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Did New York’s landmark program to give eviction help to low-income people cause a dip in emergency room visits? That’s what a new study points to, studying millions of ER visits in the first neighborhoods where the legal program rolled out.

The research , published Wednesday in the Journal of General Internal Medicine, found that emergency room visits dropped in the first 10 ZIP codes where New York began providing free attorneys to New Yorkers facing eviction in Housing Court, begun about a decade ago through its right-to-counsel program .

“Particularly for vulnerable neighborhoods, this program might help tenants avoid ED visits, and so we will be doing future research to try to dig into that a little bit more deeply,” Dr. Katherine Chen, lead author of the study and an assistant professor at UCLA’s David Geffen School of Medicine.

Simultaneously, the study found, emergency department visits related to mental health and substance use disorders actually increased in frequency after the right-to-counsel program rolled out.

New York City launched the nation’s first Right to Counsel program as a pilot in 2016 to provide low-income residents facing eviction with free legal representation. The program started in 10 ZIP codes, chosen based on factors like high rates of shelter entries and evictions, and over about three years expanded by five ZIP codes at a time. Those first 10 ZIP codes included neighborhoods such as Crown Heights and Bedford-Stuyvesant in Brooklyn, parts of Staten Island’s North Shore, Harlem and The Bronx’s Tremont and Kingsbridge, among others.

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The program eventually went citywide in March 2020 , two years ahead of schedule, in large part due to the COVID pandemic.

Chen and her team examined over 8 million emergency department visits between January 2016 and February 2020 and analyzed the data using statistical models. The study period ended before the citywide expansion of right to counsel and the COVID pandemic, which dramatically altered how New Yorkers sought healthcare.

The researchers looked at ER visits by only New York City residents who either lacked insurance or used Medicaid, not the entire universe of people who visited the emergency room. They did this because the people who have access to an attorney through the right-to-counsel program must earn below a certain income level; the researchers estimated that New Yorkers without insurance or using Medicaid would be more likely to overlap with that lower-income group.

In those first 10 ZIP codes, Chen and her team found there were at least 26 fewer visits to the emergency department per 10,000 residents. But as the program rolled out in future phases and expanded, the rate of emergency department visits didn’t change.

“It was specifically in the earliest phase where we saw this significant decrease in ED visits associated with right-to-counsel roll-out,” Chen said. “We can't definitively say for sure it was definitely right to counsel that made people go to the ER less in those early ZIP codes, but that's one leading, possible explanation.”

The study found that 30 months after right-to-counsel implementation, ZIP codes that had the program showed significantly lower rates of emergency room visits compared to ZIP codes that didn’t. The rates dropped most clearly among children, with a decrease of 32 visits per 10,0000.

Danya Keene, an associate professor at the Yale School of Public Health who studies housing policy’s effect on health, said the drop in emergency room visits aligned with previous research.