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Objective: To examine whether the Affordable Care Act's (ACA's) Medicaid expansions affected health insurance coverage for individuals in same-sex couples. Data Sources and Study Setting: We used data on adults aged 18-64 years in same-sex couples (n = 33,512) from the 2008-2018 American Community Survey (ACS). Study Design: To estimate the effect of the impact of the state Medicaid expansions under the ACA on health insurance coverage for sexual minorities, we utilize a standard difference-in-differences approach to leverage the variation across geography and time in expanding Medicaid. Data Collection: Secondary and publicly available ACS data were obtained from IPUMS at the University of Minnesota. Principal Findings: We find that Medicaid expansion significantly increased health insurance coverage among low-income men and women in same-sex couples by 4.9 (standard error [SE] = 1.75) and 6.5 (SE = 1.96) percentage points, respectively. We find increases in the likelihood of having Medicaid and reductions in private health insurance from an employer or privately purchased insurance. Effects on Medicaid take-up are consistently larger for low-income women in same-sex couples as compared to low-income men in same-sex couples. Conclusions: We provide the first evidence on the relationship between state Medicaid expansions under the ACA and health insurance coverage among sexual minority adults, a group that has been understudied in past research. Our results confirm that sexual minority adults benefitted from the ACA's Medicaid expansions with respect to increased health insurance coverage. KEYWORDS affordable care act, health insurance, LGBTQ, Medicaid expansion, sexual minority What is known on this topic * A growing body of research has examined the effects of public policies which specifically target sexual minorities (e.g., same-sex marriage bans and the subsequent legal recognition of same-sex marriage). * For instance, prior research found that same-sex marriage recognition laws are associated with increased health insurance coverage and better access to care for sexual minority couples. * Comparatively less research has examined the effects of broadly targeted population-based policies not specific to the sexual minority population. What this study adds * We provide the first evidence on the relationship between state Medicaid expansions under the Affordable Care Act (ACA) and health insurance coverage among sexual minority adults. * Low-income women in same-sex couples were especially more likely to have health insurance following the ACA's Medicaid expansions relative to low-income men in same-sex couples., 1 | INTRODUCTION A wide body of research has documented that sexual minorities (i.e., lesbians, gay men, bisexual individuals, queer [LGBTQ] and other non-heterosexual populations) have worse socio-economic outcomes than [...]

Objective: To develop an algorithm using administrative data to measure adverse childhood experiences (ADM-ACE) within routinely collected health insurance claims and enrollment data. Data Sources: We used claims and enrollment data from Tennessee's Medicaid program (TennCare) in 2018. Study Design: We studied five types of ACEs: maltreatment and peer violence, foster care and family disruption, maternal mental illness, maternal substance use disorder, and abuse of the mother. We used diagnosis and procedure codes, prescription drug fills, and enrollment files to develop the ADM-ACE, which we applied to measure the prevalence of ACEs and to examine prevalence by demographic characteristics among our sample of children in TennCare. We compared ADM-ACE prevalence to child welfare records and survey results from Tennessee. Data Collection/Extraction Methods: Our study sample included children aged 0-17 years who were linked to their mothers if also enrolled in TennCare in 2018 (N = 763,836 children). Principal Findings: Approximately 19.2% of children in TennCare had indicators for ADM-ACEs. The prevalence of ACEs was higher among children who were younger (p < 0.001), non-Hispanic white or black (compared to Hispanic) (p < 0.001), and children residing in rural versus urban counties (p < 0.001). The prevalence of maltreatment identified through the ADM-ACE (1.6%) falls between the percent of children in Tennessee who were reported to child welfare authorities and the percent for whom reports of maltreatment were substantiated. Comparison with survey reports from Tennessee parents suggests an advantage in measuring maternal mental illness with the ADM-ACE using health insurance claims data. Conclusions: The ADM-ACE can be applied to health encounter data to study and monitor the prevalence of certain ACEs, their association with health conditions, and the effects of policies on reducing exposure to ACEs or improving health outcomes for children with ACEs. KEYWORDS administrative data uses, adverse childhood experiences, child and adolescent health, child welfare, determinants of health, Medicaid, observational data, pediatrics What is known on this topic * Adverse childhood experiences (ACEs) are prevalent. * ACEs are important to monitor because they can have short-term implications for children's health and are associated with worse health, social, and economic well-being in adulthood. What this study adds * ACEs can be identified through routinely collected administrative data. * The algorithm using administrative data to measure ACEs (ADM-ACE) developed here can enable surveillance and new research opportunities to inform care practices, programs, and policies for children., 1 | INTRODUCTION In a large and growing body of literature, researchers have identified, constructed measures of, and recorded adverse childhood experiences (ACEs) among children and adolescents. (1,2) According to [...]

Objective: To examine the changes in health insurance coverage, access to care, and health services utilization among nonelderly sexual minority and heterosexual adults between pooled years 2013-2014 and 2017-2018. Data Sources: Data on 3223 sexual minorities (lesbians, gay men, bisexual individuals, and other nonheterosexual populations) and 86 181 heterosexuals aged 18-64 years were obtained from the 2013, 2014, 2017, and 2018 National Health Interview Surveys. Study Design: Unadjusted and regression-adjusted estimates compared changes in health insurance status, access to care, and health services utilization for nonelderly adults by sexual minority status. Regression-adjusted changes were obtained from logistic regression models controlling for demographic and socioeconomic characteristics. Principal Findings: Uninsurance declined for both sexual minority adults (5 percentage points, P < .05) and heterosexual adults (2.5 percentage points, P < .001) between 2013-2014 and 2017-2018. Reductions in uninsurance for sexual minority and heterosexual adults were associated with increases in Medicaid coverage. Sexual minority and heterosexual adults were also less likely to report unmet medical care in 2017-2018 compared with 2013-2014. Low-income adults (regardless of sexual minority status) experienced relatively large increases in Medicaid coverage and substantial improvements in access to care over the study period. The gains in coverage and access to care across the study period were generally similar for heterosexual and sexual minority adults. Conclusions: Sexual minority and heterosexual adults have experienced improvements in health insurance coverage and access to care in recent years. Ongoing health equity research and public health initiatives should continue to monitor health care access and the potential benefits of recent health insurance expansions by sexual orientation and sexual minority status when possible. KEYWORDS health care access, LGBT health, sexual minorities, 1 | INTRODUCTION Previous research has documented substantial disparities in health insurance coverage and access to care for sexual minorities (ie, lesbians, gay men, bisexual individuals, and other nonheterosexual populations). [...]