Medicaid Expansions from 1997 to 2009 Increased Coverage and Improved Access and Mental Health Outcomes for Low-Income Parents.

OBJECTIVE To assess the effects of past Medicaid eligibility expansions to parents on coverage, access to care, out-of-pocket (OOP) spending, and mental health outcomes, and consider implications for the Affordable Care Act (ACA) Medicaid expansion. DATA SOURCES Person-level data from the National Health Interview Survey (1998-2010) is used to measure insurance coverage and related outcomes for low-income parents. Using state identifiers available at the National Center for Health Statistics Research Data Center, we attach state Medicaid eligibility thresholds for parents collected from a variety of sources to NHIS observations. STUDY DESIGN We use changes in the Medicaid eligibility threshold for parents within states over time to identify the effects of changes in eligibility on low-income parents. PRINCIPAL FINDINGS We find that expanding Medicaid eligibility increases insurance coverage, reduces unmet needs due to cost and OOP spending, and improves mental health status among low-income parents. Moreover, our findings suggest that uninsured populations in states not currently participating in the ACA Medicaid expansion would experience even larger improvements in coverage and related outcomes than those in participating states if they chose to expand eligibility. CONCLUSIONS The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage.

[1]  R. Cohen,et al.  Health insurance coverage : early release of estimates from the National Health Interview Survey, 2015 , 2016 .

[2]  G. Kenney Taking Stock: Health Insurance Coverage for Parents under the ACA in 2014 , 2014 .

[3]  S. Long QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014 , 2014 .

[4]  S. Long Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start , 2014 .

[5]  B. Dowd,et al.  The effect of HIFA waiver expansions on uninsurance rates in adult populations. , 2012, Health services research.

[6]  Matthew J. Notowidigdo,et al.  Health Insurance and the Consumer Bankruptcy Decision: Evidence from Expansions of Medicaid , 2011 .

[7]  S. Busch,et al.  Family coverage expansions: impact on insurance coverage and health care utilization of parents. , 2005, Journal of health economics.

[8]  G. Kenney,et al.  Expanding public health insurance to parents: effects on children's coverage under Medicaid. , 2003, Health services research.

[9]  A. Aizer,et al.  Parental Medicaid Expansions and Health Insurance Coverage , 2003 .

[10]  J. Gruber,et al.  Does Public Insurance Crowd Out Private Insurance? , 1995 .

[11]  Matthew D. Kim,et al.  Participation and crowd out: assessing the effects of parental Medicaid expansions. , 2013, Journal of health economics.

[12]  S. Blaney,et al.  Expanding Family Coverage: States' Medicaid Eligibility Policies for Working Families in the Year 2000 , 2002 .

[13]  T. Gilmer,et al.  Insuring low-income adults: does public coverage crowd out private? , 2002, Health affairs.