Medicaid expansion improves housing stability

Oklahomans who voted for State Question 802 in 2020 knew that Medicaid expansion would bring greater access to quality health care, but what voters may not have known is that Medicaid expansion plays a role in keeping people safely housed. For low-income families, one medical emergency can lead to a financial crisis, making it impossible to pay rent or a mortgage. Poor health – exacerbated by lack of health insurance – can make it difficult to work and meet financial obligations such as rent. While Medicaid expansion will reduce medical costs and improve health outcomes in the state, it will also help many of our friends and neighbors keep a roof over their head.

Medicaid expansion can play a role in reducing evictions

Research in states that have expanded Medicaid coverage shows how health insurance coverage helps prevent eviction. When California adopted Medicaid expansion, the state saw a reduction of evictions of 22 fewer evictions for every thousand new Medicaid enrollees. In Michigan, adverse financial outcomes — which often lead to eviction — dropped by 11 percent to 16 percent in the first year following Medicaid expansion. Medicaid coverage has been shown to reduce poverty and medical debt in expansion states by reducing the cost of medical care for low-income households. Reduced health care costs mean households have more money for other basic needs like food and shelter.

Medicaid enrollees will have an easier time meeting housing costs during tight financial times as the burden of medical costs are lessened. Oklahoma families already face significant financial obstacles for operating their households. Rising housing and rental costs in Oklahoma mean that 108,900 low-income households pay more than half their income for rent. This does not leave a lot of money for other expenses, and cost-burdened families often have to choose between necessities like groceries, a car repair, or paying rent. In 2017, 4 out of 10 Oklahomans said they did not have emergency savings for unexpected household expenses such as medical treatment. Rising rents and stagnant wages are stretching family budgets even more. Rent in Tulsa and Oklahoma City is up 15 percent from 2021. Alleviating the financial burden of medical care frees up money for other essential expenses, like housing. 

Health and housing are inextricably linked

Poor health can be both a cause and consequence of housing instability. Evictions are associated with a broad range of poor health outcomes, including increased mental health hospitalizations, poor birth outcomes, and increased all-cause mortality. Conversely, poor health can lead to absenteeism or job loss and the resulting income reduction can make it hard to afford housing. Lack of affordable health care is a contributing factor to homelessness because it can start a downward spiral of job loss, depleted savings, and eventual eviction. Housing and health are intertwined in a vicious cycle – evictions and homelessness lead to poor health and poor health can lead to evictions and homelessness. Medicaid access is one way to begin breaking that cycle.

Medicaid expansion will help, but more needs to be done to keep Oklahomans in their homes

Evictions are on the rise in Oklahoma due to a number of factors, including a lack of affordable housing, stagnant wages, and poor tenant protections against eviction. Thankfully, for the over 300,000 Oklahomans who now have comprehensive and affordable health coverage through Medicaid expansion, having to choose between health care and rent won’t be one of them. However, Medicaid expansion alone won’t be enough to stop Oklahoma’s eviction crisis. 

Some areas of Oklahoma have seen spikes in the number of eviction filings in recent months with several counties reaching all-time highs. While Medicaid expansion is vital to supporting low-income households, more needs to be done to ensure Oklahomans can keep a roof over their heads. Lawmakers should work toward solutions that will keep Oklahomans stably housed, including increasing affordable housing options in the state, providing tenants with much needed protections in eviction proceedings (including a right to legal counsel in eviction court and ensuring tenants won’t be evicted or lose their lease for requesting repairs), and increasing the state’s minimum wage. Medicaid expansion was a solid step on the path to financial and housing stability; now more action is needed to keep families in their homes.


Sabine Brown joined the Oklahoma Policy Institute as Housing Senior Policy Analyst in January 2022. She previously worked at OK Policy from January 2018 until September 2020 as the Outreach and Legislative Director, and earned a Master of Public Administration degree from the University of Oklahoma-Tulsa. Before joining OK Policy she served as the Oklahoma Chapter Leader for Moms Demand Action for Gun Sense in America. Sabine also earned a Bachelor of Science and a Master of Health Science from the University of Oklahoma and was a physician assistant prior to discovering advocacy work. She grew up in Germany but has called Oklahoma home since 1998.

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