NYC Tenant Right-to-Counsel Linked to Fewer ED Visits in Some Groups

Researchers used all-payer emergency department (ED) data from January 2016 through February 2020 to assess whether New York City’s staggered, ZIP-code-based rollout of free legal representation for tenants facing eviction was associated with ED use among Medicaid-insured and uninsured residents. The retrospective cohort analysis included 8,206,986 visits, aggregated into 8,550 ZIP-code-months, and examined all-cause and cause-specific utilization rates.

Overall, implementation was not significantly associated with all-cause ED visits: the difference-in-differences estimate was −10.8 visits per 10,000 residents (95% CI −32.8 to 11.2). In neighborhoods targeted during the first phase because of high eviction risk, visits decreased by 26.4 per 10,000 (95% CI −52.6 to −0.2). A reduction among children was not statistically conclusive (−32.4; 95% CI −67.2 to 2.4). Mental-health-related and substance-use-disorder-related ED visits increased by 2.5 and 2.7 per 10,000, respectively; visits for ambulatory-care-sensitive conditions did not significantly differ.

The findings suggest possible health benefits in some populations, but not an overall reduction in ED use. The observational, location-based analysis cannot establish causation, and the reasons for increased mental health and substance use visits require further study.