An analysis by SHADAC examines housing affordability, looking specifically at the percent of rental households that spend more than 30% of their monthly income on rent. This measure is now available on SHADAC’s State Health Compare for all states from 2012 through 2017, and can be broken down by household income, Medicaid enrollment, race/ethnicity, and disability status.[1]

Background
SHADAC analyzed a key social determinant of health factor—housing affordability. A lack of affordable housing contributes to housing instability and homelessness, both of which are strong predictors of higher health care costs and poor health outcomes, among others.[2] Many states—especially those with high housing costs and large numbers of low-income residents—face housing affordability challenges.

Breaking Down the Issue of Unaffordable Rents
SHADAC looked at the percent of cost-burdened rental households in each state in 2017, examining unaffordable rents overall while also analyzing unaffordable rents among rental households with: a Medicaid enrollee, a person of color, a person that has a disability, and an income of less than $25,000. The infographic presented here shows these estimates for the U.S. SHADAC researchers have also created state infographics for the five states with the highest percentages of unaffordable rents among rental households that had a Medicaid enrollee—Florida (65.3%), California (65.1%), New Jersey (64.2%), New York (63.8%), and Nevada (63.5%).

Discussion: How State Medicaid Policy Can Alleviate the Burden of Unaffordable Rents
Since recent attention has been given to the idea of using Medicaid to address housing instability at the state level, the rate of unaffordable rents among rental households with Medicaid enrollees (59.7% nationally) is a particularly salient estimate, indicating that a substantial portion of this population could benefit from such efforts.

Though federal law directly prohibits federal-level matching of state Medicaid spending on housing (excepting nursing home facilities, which are already specified as a Medicaid coverage benefit), states can use Medicaid demonstration waivers and State Plan Amendments to leverage federal dollars for a wide range of housing-related services and activities, including support services for individuals with disabilities, older adults needing long-term services and supports, and individuals experiencing chronic homelessness. Medicaid can also be used to provide services to support individuals’ housing transitions, to help individuals sustain their tenancy, and to develop strategic housing collaboratives. In addition, several states, in an effort to integrate their separate yet related Medicaid and housing programs, have begun to reorganize part or all of their Medicaid delivery systems into accountable care organizations (ACOS) for more ease in using Medicaid dollars for non-medical “flexible services,” which include housing supports.[3]

Visit SHADAC and State Health Compare for More

The infographics presented here are part of SHADAC’s “Measures That Matter” product series. This series highlights measures available from State Health Compare, a web tool that states can use to explore measures related to health and health care within and across states and the nation.

The previous infographics in the series, “Education Matters,” highlighted the role education plays in inequities in health care affordability and access. Learn more about this analysis here.

Learn more about the estimates used in this analysis, as well as other measures related to social determinants of health, at State Health Compare.