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Primary Submission Category: Health care/services
Medicaid in Midlife: State-Level Medicaid Program Generosity and Enrollment Outcomes
Authors: Sarah Petry, Stefani Baca-Atlas,
Presenting Author: Sarah Petry*
The US Medicaid program provides health insurance to millions of low-income Americans, facilitating access to health care across the life course. However, recent federal actions that will impose additional restrictions on Medicaid access are expected to result in more than 8 million people losing coverage. At the same time, individual states have some discretion over Medicaid eligibility and enrollment criteria that can reduce the burden on individuals seeking to access this program. Thus, the purpose of this research is to investigate whether unique elements of state-level Medicaid implementation are associated with higher enrollment during a period of substantial policy change among a nationally representative sample of participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health). We estimate multilevel logistic regression models to examine the impact of state-level policies on Medicaid participation during young- and middle-adulthood in Waves III-VI of Add Health (2000-2025). We further examine differential impacts across social categories. Our results indicate that overall state Medicaid program generosity was not associated with enrollment prior to the ACA (Waves III and IV). In Wave V, however, greater overall generosity is associated with 6.1% greater participation. Specifically, in states with policies that reduce burdensome application and enrollment procedures, such as automatic renewal policies, participation is 5.9% higher. These policies have the largest association with program participation for females (6.9% higher) and non-Hispanic Black individuals (7.3%). Further, more expansive eligibility criteria is associated with 11.0% higher participation among non-Hispanic Black adults. These results suggest that state-level actions to reduce burdensome Medicaid application and enrollment procedures may counteract expected increases in uninsurance for middle aged adults, especially for marginalized populations.