The journal of mental health policy and economics · 2026
The Effects of Medicaid Expansion on Mental Health for White, Black, and Hispanic Americans: Estimates for 2014-2022.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Brown Timothy, Cuellar Alison, Graaf Genevieve, Green Victoria R, Morales Alfaro Jorge A, Snowden Lonnie R
Аннотация
BACKGROUND: The Affordable Care Act expanded Medicaid as a state option. Despite potential for Medicaid expansion to improve mental health for low-income adults, among whom Hispanic and Black adults are overrepresented, Medicaid expansion research has mostly overlooked differential mental health impacts.
AIMS OF THE STUDY: This study examines whether Medicaid expansion improved mental health overall and across white, Black, and Hispanic adults.
METHODS: Using 2011-2022 Behavioral Risk Factor Surveillance System data, we identified 474,801 Medicaid-eligible adults aged 18-64. State Medicaid expansions (2014-2021) were analyzed using the Callaway and Sant'Anna difference-in-differences estimator. Five mental health outcomes were examined overall and by race/ethnicity. Robustness was assessed through evaluation of 16 concurrent state-level policies against the common shocks criterion, including empirical testing of the two policies that satisfy the criterion. Validation tests assessed insurance coverage, cost barriers, elderly (age ≥65) placebo, and immigration enforcement as a moderator for Hispanics.
RESULTS: Of 20 equations (5 outcomes across overall, Black, Hispanic, and white subsamples), 18 exhibited parallel trends. Among Hispanic adults, frequent mental distress (14+ poor mental health days) decreased by 2.7 percentage points (p < 0.001); controlling for the sole identified policy confounder (medical marijuana) strengthened this to 5.3 percentage points (p = 0.003). Any poor mental health days also decreased by 5.4 percentage points (p = 0.048). In the full sample, frequent mental distress decreased by 1.2 percentage points (p = 0.032), any activity-limiting days decreased by 2.0 percentage points (p = 0.043), and the number of activity-limiting days decreased by 1.9 days (p = 0.001). Among white adults, activity-limiting days decreased by 1.7 days (p = 0.020). Among Black adults, expansion increased insurance coverage by 6.5 percentage points (p = 0.032); the number of poor mental health days showed a reduction of 0.7 days (p = 0.054), with Black subgroup minimum detectable effects (MDEs) 1.1-2.6 times full-sample MDEs. Validation tests confirmed insurance coverage increased 7-9 percentage points and cost barriers decreased 4-5 percentage points. Of 16 concurrent state-level policies evaluated against the common shocks criterion, two satisfied both conditions for potential confounding. Including recreational marijuana policies produced results identical to baseline. Including medical marijuana policies strengthened the Hispanic result.
DISCUSSION: Medicaid expansion reduced frequent mental distress and poor mental health days among Hispanic adults. Activity-limiting days declined in the full sample and among white adults. Among Black adults, there were marginally significant mental health improvements. Limitations include reliance on self-reported outcomes and subgroup minimum detectable effects 1.1-2.6 times the full-sample MDEs.
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Medicaid is an important source of mental health treatment and may reduce disparities for Black and Hispanic Americans.
IMPLICATIONS FOR HEALTH POLICY: H.R. 1 (2025) will reduce federal Medicaid matching and create work requirements for expansion beneficiaries. Because Black and Hispanic adults rely more heavily on Medicaid under expansion, these populations may be disproportionately affected.
IMPLICATIONS FOR FURTHER RESEARCH: Future research should disentangle contributions of coverage expansion from correlated state policies.
AIMS OF THE STUDY: This study examines whether Medicaid expansion improved mental health overall and across white, Black, and Hispanic adults.
METHODS: Using 2011-2022 Behavioral Risk Factor Surveillance System data, we identified 474,801 Medicaid-eligible adults aged 18-64. State Medicaid expansions (2014-2021) were analyzed using the Callaway and Sant'Anna difference-in-differences estimator. Five mental health outcomes were examined overall and by race/ethnicity. Robustness was assessed through evaluation of 16 concurrent state-level policies against the common shocks criterion, including empirical testing of the two policies that satisfy the criterion. Validation tests assessed insurance coverage, cost barriers, elderly (age ≥65) placebo, and immigration enforcement as a moderator for Hispanics.
RESULTS: Of 20 equations (5 outcomes across overall, Black, Hispanic, and white subsamples), 18 exhibited parallel trends. Among Hispanic adults, frequent mental distress (14+ poor mental health days) decreased by 2.7 percentage points (p < 0.001); controlling for the sole identified policy confounder (medical marijuana) strengthened this to 5.3 percentage points (p = 0.003). Any poor mental health days also decreased by 5.4 percentage points (p = 0.048). In the full sample, frequent mental distress decreased by 1.2 percentage points (p = 0.032), any activity-limiting days decreased by 2.0 percentage points (p = 0.043), and the number of activity-limiting days decreased by 1.9 days (p = 0.001). Among white adults, activity-limiting days decreased by 1.7 days (p = 0.020). Among Black adults, expansion increased insurance coverage by 6.5 percentage points (p = 0.032); the number of poor mental health days showed a reduction of 0.7 days (p = 0.054), with Black subgroup minimum detectable effects (MDEs) 1.1-2.6 times full-sample MDEs. Validation tests confirmed insurance coverage increased 7-9 percentage points and cost barriers decreased 4-5 percentage points. Of 16 concurrent state-level policies evaluated against the common shocks criterion, two satisfied both conditions for potential confounding. Including recreational marijuana policies produced results identical to baseline. Including medical marijuana policies strengthened the Hispanic result.
DISCUSSION: Medicaid expansion reduced frequent mental distress and poor mental health days among Hispanic adults. Activity-limiting days declined in the full sample and among white adults. Among Black adults, there were marginally significant mental health improvements. Limitations include reliance on self-reported outcomes and subgroup minimum detectable effects 1.1-2.6 times the full-sample MDEs.
IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Medicaid is an important source of mental health treatment and may reduce disparities for Black and Hispanic Americans.
IMPLICATIONS FOR HEALTH POLICY: H.R. 1 (2025) will reduce federal Medicaid matching and create work requirements for expansion beneficiaries. Because Black and Hispanic adults rely more heavily on Medicaid under expansion, these populations may be disproportionately affected.
IMPLICATIONS FOR FURTHER RESEARCH: Future research should disentangle contributions of coverage expansion from correlated state policies.