The report Picture of Housing and Health (released by ASPE in 2014), found high prevalence of chronic conditions and higher health care utilization for HUD-assisted Medicare beneficiaries compared to unassisted beneficiaries. This second report seeks to understand whether the characteristics of the sample could explain the higher utilization. The study compares health care utilization and spending between HUD-assisted Medicare beneficiaries and unassisted beneficiaries taking into account confounding factors. This information could help inform targeted interventions and policies among specific HUD-assisted subgroups to ensure appropriate use of health care services and to better meet resident needs. In summary, after taking into account characteristics associated with health care utilization and payment, this study demonstrates that HUD-assisted Medicare beneficiaries do not consistently have higher health care utilization and payment than unassisted Medicare beneficiaries.