NYC right to counsel tied to fewer ER visits in highest-risk areas

What happened

A UCLA Health study published in the Journal of General Internal Medicine looked at whether New York City's tenant right-to-counsel program, which provides free lawyers to low-income tenants facing eviction, was linked to emergency department (ED) use. Researchers analyzed more than 8 million ED visits from January 2016 through February 2020. They limited the data to New York City residents who were uninsured or on Medicaid. The City reported this was because those groups were more likely to overlap with tenants who qualify for the program.

Overall, the study found no clear link between the program and ED visit rates, with only a slight estimated drop across all covered ZIP codes. In the first 10 ZIP codes, chosen for especially high eviction risk, the program was associated with more than 26 fewer ED visits per 10,000 residents, which the researchers called a significant reduction. ED visit rates stayed about the same in ZIP codes added in the second and third phases. The City reported that the first 10 ZIP codes included Crown Heights and Bedford-Stuyvesant in Brooklyn, parts of Staten Island's North Shore, Harlem, and Tremont and Kingsbridge in the Bronx.

The study also found an unexpected rise in ED visits tied to mental health and substance use disorders in ZIP codes where the program was in place. Lead author Dr. Katherine L. Chen of UCLA's David Geffen School of Medicine said possible reasons include lawyers encouraging people to seek care for undertreated conditions, or legal proceedings adding short-term stress. She said the finding needs more research. The City reported that Chen called the program a leading possible explanation for the drop, not a proven cause.

Sources differ on the program's start. Phys.org said it was introduced in 2017. The City said it launched as a pilot in 2016, expanded about five ZIP codes at a time over roughly three years, and went citywide in March 2020, two years ahead of schedule, largely because of COVID. The study period ended before that citywide expansion.