Housing Costs & Heart Failure: Medicaid Patient Health Risks

Rising housing costs are more than a financial strain for many Americans; they can directly impact health, particularly for those with existing medical conditions. A recent study published in JAMA Health Forum highlights a concerning link between area-level housing cost burden and poorer health outcomes among Medicaid beneficiaries with heart failure. The research, analyzing data from 2018-2019, suggests that individuals living in areas with high housing costs are at increased risk of cardiovascular-related hospitalizations and emergency department visits.

Heart Failure and the Weight of Housing Costs

The study focused on 233,195 Medicaid beneficiaries aged 19 to 64 with a pre-existing diagnosis of heart failure (HF). Researchers defined “housing cost burden” as the proportion of housing units in a zip code occupied by households earning less than $35,000 annually who spend 30% or more of their income on housing. The mean housing cost burden across the 19,577 zip codes analyzed was 67.4%. This means that in a significant number of areas, the majority of lower-income residents are severely cost-burdened by their housing expenses. The study, conducted between October 2024 and October 2025, used data from the Transformed Medicaid Statistical Information System Analytic Files.

Heart failure, a chronic condition where the heart can’t pump enough blood to meet the body’s needs, requires ongoing medical management. It’s a leading cause of hospitalization in the United States, and managing it effectively relies on consistent access to care and adherence to treatment plans. The findings suggest that financial stress related to housing can disrupt this process, potentially leading to delayed care, medication non-adherence, and more severe health events.

What the Study Actually Showed – and Didn’t

The researchers used generalized estimating equation models to evaluate the association between housing cost burden and the probability of CV-related hospitalization or emergency department visits. Whereas the study demonstrated a statistically significant association, it’s crucial to understand that it does not prove causation. This was a cross-sectional study, meaning it captured data at a single point in time. It cannot determine whether high housing costs cause worse health outcomes, or whether individuals with pre-existing health conditions are more likely to live in areas with affordable housing options. There could be other underlying factors, or confounding variables, at play.

the study excluded data from Alabama, Rhode Island, and Utah due to data quality issues, which may limit the generalizability of the findings to the entire US population. The study population was also limited to Medicaid beneficiaries, meaning the results may not be directly applicable to individuals with different insurance coverage or income levels. AJMC reports that the study underscores the need for further investigation into the complex relationship between housing affordability and health.

Defining Housing Cost Burden

The 30% threshold used in the study to define housing cost burden is a commonly used metric. It’s based on the idea that spending more than 30% of income on housing leaves less money available for other essential needs, such as food, healthcare, and transportation. However, the “acceptable” level of housing cost burden can vary depending on individual circumstances and regional cost of living.

Beyond Heart Failure: A Wider Public Health Concern

While this study focused specifically on Medicaid beneficiaries with heart failure, the link between housing instability and poor health is well-documented across a range of conditions. Lack of stable housing can exacerbate chronic illnesses, increase the risk of infectious diseases, and negatively impact mental health. Individuals experiencing homelessness, for example, face significantly higher rates of morbidity and mortality. Research published in PubMed suggests that addressing housing affordability could be a crucial component of improving health outcomes for vulnerable populations.

The Role of Medicaid and Social Determinants of Health

Medicaid, as a public health insurance program for low-income individuals and families, plays a critical role in addressing health disparities. Recognizing the impact of social determinants of health – the non-medical factors that influence health outcomes, such as housing, food security, and transportation – is becoming increasingly important. Some states are beginning to implement programs that provide rental assistance, housing vouchers, or supportive housing services to Medicaid beneficiaries. These initiatives aim to address the root causes of health inequities and improve overall well-being.

What Comes Next: Surveillance and Potential Interventions

The findings of this study reinforce the need for continued surveillance of housing cost burden and its impact on health outcomes. Public health agencies and healthcare providers should consider incorporating housing status into routine health assessments and screenings. Further research is needed to identify effective interventions that can mitigate the negative health consequences of housing instability. This includes evaluating the impact of policies aimed at increasing affordable housing options, providing rental assistance, and strengthening tenant protections. The study authors suggest that investigating strategies to address housing affordability could play a role in improving health outcomes for individuals with heart failure and other chronic conditions. Ongoing monitoring of data from the Transformed Medicaid Statistical Information System Analytic Files will be essential to track trends and evaluate the effectiveness of interventions.