Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions

J Gen Intern Med. 2018 Mar;33(3):376-383. doi: 10.1007/s11606-017-4217-5. Epub 2017 Nov 27.


Background: While the Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit.

Objective: To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions.

Design: We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status.

Participants: Childless adults, aged 18-64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628).

Intervention: Active Medicaid expansion in state of residence.

Main measures: Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor.

Key results: Medicaid expansion was associated with reductions in poor health days (-1.2 days [95% CI, -1.6,-0.7]) and days limited by poor health (-0.94 days [95% CI, -1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (-1.1 days [95% CI, -1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (-3.4 percentage points [95% CI, -6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults.

Conclusions: Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / trends*
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / trends
  • Male
  • Medicaid / economics
  • Medicaid / trends*
  • Medically Uninsured*
  • Mental Health / economics
  • Mental Health / trends*
  • Middle Aged
  • Patient Protection and Affordable Care Act / economics
  • Patient Protection and Affordable Care Act / trends
  • Poverty / economics
  • Poverty / trends*
  • Random Allocation
  • Surveys and Questionnaires
  • United States / epidemiology
  • Young Adult