Child Health Impact Assessment of the Massachusetts Rental Voucher Program

Authors: Boston Medical Center, Boston University School of Medicine

Location: Massachusetts, United States

Completion Date: June 2005

HIA Report: Affordable Housing and Child Health: A Child Health Impact Assessment of the Massachusetts Rental Voucher Program

Summary of the HIA

Proposed Policy or Project

Potential modifications to the Massachusetts Rental Voucher Program (MRVP), which provides low-income families with rental subsidies. Proposed modifications include: (1) a $2 million increase in statewide funding to $26,283,345 per year, (2) a 36-month limit on continuous use of benefits and a 60-month limit on lifetime use of benefits, (3) 20-30 hours of required work or alternative activities for non-elderly, non-disabled adult household members, (4) cap tenants’ share of rent at 40% of income, and (5) eligibility re-determination twice a year rather than annually.

Background and Policy Context

The Massachusetts Rental Voucher Program (MRVP) was established in 1992 to “provide a permanent improvement in the lives of individuals and families by offering both tenant-based and project-based rental subsidies” while simultaneously limiting expenditure on rental assistance. Since 1992, the legislature has decreased funding for MRVP (see Figure 1). In fiscal year 2005, the state budget appropriation for MRVP was approximately $24.3 million, down from approximately $88.5 million in 1992. Funding decreases correspond with reductions in the number of households assisted, from a high of 14, 886 in 1993 to the current low of 4,715 households assisted in 2005. A household receiving tenant-based assistance can use its voucher in any private apartment in Massachusetts where the landlord will accept it. Families using tenant-based vouchers must pay at least 30% of their income toward rent, but there is no upper limit on the percent of income they must contribute. Currently, there are 1,544 tenant-based vouchers in use. In for Fiscal Year 2006 the Governor and legislature proposed a number of changes to the MVRP. Concerned about the health consequences of these policy changes, a multidisciplinary working group of pediatricians, public health researchers, health economists and attorneys from several universities and hospitals in the Boston area developed a Child Health Impact Assessment (CHIA).

Scope and Methods

The HIA focused on the health and well being of children since this is the mission of the The Medical Legal Partnership for Children which sponsored the HIA. The analysis was based on a synthesis of existing research literature and data.

Summary of Findings

Housing has a substantial and well-documented influence on child health and well-being. Based on a review of the available evidence, the following is a summary of the likely impacts of specific proposed changes to the MRVP. Children from families that struggle with housing costs suffer disproportionately from long-term physical and developmental health effects that harm them and result in substantial economic costs to the Commonwealth. This HIA examines research on housing and its influence on such childhood conditions as asthma, injuries, inadequate primary preventive care, mental health conditions, as well as developmental and educational attainment.

  • Instituting time limits for housing subsidies in a region that lacks affordable housing puts children's health at risk due to budget trade-offs between housing expenses and other basic needs, such as food, and to exposure to substandard housing.
  • Instituting work requirements will likely result in MRVP dis-enrollments for some families not currently subject to other work requirements, leading to housing instability and its adverse health and developmental effects.
  • Increasing the frequency of eligibility re-determinations may increase the number of families who disenroll from the program.
  • Proposals that decrease tenant rent share will decrease the need for budget trade-offs between housing and other basic needs, such as food or medical care.
  • Proposals that lead to increased homelessness or housing instability will result in increased education costs.
  • Insufficient data is available to predict direction and extent of effects of proposed changes to increase tenant mobility.
  • Children in families who are not able to use their mobile vouchers to move out of high poverty areas may still experience the health benefits of increase household resources available for other basic needs.

Background Reports


Lauren A. Smith, MD, MPH

250 Washington St.

(617) 414-7911