This study was designed to identify the contribution of MTW status to cost effectiveness, measured as households served per dollar of HUD funding received. To isolate the impact of MTW from other factors that could affect this measure, the analysis begins with pre-MTW baseline data for 18 MTW agencies. Using data spanning 2003-2017 for HUD funding received and households served by the 18 sampled MTW agencies and 709 comparable traditional agencies, as well as variables that account for the costs of rent and labor in each PHA’s area, statistical analysis shows no impact of receiving MTW status on the number of households served per HUD dollar received. Further, changes in program mix, housing quality and affordability, and types of households do not explain the stable cost per household after an agency joins the MTW demonstration. We know that on average MTW agencies serve fewer households per HUD dollar received than do traditional agencies, and this study helps us to understand why: it shows that these higher costs are not due to MTW status, but predate agencies’ participation in the demonstration. This finding supports the conclusion MTW flexibilities are not the cause of the higher costs to HUD per household served at MTW agencies. Note that the study did not attempt to measure per-unit subsidy cost or voucher utilization. Instead, this study assessed the impact of MTW status on the ratio of HUD funding to households served.