LOS ANGELES — Residential evictions are associated with adverse health outcomes, particularly among low-income populations. Less is known, however, about whether interventions designed to prevent evictions can improve health outcomes — including whether they may reduce visits to the emergency department (ED).
UCLA Health researchers explored this question by examining the relationship between New York City’s tenant right-to-counsel program, which provides free legal representation to tenants facing eviction, and emergency department use.
The study, published in the Journal of General Internal Medicine , found no overall association between right-to-counsel programs and ED visit rates. However, among certain population subgroups that were at the highest risk for eviction, these programs were linked to lower rates of all-cause emergency department visits — suggesting possible population health benefits.
At the same time, certain types of ED visits (specifically those related to mental health and substance use disorders) increased in frequency after the tenant right-to-counsel program was launched.
“Our finding that right-to-counsel was associated with reduced ED visit rates in populations at elevated risk for eviction underscores the importance of housing stability for overall health,” said Katherine L. Chen, MD, assistant professor of internal medicine and population health scientist at the David Geffen School of Medicine at UCLA . Chen was the study’s first and corresponding author.
Researchers analyzed more than 8 million ED visits from January 2016 through February 2020, limiting the analysis to Medicaid-insured and uninsured New York City residents.
They used the program’s staggered rollout as a natural experiment to find out how it may have impacted emergency department usage among residents of zip codes where the program was implemented. They also explored differences across age groups and phases of program implementation.
New York City’s program , the country’s first tenant right-to-counsel policy when it was introduced in 2017, contracts with nonprofit law offices to provide free legal representation to low-income tenants facing eviction proceedings. The program was launched in 10 zip codes with especially high eviction risk, homelessness rates and limited housing resources, then expanded to additional zip codes in phases.
Across all covered zip codes, the researchers estimated a slight drop in ED visits per 10,000 residents following program implementation. However, the scenario differed in the neighborhoods targeted for the earliest phase of the program due to their especially high eviction risk. During its initial phase, the right-to-counsel program was associated with more than 26 fewer ED visits per 10,000 residents – a significant reduction. The rate of ED visits stayed about the same in neighborhoods included in the second or third implementation phases.
The study also identified an unexpected increase in ED visits related to mental health and substance use disorders in zip codes where right-to-counsel was implemented.
“We speculated on several potential explanations in the paper, including the possibility that interactions with right-to-counsel lawyers might encourage some people to seek care for undertreated conditions, or that these legal interactions might increase patients’ stress in the short term even while helping them avoid eviction in the long run,” Chen said. “This finding definitely warrants further research.”
Chen said an important direction for future research will be to link eviction records to health data to find out how right-to-counsel impacted the health of people who actually received an eviction filing. Soliciting patient feedback via qualitative interviews also would help provide more clarity on why mental health and substance use disorder-related visits increased after program implementation.
Since NYC’s program, 26 other jurisdictions nationwide, including Los Angeles, have introduced similar programs. Chen and collaborators believe these programs could offer benefits beyond housing stability.
“Right to counsel has become an important approach to eviction prevention that could help some patients avoid ED visits for health issues exacerbated by the stress and disruption of evictions,” she said. “Policymakers considering similar programs in other areas may wish to consider the potential population-health implications alongside the more direct effects on housing.”
A uthors
Additional authors involved in the review were Craig E. Pollack, MD, MHS, Iraj Qureshi, MA, Frederick J. Zimmerman, PhD, Alene Kennedy-Hendricks, PhD, Leah Robinson, MPH, Sabriya L. Linton, PhD, Yimin Ge, PhD, Matthew D. Eisenberg, PhD and Kathryn M Leifheit, PhD.
Funding
Funding for this study was provided by the National Institute of Nursing Research (R01NR020854), National Heart, Lung, and Blood Institute (K01HL179242), Ziman Center for Real Estate, University of California, Los Angeles, Center for Mental Health and Addiction Policy, Bloomberg American Health Initiative and the National Institute on Drug Abuse (R01DA056235).
Journal of General Internal Medicine
Meta-analysis
People
Tenant Right-to-Counsel and Emergency Department Use in Low-Income and Uninsured Populations
21-Oct-2026
Dr. Chen served as a consultant to the California Health Interview Survey outside of the submitted work. Dr. Pollack reports stock ownership of Gilead Pharmaceuticals and board membership of the non-profit American Association of Service Coordinators; he also reports funding from the National Institutes of Health, Enterprise Community Partners, and Johns Hopkins. Dr. Kennedy-Hendricks reports funding from the Centers for Disease Control and Prevention and National Institutes of Health. Dr. Linton reports funding from the National Institutes of Health, Center for Mental Health and Addiction Policy, and Bloomberg American Health Initiative. Dr. Eisenberg reports funding from the National Institutes of Health and Commonwealth Fund. Dr. Leifheit reports funding from the National Institutes of Health and received an honorarium from the Robert Wood Johnson Foundation’s County Health Rankings & Roadmaps Program to review “Legal supports for tenants in eviction proceedings” as a strategy for the organization’s “What Works for Health” initiative. Dr. Leifheit is an unpaid participant in the National Coalition for a Civil Right to Counsel (NCCRC).