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.