the intervention, and six months post-intervention.

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Health: Mental health outcomes were mixed. Six months into the pilot, participants experienced notable improvements in mental health. However, six months after the pilot ended, more participants reported feeling anxious than before the pilot began. Food security improved during the pilot and remained better than baseline six months post-intervention.

Social: Housing security improved, with the share of participants caught up on rent increasing by 19% (from 48% to 67%) by the end of the pilot. Participants used cash for social investments such as expanding professional networks or helping others, fostering supportive relationships, and job connections. Participants allocated over 50% of their cash to housing costs, more than twice the amount spent on any other category. 34% of participants used the cash for future-oriented investments, such as skills building, education, or financial growth. Median household incomes rose during and after the pilot, likely due to these investments. About 30% of participants reported obtaining better jobs or higher salaries.

Boudreaux et al. (2020)

2,992 families with children under 17 receiving rental assistance or participating in a rental assistance program within two years of the survey interview.

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Participation in the HUD rental assistance programs, including vouchers or other subsidized units.

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Observational study with a comparison group. This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. Data analysis was performed from January 15, 2018, to August 31, 2019.

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Healthcare Cost, Utilization & Value: Among children with an asthma attack in the past year, participation in a rental assistance program was associated with reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6). Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3).

‍Health: No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points).

Brady et al. (2024)

U.S. households participating in the Household Pulse Survey from June 2022 to May 2023, stratified by rent burden status (rent-burdened households spending more than 30% of income on rent and non-rent-burdened households).

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Two COVID-19 economic support policies: Supplemental Nutrition Assistance Program (SNAP) emergency allotments, which provided enhanced nutrition assistance, and ERA, which offered financial support for housing costs.

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Observational study with a comparison group. The study compared 40,895 households that received SNAP emergency allotments or ERA to those that did not (e.g., those denied assistance or waitlisted), stratified by rent burden status.

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Social: SNAP emergency allotments improved food sufficiency, with a stronger positive impact observed in rent-burdened households (72.4% vs. 67.2% for states with and without SNAP emergency allotments). ERAe was associated with greater food sufficiency improvements among non-rent-burdened households.

Among recipients, 78.7% reported being current on rent compared to 56.4% of households that were waitlisted or denied assistance. Housing stability gains were more pronounced in non-rent-burdened households.

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Collinson et al. (2024)

Applicants to ERA programs in four U.S. metropolitan areas: Chicago, Harris County (Houston), King County (Seattle), and Los Angeles. Over 200,000 households applied for assistance between May and December 2020, while no overall approval rate was identified, approval rates were over 72% for all localities.

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Five ERA programs that provided $1,000 to $3,400 in direct financial assistance to households during the COVID-19 pandemic. These programs aimed to stabilize housing by increasing rent payments and reducing evictions and homelessness. Assistance amounts were flat in most cities, while King County provided assistance of up to 80% of rent for three months.

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Randomized Controlled Trial. Lotteries were used to select assistance receipt.

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Health: ERA receipt reduced self-reported anxiety or depression by 3.4% to 7% on average. Assistance also decreased worries about eviction by 4.6% to 15% overall.

Social: ERA increased the likelihood of rent payment in the months following the lottery by 5–13% across cities in a pre-measurement period to a range of 8–36% post-measurement, with greater effects in cities offering more generous assistance or direct landlord payments. However, ERA did not significantly reduce the likelihood of applicants moving, and no significant impacts were found on eviction filings or homelessness system use.

ERA had small short-term effects on financial distress, such as $74 less in collections two months after assistance, but these effects faded over time. Ten months post-lottery, financial metrics for recipients were indistinguishable from those of non-recipients.

Denary et al. (2021)

A cohort of 400 low-income adults living in New Haven, CT. Participants were categorized into three groups: 81 receiving rental assistance, 100 on waiting lists, and 219 neither receiving nor waitlisted for assistance.

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Rental assistance, administered through HUD programs, including vouchers and affordable housing units.

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Observational study with a comparison group. The study used a cross-sectional analysis to compare those receiving assistance to those waitlisted, alongside a longitudinal fixed-effects analysis to assess within-person changes after entering rental assistance.

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Health: Those receiving rental assistance report significantly less psychological distress than those on waiting lists, and transitions into rental assistance are associated with statistically non-significant decreases in psychological distress.

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Denary et al. (2023)

36,039 adults. The sample included individuals who were either receiving rental assistance or eligible for rental assistance but not receiving it (pseudo-waitlist group).

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Rental assistance provided through HUD voucher programs.

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Observational study with a comparison group. The study used cross-sectional regression analysis to compare outcomes between rent-assisted individuals and a pseudo-waitlist group. Data came from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016, which was linked to HUD administrative records.

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Social: Rental assistance was associated with improved food security outcomes. Tenants receiving rental assistance based on the project offerings were significantly less likely to experience food insecurity (B = −0.18, p = 0.02). Additionally, rent-assisted individuals consumed 0.23 more cups of fruits and vegetables daily compared to the pseudo-waitlist group.

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Fenelon et al. (2022)

1,050 adults aged 45 years or older.

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Rental assistance provided through HUD programs, including place-based housing programs (subsidized housing developments, including public housing) and tenant-based housing vouchers (subsidies for private market housing).

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Observational study with a comparison group. Data were collected from NHANES linked with HUD administrative records of rental assistance participation from January 1999 to December 2016. Linear and logistic regression analyses were used to compare HbA1c levels and diabetes outcomes between participants receiving rental assistance and those in the waitlist group.

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Health: Living in subsidized housing developments was associated with a reduced likelihood of uncontrolled diabetes (HbA1c ≥ 9%; −3.7 percentage points; 95% CI, −7.0 to −0.0 percentage points) compared to the waitlist group. No significant associations were found for HbA1c levels or uncontrolled diabetes among participants receiving housing vouchers.

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Gonzalez-Lopez et al. (2024)

435 adults from NHANES data (1999–2018) who had diabetes and were either receiving rental assistance or expected to receive it within two years. Median age was 54.5 years, 68.5% were female, and 32.5% were non-Hispanic White.

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Rental assistance provided through federal programs, including affordable housing and subsidy initiatives, aimed to reduce housing cost burdens and improve access to resources.

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Observational study with a comparison group. The study compared adults currently receiving rental assistance to those who would receive it within the next two years, using linked NHANES data and HUD records. Adjusted logistic regression was used to estimate associations with undiagnosed diabetes.

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Health: Adults receiving rental assistance had lower odds of undiagnosed diabetes (OR 0.52, 95% CI 0.28–0.94) compared to those in the future assistance group. Rates of undiagnosed diabetes were 15% among current rental assistance recipients and 25.3% among those in the future assistance group (p = 0.07). Individuals in the study aged 45-64 years also had significantly lower odds of undiagnosed diabetes (OR 0.21, 95% CI 0.08–0.53) compared to those aged 18–44.

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Keene et al. (2022)

400 low-income adults in New Haven, Connecticut. The sample included 73 participants receiving rental assistance, 100 on waiting lists, and 227 who were neither assisted nor waitlisted.

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Rental assistance provided through HUD, including vouchers and place-based subsidized housing.

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Observational study with a comparison group. The study compared self-rated health outcomes between rent-assisted individuals, those on waitlists, and those without rental assistance.

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Health: Individuals receiving rental assistance were less likely to report poor or fair self-rated health compared to those on rental assistance waitlists (OR 3.03, 95% CI 1.38–6.64) and those in the unassisted group (OR 2.35, 95% CI 1.11–4.99). These associations persisted after adjusting for factors such as age, disability status, criminal justice history, and recent substance use.

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Kim et al. (2023)

Nationally representative sample of adults aged 20 years or older from NHANES data (2005–2018) linked to HUD administrative records. Participants included those receiving HUD assistance and HUD-assistance-eligible adults not receiving assistance.

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Federal housing assistance provided through HUD programs, such as aid or reduced rent, aimed to improve housing stability and affordability for low-income adults.

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Observational study with a comparison group. The study compared chronic disease outcomes between adults receiving HUD assistance and HUD-assistance-eligible adults not receiving assistance, adjusting for potential confounders using propensity scores.

Health: Adults receiving HUD assistance had a higher prevalence of obesity (47.5%; 95% CI, 44.8%–50.3%) compared to HUD-assistance-eligible adults not receiving assistance (42.1%; 95% CI, 40.4%–43.8%).

Housing assistance was significantly associated with obesity (adjusted OR = 1.29; 95% CI, 1.12–1.47), but this association was not significant in sensitivity analyses accounting for disability status.

No significant associations were found between housing assistance and diabetes or hypertension.

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Knox et al. (2024)

Adult Medicaid beneficiaries receiving social needs case management as part of a Whole-Person Care (Medicaid 1115 waiver) pilot program in Contra Costa County, California.

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Receipt of a housing deposit between October 2018 to December 2021 along with case management. The matched comparison group received case management only.

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Observational study with a comparison group. Housing deposit recipients were propensity score-matched 1:1 using nearest neighbor matching with no replacement to identify similar case management participants who did not receive a move-in deposit. Of 1,690 case management participants, 845 received a housing deposit (362 [42.8%] <40 years old; 422 [49.9%] male) and 845 received case management only (367 [43.4%] <40 years old; 426 [50.4%] male).

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Healthcare Cost, Utilization & Value: In adjusted analyses, deposit recipients had no statistically significant differential changes in healthcare use for any measure compared to participants who received case management alone. Twelve-month sensitivity analyses yielded consistent results.

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Pfeiffer (2018)

Low-income renters.

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Renter housing assistance through low or fixed housing cost, protection from eviction, or connection to higher quality housing.

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Observational study with a comparison group. Data used was from the Survey of Income and Program Participation.

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Healthcare Cost, Utilization & Value: Renters receiving assistance spent less on health care over the year than unassisted low-income renters did after controlling for other characteristics. This finding suggests that assisted housing leads to health benefits that may reduce low-income renters from the need to purchase health services.

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Sullivan et al. (2016)

55 low income, primarily Black, intimate partner violence (IPV) survivors in Washington, District of Columbia (DC). Those who received funds were 95% women; mean age 34.8 years; 93% Black. At the time of receiving the flexible funding, participants were either at risk of losing their current housing (65%) or were homeless (35%).

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55 IPV survivors received flexible funding to spend on items to facilitate either remaining in their homes or obtaining safe and permanent housing. (Some participants just needed immediate financial assistance to have a month’s back rent paid. Others needed an advocate to intervene on their behalf as well, for example with a potential landlord, a community service provider, or the legal system). The average amount of funds that participants received was $2,079 (ranging from less than $300 to more than $8,000).

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Qualitative study. Fund recipients were interviewed at 30 days, three-months, and six-months follow-up.

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Health: In relation to mental health benefits, most survivors talked about how the funds provided stress relief by enabling them to address their most pressing concerns—whether it be the looming loss of belongings or eviction. Participants also talked about the radiating impacts of that relief—feeling more able to concentrate at work, sleeping better, and feeling better able to parent their children.

Social: 94% of participants were housed six-months after funding was received. Of the 55 grants, almost half (26 [47%]) were used for rental assistance. The remaining participants used the funds for things such as cellphone bills, transportation, car payments, utility bills, food, childcare, and security deposits.

Stevens et al. (2021)

Families of pregnant women who had unstable housing situations and were earning extremely low incomes. A majority were Black or African American.

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Provision of rental assistance with housing stabilization services. Both cases and controls received usual care services including referrals to social services (e.g., behavioral health treatment) and access to prenatal care and job coaching services. The intervention group was enrolled in Healthy Beginnings at Home (HBAH) and received rental assistance and comprehensive housing stabilization services. Some participants in the intervention group received ongoing housing rental assistance, meaning a long-term subsidy that would continue beyond the pilot study. Others received time-limited housing rental assistance.

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Randomized control trial. Study participants were randomized into an intervention group (n=50) and a control group (n=50). Phone interviews were conducted with intervention and control group participants at baseline, six-, 12-, and 18-months post enrollment. Claims data were analyzed with a focus on maternal and child health outcomes as well as utilization and cost data related to delivery. Some housing and food security outcomes were assessed.

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Healthcare Cost, Utilization & Value: HBAH participants had far lower healthcare spending than the control group households. For example, the average spending for infants at the time of delivery was $4,175 for the intervention group compared to $21,521 for the control group, largely driven by lower NICU utilization.

Health: 40 of the 51 live births in the HBAH group (78%) were infants born full-term at a healthy weight, compared to 24 of 44 in the control group (55%). There were no fetal deaths in the HBAH group, compared to 4 in the control group. While these results were promising, they were not statistically significant due to the study size. There were no notable differences in self-reported maternal health outcomes.

‍Social: HBAH group participants were much less likely than control group participants to have spent time in a homeless shelter during or after enrollment in the project. For the HBAH group, total household days in a shelter declined from 695 prior to HBAH enrollment (9/2016 to 9/2018), to 77 during enrollment to zero within the post-enrollment period; compared to 834, 436, and 114 days, respectively, for the control group.

Stransky et al. (2022)

People experiencing high-risk pregnancies and their infants from Boston, Massachusetts from 2019 to 2020 (average age 28.7 years; Race: 46% Black, 48% White; Ethnicity: 54% Latinx).

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Upstreaming Housing for Health includes a discretionary fund to help meet families’ immediate housing- and health-related expenses as well as multisectoral partnership convenings, legal education, technical assistance, and biweekly interdisciplinary meetings for frontline staff. The flexible fund (cash transfer) was originally designed to address housing stability (rent arrears, security deposit, first/last month’s rent, and moving expenses). However, as it was discovered that some participants needed furniture, such as cribs or appliances, to make housing situations more appropriate for newborns, the flexible fund was expanded to address these material needs. The average amount of funds received was $1,343 (ranging from $106–$2,550). 51% of funds addressed rent needs alone, 19.7% paid for rent and furniture and/or infant items, and the remaining 30% was used for infant and/or furniture items alone (strollers, beds and bedding, pack and plays, and bottle warmers and sterilizers).

Qualitative study. 20 interviews were conducted with personnel from the partnering organizations: Community Care Cooperative (n = 3), Boston Housing Authority (n = 4), Boston Public Health Commission (n = 11, seven frontline personnel and four senior management), and Medical Legal Partnership Boston (n = 2). Three program participants agreed to interviews.

Social: Interviews of staff members (n= 20) from the pilot reported that the flexible fund was key to housing stability and health in that it helped to provide stability for individuals who previously would have had to choose between paying rent or other essential costs (for example electricity and groceries). Staff also reported that the flexible fund was important because requests could be acted upon immediately, while other programs had long waiting periods and complex application procedures.

Calhoun et al. (2024)

People experiencing homelessness in the United States.

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Cash benefit programs for U.S. persons experiencing homelessness, which includes offering participants money for essential resources.

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Systematic review. The review included 16 articles of which one explored mental health outcomes.

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Health: A review of current evidence suggests that cash benefit programs improve mental health outcomes through various levels of reduction in mental health and substance use disorder diagnoses.

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Chen et al. (2022)

Households experiencing housing instability

Primary prevention interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households or by enhancing community-level housing supply and affordability in partnership with the health sector. The study considered emergency rental assistance, emergency legal assistance, and eviction moratoriums associated with COVID-19 to be primary interventions.

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Systematic review. The review included 26 studies published from 2005 to 2021 (16 longitudinal designs and four cross-sectional quasi-waiting list control designs).

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Health: Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations (both physical and mental health) of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance.

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The Community Prevention Services Task Force (CPSTF) Community Guide (2020)

Residents of buildings with tenant-based housing voucher programs.

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Tenant-based housing voucher programs are programs where vouchers are tied to households rather than housing units and cover a substantial portion of, or all of, a person’s rent.

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Systematic review. Seven studies and 20 publications that evaluated tenant-based housing voucher programs were assessed. Included studies evaluated intervention effectiveness for one or more of the following outcomes: housing quality, neighborhood opportunities, housing security, education, income, employment, physical and mental health, healthcare use, and risky behaviors. Studies reported outcomes for households that were offered vouchers (intent-to-treat analysis) or households that used vouchers (treatment-of-the-treated analysis). Comparison groups were households that were not offered housing assistance from voucher programs.

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Health: There was sufficient evidence of the effectiveness of tenant-based housing voucher programs in improving health and health-related outcomes for adults. Health-related outcomes included housing quality and security, preventive healthcare use, and neighborhood opportunities (e.g., lower poverty level, better schools).

‍Social: Children aged 12 years and younger whose households used vouchers showed improvements in education, employment, and income later in life.

Strong Evidence

There is strong evidence that the intervention will produce the intended outcomes.

At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and
Consistent findings of health effects from other studies (cohort, case-control, and other designs).

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Sufficient Evidence

There is sufficient evidence that the intervention will produce the intended outcomes.

At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or
Multiple expert opinions/government agencies supporting the intervention.

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More Evidence Needed or Mixed Evidence

There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.

Lack of demonstration of improved health outcomes based on any of the following: (a) a systematic review or meta-analysis; (b) a large randomized controlled trial; (c) consistent positive results from multiple studies in high-quality journals; or (d) multiple expert opinions or government agencies supporting the intervention.
An insufficient evidence rating does not mean there is no evidence, or that the intervention is unsafe or ineffective.
In many cases, there is a need for more research or longer-term follow-up.

There is strong evidence that the intervention will produce the intended outcomes.

There is sufficient evidence that the intervention will produce the intended outcomes.

There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.

At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and
Consistent findings of health effects from other studies (cohort, case-control, and other designs).

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At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or
Multiple expert opinions/government agencies supporting the intervention.

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Lack of demonstration of improved health outcomes based on any of the following: (a) a systematic review or meta-analysis; (b) a large randomized controlled trial; (c) consistent positive results from multiple studies in high-quality journals; or (d) multiple expert opinions or government agencies supporting the intervention.
An insufficient evidence rating does not mean there is no evidence, or that the intervention is unsafe or ineffective.
In many cases, there is a need for more research or longer-term follow-up.

[1] DeSilver, D. (2024b, October 25). A Look At The State Of Affordable Housing In The U.S. Pew Research Center. https://www.pewresearch.org/short-reads/2024/10/25/a-look-at-the-state-of-affordable-housing-in-the-us/

[2] Cai JY, Fremstad S, Kalkat S. Housing insecurity by race and place during the pandemic. Washington (DC): Center for Economic and Policy Research; 2021 March. Available at: https://cepr.net/publications/housing-insecurity-by-race-and-place-during-the-pandemic/ Accessed on July 12, 2022.

[3] Gromis A, Fellows I, Hendrickson JR, et al. Estimating eviction prevalence across the United States. Proceedings of the National Academy of Sciences of the United States of America. 2022 May 24;119(21):e2116169119.

[4] Hepburn P, Jin O, Fish E., et al. Preliminary analysis: Eviction Filing Patterns iI 2021. March 8, 2022. Available at: https://evictionlab.org/us-eviction-filing-patterns-2021/. Access on December 2, 2024.

[5] Gromis A, Fellows I, Hendrickson JR, Edmonds L, Leung L, Porton A, Desmond M. Estimating eviction prevalence across the United States. Proc Natl Acad Sci U S A. 2022 May 24;119(21):e2116169119. doi: 10.1073/pnas.2116169119. Epub 2022 May 16. PMID: 35576463; PMCID: PMC9173767.

[6] Gromis A, Fellows I, Hendrickson JR, Edmonds L, Leung L, Porton A, Desmond M. Estimating eviction prevalence across the United States. Proc Natl Acad Sci U S A. 2022 May 24;119(21):e2116169119. doi: 10.1073/pnas.2116169119. Epub 2022 May 16. PMID: 35576463; PMCID: PMC9173767.

[7] United States Conference of Mayors. (2025, January 23). Bloomberg/CityLab: Mayors Chart an Agenda for Tackling the Housing Crisis Under Trump. Retrieved: https://www.usmayors.org/2025/01/23/icymi-national-survey-reveals-worsening-housing-crisis/#:~:text=In%20the%20past%20three%20years,concerned%20by%20rising%20housing%20costs.

[8] United States Conference of Mayors. (2025, January 23). Bloomberg/CityLab: Mayors Chart an Agenda for Tackling the Housing Crisis Under Trump. Retrieved: https://www.usmayors.org/2025/01/23/icymi-national-survey-reveals-worsening-housing-crisis/#:~:text=In%20the%20past%20three%20years,concerned%20by%20rising%20housing%20costs.

[9] de Souza, T., Andrichik, A., Prestara, E., Rush, K., Tano, C., Wheeler, M., & Abt Associates. (2023, December). 2023 Annual Homelessness Assessment Report (AHAR) to Congress ... The U.S. Department of Housing and Urban Development . https://www.huduser.gov/portal/sites/default/files/pdf/2023-ahar-part-1.Pdf

[10] State of Homelessness: 2024 edition. National Alliance to End Homelessness. (2024, August 5). https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/#on-the-brink

[11] de Souza, T., Andrichik, A., Prestara, E., Rush, K., Tano, C., Wheeler, M., & Abt Associates. (2023, December). 2023 Annual Homelessness Assessment Report (AHAR)r to Congress... The U.S. Department of Housing and Urban Development . https://www.huduser.gov/portal/sites/default/files/pdf/2023-ahar-part-1.Pdf

[12] Rao, S., Essien, U.R., Powell-Wiley, T.M. et al. Association of US County-Level Eviction Rates and All-Cause Mortality. J GEN INTERN MED 38, 1207–1213 (2023). https://doi.org/10.1007/s11606-022-07892-9

[13] Hernández D, Swope CB. Housing as a Platform for Health and Equity: Evidence and Future Directions. Am J Public Health. 2019 Oct;109(10):1363-1366. doi: 10.2105/AJPH.2019.305210. Epub 2019 Aug 15. PMID: 31415202; PMCID: PMC6727307.

[14] U.S. Department of Health and Human Services. (n.d.). Quality of Housing. Quality of Housing - Healthy People 2030. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/quality-housing

[15] Crawford DM, Trotter EC, Hartshorn KJ, et al. Pregnancy and mental health of young homeless women. Am J Orthopsychiatry. 2011;81(2):173-183.

[16] DiTosto JD, Holder K, Soyemi E, et al. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021; 3(6):100477.

[17] Green JM, Fabricant SP, Duval CJ, et al. Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy. JAMA Netw Open. 2023;6(7):e2326352. doi:10.1001/jamanetworkopen.2023.26352

[18] American College of Obstetrics and Gynecology. Committee Opinion 576 Health Care for Homeless Women. October 2013. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/10/health-care-for-homeless-women Accessed on August 26, 2022.

[19] DiTosto JD, Holder K, Soyemi E, et al. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021; 3(6):100477.

[20] Stahre M, VanEenwyk J, Siegel P, et al. Housing insecurity and the association with health outcomes and unhealthy behaviors, Washington state 2011. Prev Chronic Dis. 2015;12:140511.\

[21] Himmelstein G, Desmond M. Association of eviction with adverse birth outcomes among women in Georgia, 2000 to 2016. JAMA pediatrics. 2021; 175(5):494-500.

[22] Cutts DB, Coleman S, Black MM, et al. Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes. Maternal and child health journal. 2015; 19(6):1276-1283.

[23] St Martin BS, Spiegel AM, Sie L, et al. Homelessness in pregnancy: perinatal outcomes. Journal of perinatology : official journal of the California Perinatal Association. 2021; 41(12):2742-2748.

[24] Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness contributes to pregnancy complications.Health affairs (Project Hope). 2019; 38(1):139-146.

[25] Leifheit KM, Schwartz GL, Pollack CE, et al. Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes. International journal of environmental research and public health. 2020; 17: 22.

[26] Pantell MS, Baer RJ, Torres JM, et al. Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. American journal of obstetrics & gynecology MFM. 2019; 1(4):100053.

[27] Bailey, Anna, et al. Policymakers Can Solve Homelessness by Scaling Up Proven Solutions: Rental Assistance and Supportive Services. Center on Budget and Policy Priorities, 2024. JSTOR, http://www.jstor.org/stable/resrep60776. Accessed 4 Dec. 2024.

[28] Fischer, Will et. al. More Housing Vouchers: Most Important Step to Help More People Afford Stable Homes. Center on Budget and Policy Priorities, 2021. Accessed December 6, 2024.

[29] Congressional Research Service. The Temporary Assistance for Needy Families Block Grant: Responses to Frequently Asked Questions. 2024. Retrieved on 12/4/2024

[30] Bailey, Anna, et al. Policymakers Can Solve Homelessness by Scaling Up Proven Solutions: Rental Assistance and Supportive Services. Center on Budget and Policy Priorities, 2024. JSTOR, http://www.jstor.org/stable/resrep60776. Accessed 6 Dec. 2024.

[31] Office of Community Services. LIHEAP FAQs for Consumers (2020). Retrieved on December 6, 2024.

[32] Bailey, Anna, et al. Policymakers Can Solve Homelessness by Scaling Up Proven Solutions: Rental Assistance and Supportive Services. Center on Budget and Policy Priorities, 2024. JSTOR, http://www.jstor.org/stable/resrep60776. Accessed 4 Dec. 2024.

[33] Centers for Medicare and Medicaid Services. Coverage of Health Related Services in Medicaid and the Children’s Health Insurance Program (2023) Retrieved on December 6, 2024.

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