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Objectives. To estimate the effect of Medicaid expansion on noncitizens' and citizens' participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens. [ABSTRACT FROM AUTHOR]

Objectives. To determine enrollment rates and predictors of enrollment for newly eligible low-income adults in California following the Affordable Care Act's (ACA's) Medicaid expansion. Methods. We used data from the 2014 to 2015 California Health Interview Survey to examine post-ACA Medicaid enrollment rates and multivariable logistic regression to assess the association of demographic factors, income, and health with enrollment. Results.Wefound a 78.5% enrollment rate for the newly eligible Medicaid population, translating to 3.8 million adults enrolled and 1.1 million adults who were eligible but did not enroll. Significant predictors of enrollment were participating in a public welfare program (odds ratio [OR] = 6.59; 95% confidence interval [CI] = 3.09, 14.04), having heart disease (OR = 4.03; 95% CI = 1.34, 12.15), being in the top quartile of income (OR = 3.59; 95% CI = 1.64, 7.85), enrolling in 2015 (OR = 3.28; 95% CI = 1.94, 5.56), being unemployed (OR = 2.10; 95% CI = 1.15, 3.82), and being female (OR = 1.71; 95% CI = 1.03, 2.85).Wedid not find significant disparities across race/ethnicity, education level, or geography. Conclusions. Repeal of Medicaid expansion would have a substantial effect on health insurance coverage among California's low-income adults, many of whom report chronic health conditions and no alternative sources of affordable coverage. Future research should examine the mechanisms explaining the higher enrollment rates among California's Medicaid expansion population. [ABSTRACT FROM AUTHOR]