Does Poor Health Influence Residential Selection? Understanding Mobility Among Low-Income Housing Voucher Recipients in the Moving to Opportunity Study

Housing-mobility programs and housing choice vouchers provide low-income families with a potentially transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity for Fair Housing Demonstration Project (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover, the low-poverty neighborhood voucher plus counseling treatment promoted higher-opportunity neighborhood attainment than controls, regardless of the baseline health of the family. However, families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher (HCV) treatment as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher-opportunity neighborhoods for families with health challenges. Providing housing vouchers alone is insufficient to promote low-income-family high-opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing-mobility programs, to provide tailored support for low-income families to use HCVs to make high-opportunity moves, which is particularly necessary for families with health challenges.