Faculty Spotlight: Oanh Nguyen, MD, MAS
Oanh Nguyen, MD, MAS, on the Silicon Valley Guaranteed Income Project
For people across the country, health and housing security present major challenges. Enter the Silicon Valley Guaranteed Income Project (SVGIP). Led by Principal Investigator and implementation science expert Dr. Oanh Nguyen, SVGIP is a UCSF BHHI collaboration with community partners to study and understand the potential effects of guaranteed income payments on housing stability, health, and well-being.
The only randomized controlled trial in the U.S. focused solely on family homelessness, SVGIP seeks to better understand the experiences and needs of families experiencing unstable housing or homelessness.
Dr. Nguyen—ARC Core Faculty member, associate professor and chief of the Division of Hospital Medicine at ZSFG—took a recent moment to talk in detail about the ongoing project, current evidence, and the relationship between guaranteed income and secure housing outcomes.
ARC: Recent rhetoric around Universal Basic Income (UBI) and Guaranteed Income (GI) is increasingly unclear. Laymen commentaries from billionaire funders toss around terms like “universal high income” or “universal basic compute,” and argue about who would foot the costs. What’s lost in conversation are the needs of people on the ground today. Can you contextualize how GI fits into the current social framework?
Dr. Nguyen: Universal Basic Income and Guaranteed Income are often discussed together, but they are not the same. UBI imagines replacing all public assistance with a flat cash payment to everyone, under the assumption that money alone is more efficient than complex social programs. The problem is that cash cannot buy what does not exist — like affordable housing or accessible health care — and most UBI proposals fall far short of what families actually need to cover those costs.
Guaranteed Income takes a different approach. It is targeted and time-limited, designed not to replace social services but to fill the gaps between them. It can help a family bridge the delay between getting a housing voucher and finding a home or afford a car that opens the door to better employment. While public debates often focus on abstract ideas about the future, Guaranteed Income is about meeting real needs today, in ways that complement, not replace, the broader social safety net.
Several GI pilots have launched in recent years. What distinguishes your study's methodology, target population, or research design from its predecessors?
Our study is one of the few randomized controlled trials (RCTs) of guaranteed income, using a single-blinded design to minimize bias. Unlike most prior pilots, we focus specifically on families experiencing homelessness, a population rarely included in this type of research. Despite the challenges of following such a mobile group, we’ve achieved an extraordinary one-year retention rate. We are also proud that more than two-thirds of participants speak Spanish as their preferred language, bringing valuable perspectives from communities often overlooked in policy and research.
You and your staff have achieved an unprecedented 90% retention rate, what do you say to observers who explain the high retention rate of your participants by saying, 'Of course participants stick around---it's free money!' What does such simplification overlook?
Only half of our participants receive guaranteed income; the other half are in the usual care group and receive only small study incentives. Those incentives aren’t what keep families engaged. What truly drives retention is the sense of purpose participants feel — wanting to help families like their own, to share their stories, and to contribute to something bigger than themselves. Many are juggling multiple jobs and caring for children, so taking part in interviews is a real commitment. The topics we discuss are often personal and emotionally difficult. It takes trust, not money, to stay engaged through that.
Why Cash? What is about cash as an intervention that presents a sort of express train to better health?
We don’t actually know if cash is an express train to better health — that’s what we’re trying to find out. What we do know is that poverty and its ripple effects, like housing instability, drive poor health. Cash addresses poverty directly, but we still don’t know how much is needed or for how long to make a difference. There are also many things money can’t buy — love, happiness, or guaranteed health — but it might create the stability that makes those things more attainable. What makes cash such an interesting intervention is its flexibility: families face very different challenges, and cash is one of the few tools adaptable enough to meet that wide range of needs. Unlike most other forms of social assistance, cash is compelling not only because it is adaptable, but because it conveys trust in people’s ability to determine their own path forward.
Can you explain how month-to-month income fluctuations specifically affect health, and how GI addresses this differently than episodic interventions like tax credits?
We don’t yet know whether steady monthly payments or larger one-time sums do more to improve health and stability — this is one of the things we are studying. A one-time larger infusion of cash (like you would receive with a tax credit) might help families climb out of a crisis, while steady payments could provide ongoing stability and predictability. To explore both, families in our study can choose between two options: $1,000 per month for 12 months, or a hybrid model with a $6,500 lump sum up front followed by $500 per month for the next 11 months. After the first year, they can stay with their original plan or switch to the other for a second year, allowing us to learn how different payment structures affect family well-being over time.
What spending patterns emerged in your study, and how do you respond to critics who claim cash transfers enable 'irresponsible' behavior? (Data from the Stockton Economic Empowerment Demonstration project, for example, showed less than 1% of funds went to alcohol or tobacco, contradicting common assumptions).
We do not track how participants spend their guaranteed income directly, but we do ask about their overall monthly spending. As one might expect, the vast majority of spending goes toward essentials, like housing, food, and transportation. The notion that people in poverty will use cash irresponsibly is not supported by evidence from guaranteed income studies to date. What we see instead are families using funds to meet basic needs, reduce stress, and regain a sense of stability and control over their lives.
What does your data reveal about the minimum duration needed for meaningful health impacts? How could this inform policy design around temporary versus permanent programs?
We do not yet know how long guaranteed income needs to last to create lasting health benefits; that is one of the key questions our study aims to answer. We plan to follow participants for a year after the payments end and are applying for additional funding to extend follow-up for up to three years. That will help us understand whether improvements in stability, stress, and well-being persist once the guaranteed income stops, or if they fade when the financial support does.
It is also possible that the amount or duration is simply too limited to shift long-term health trajectories on its own. That uncertainty is important for policy design. Temporary programs may offer immediate relief but not necessarily durable impact, while ongoing or recurring support might be required to influence health over time. Our hope is that the data will help policymakers weigh those trade-offs, between short-term stabilization and long-term structural change.
Given the current political attitude against demographically-targeted programs, do you see a strategic path forward—whether that's reframing language, broadening eligibility, or building different coalitions—to move from pilots to policy implementation?
I think what is needed most is a reframing. We already provide guaranteed income to corporations and billionaires through tax breaks, subsidies, and bailouts, but we do not call those handouts. When similar investments are directed toward low-income families, they are often framed as dependency or waste. That rhetoric keeps public attention focused on people fighting for pennies in assistance, while the real money flows upward through policies that quietly guarantee stability for those who already have it.
The scale of this imbalance is striking. In 2024, federal tax breaks and corporate subsidies totaled an estimated $1.8 trillion, with roughly half benefiting the top 20 percent of earners. By comparison, all direct public assistance programs for low-income families, including food, housing, and cash aid, amount to roughly half that. Yet, while these corporate and high-income supports are treated as sound economic policy, programs that help families meet basic needs are often framed as wasteful.
We debate endlessly about programs that represent a comparative sliver of the budget while ignoring the far larger and mostly invisible forms of government support that flow upward. The public conversation often pits families in poverty against each other for small amounts of aid, while the largest transfers of public wealth to corporations and high-income households go unquestioned.
Guaranteed income challenges that double standard. We already guarantee stability for corporations through tax breaks and subsidies yet call it dependency when families need help on a much smaller scale. If we can invest public funds to ensure predictability and security for those who have the most, we can apply the same principle to families working to regain their footing and who need the most. It is not about charity; it is about fairness, consistency, and using evidence to build a system that supports stability at every level.
For added insight, watch Dr. Nguyen’s UCSF Department of Medicine Ground Rounds, More Money, Fewer Problems? Examining Guaranteed Income and Housing Stability, moderated by Bob Wachter.