Journal of General Internal Medicine

, Volume 33, Issue 3, pp 376–383 | Cite as

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

  • Tyler N.A. Winkelman
  • Virginia W. Chang
Health Policy



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.


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.


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.


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).


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.


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 These positive trends are likely to be reversed if Medicaid expansion is repealed.



This research was funded with support from the Robert Wood Johnson Clinical Scholars Program and the Ann Arbor VA Healthcare System.

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflict of interest.

Supplementary material

11606_2017_4217_MOESM1_ESM.docx (100 kb)
ESM 1 (DOCX 100 kb)


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  1. 1.Division of General Internal MedicineHennepin County Medical CenterMinneapolisUSA
  2. 2.Center for Patient and Provider Experience Minneapolis Medical Research FoundationMinneapolisUSA
  3. 3.Department of Social and Behavioral Sciences, College of Global Public HealthNew York UniversityNew YorkUSA
  4. 4.Department of Population Health, School of MedicineNew York UniversityNew YorkUSA

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