Effect of Medicaid Expansions on Health Insurance Coverage and Access to Care among Low‐Income Adults with Behavioral Health Conditions

Objective

To examine the effect of Medicaid expansions on health insurance coverage and access to care among low‐income adults with behavioral health conditions.

Data Sources/Study Setting

Nine years (2004–2012) of individual‐level cross‐sectional data from a restricted‐access version of National Survey on Drug Use and Health.

Study Design

A quasi‐experimental difference‐in‐differences design comparing outcomes among residents in 14 states that implemented Medicaid expansions for low‐income adults under the Section §1115 waiver with those residing in the rest of the country.

Data Collection/Extraction Methods

The analytic sample includes low‐income adult respondents with household incomes below 200 percent of the federal poverty level who have a behavioral health condition: approximately 28,400 low‐income adults have past‐year serious psychological distress and 24,900 low‐income adults have a past‐year substance use disorder (SUD).

Principal Findings

Among low‐income adults with behavioral health conditions, Medicaid expansions were associated with a reduction in the rate of uninsurance (p < .05), a reduction in the probability of perceiving an unmet need for mental health (MH) treatment (p < .05) and for SUD treatment (p < .05), as well as an increase in the probability of receiving MH treatment (p < .01).

Conclusions

The ongoing implementation of Medicaid expansions has the potential to improve health insurance coverage and access to care for low‐income adults with behavioral health conditions.