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Objective: To estimate the effects of Affordable Care Act (ACA) Medicaid expansion on insurance and health services use for adults with disabilities who were newly eligible for Medicaid. Data Sources: 2008-2018 Medical Expenditure Panel Survey data. Study Design: We used the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults aged 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states had those states opted to expand. Outcomes included insurance coverage; access to care; receipt of primary care, outpatient specialty physician services, and preventive services; and out-of-pocket health care spending. To estimate the effects of Medicaid expansion, we used two-way fixed effects models and a triple differences framework to compare pre-post changes in each outcome in expansion and non-expansion states for adults with and without disabilities. Extraction Methods: We simulated Medicaid eligibility with the AHRQ PUBSIM model, which uses state-specific Medicaid rules and MEPS data on family relationships, state of residence, and income. Principal Findings: Among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage (35.9 percentage points [pp], p < 0.001), receipt of primary care (15.5 pp, p < 0.01), and receipt of flu shots (19.2 pp, p < 0.01), and a significant decrease in out-of-pocket spending (-$457, p < 0.01). There were larger improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage (11.0 pp, p < 0.01) and receipt of flu shots (18.0 pp, p < 0.05). Conclusions: Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid. For insurance coverage, preventive care, and some primary care measures, there were differentially larger improvements for adults with disabilities than for those without disabilities. KEYWORDS *health equity, access/demand/utilization of services, disability, health care financing/insurance/premiums, health policy/politics/law/regulation, Medicaid What is known on this topic * Adults with disabilities often have additional health care needs but also face additional barriers to accessing care. * Prior studies of low-income adults with disabilities found Medicaid expansion was associated with more insurance coverage and fewer cost-related barriers to care but no effects on access and service use. What this study adds * Among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with increased receipt of primary and preventive care and reduced out-of-pocket health spending. * Among newly eligible adults, Medicaid expansion differentially increased the probability of having full-year Medicaid coverage and or receiving a flu shot for adults with disabilities relative to those without disabilities., 1 | INTRODUCTION In 2019, 24% of the adult population aged 18-64 years had a disability. (1) This population faces significant barriers to health care. For example, in 2019 adults [...]

Objective: To quantify the impact of Medicaid enrollment on access to care and adherence to recommended preventive services. Data Source: 2005-2015 Medical Expenditure Panel Survey Household Component. Study Design: We examined several access measures and utilization of several preventive services within the past year and within the time frame recommended by the United States Preventive Services Task Force, if more than a year. We estimated local average treatment effects of Medicaid enrollment using a new, two-stage regression model developed by Nguimkeu, Denteh, and Tchernis. This model accounts for both endogenous and underreported Medicaid enrollment by using a partial observability bivariate probit regression as the first stage. We identify the model with an exogenous measure of Medicaid eligibility, the simulated Medicaid eligibility rate by state, year, and parents vs childless adults. A wide range of changes in Medicaid eligibility occurred during the time period studied. Data Collection/Extraction methods: Sample of low-income, nonelderly adults not receiving disability benefits. Principal Findings: Medicaid enrollment decreased the probability of having unmet needs for medical care by 7.5 percentage points and the probability of experiencing delays getting prescription drugs by 7.7 percentage points. Medicaid enrollment increased the probability of having a usual source of care by 16.5 percentage points, the probability of having a routine checkup by 17.1 percentage points, and the probability of having a flu shot in past year by 12.6 percentage points. Conclusion: Medicaid enrollment increased access to care and use of some preventive services. Additional research is needed on impacts for subgroups, such as parents, childless adults, and the smaller and generally older populations for whom screening tests are recommended. KEYWORDS access to care, Medicaid, preventive services, 1 | INTRODUCTION Medicaid is a joint state and federal program providing health care to low-income populations. Within statutory and regulatory constraints set at the federal level, states have discretion [...]

Objective: To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data Source/Study Setting: Medicaid State Drug Utilization Database (SDUD) 20112018, comprising the universe of outpatient prescription medications covered under the Medicaid program. Study Design: Differences-in-differences and event-study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time. Principal Findings: Relative to nonexpansion states, Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre-expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event-study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3-5 years postexpansion. Conclusions: Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer. KEYWORDS breast cancer, differences-in-differences, Medicaid, prescription medications, public insurance, 1 | INTRODUCTION The Affordable Care Act (ACA) expanded Medicaid eligibility to allow enrollment of nonelderly adults with incomes through 138 percent of the federal poverty level (FPL). (1) However, [...]

Objective: To measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden, that is, families spending more than 10 percent of income on medical care. Data Source: Matched longitudinal sample of CPS data for 2013 and 2014 calendar years. Study Design: The CPS used a split-sample design to field traditional and redesigned questions about 2013 income, and old and new out-of-pocket premium imputation procedures, respectively. For both samples, CPS data for 2014 were from the redesigned income questions and the new imputation procedures. We quantify the effects of the combined survey improvements using differences-in-differences methods. Principal Findings: The improvements were not associated with changes in the estimate of burden in the full sample. Estimated prevalence increased by 2.6 percentage points among nonelderly adults with private insurance, decreased by 6.6 percentage points among nonelderly adults with public coverage, and decreased by 5.8 percentage points among elderly adults with Medicare and no private coverage. Conclusions: Improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups. Researchers should use caution when tracking burden across the time-period in which these improvements were implemented. KEYWORDS affordability, data quality, financial burden, imputation, medical care, 1 | INTRODUCTION Affordability is a key dimension of access to medical care. This concept is often measured by health services researchers as the prevalence of high out-of-pocket spending on [...]

Objective. To quantify the effect of Medicaid expansions on office-based care among the newly eligible. Data Source. 2008-2014 Medical Expenditure Panel Survey. Study Design. The main sample is adults age 26-64 with incomes [less than or equal to]138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act. For this population, difference-in-differences linear probability models compare utilization between expansion and nonexpansion states and between 2008-2013 and 2014. Extraction Methods. Medicaid eligibility is simulated using data on family relationships, state of residence, and income. Principal Findings. Relative to comparable adults in nonexpansion states, newly eligible adults in expansion states were 9.1 percentage points more likely to have any office-based primary care physician visit in 2014, a 21.4% increase from 2013 (p-value = .004); 6.9 percentage points more likely to have a specialist visit, a 25.2% increase from 2013 (p-value = .036); and 5.1 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant, a 34.5% increase from 2013 (p-value = .016). Conclusions. State Medicaid expansions in 2014 were associated with greater likelihoods of visits with a variety of office-based providers. The estimated effects are larger among newly eligible compared with previous estimates on broader populations of low-income adults. Key Words. Primary care, Medicaid, utilization of services, The Affordable Care Act (ACA) provided generous federal matching funds for states to expand their Medicaid programs to all nonelderly adults (ages 19-64) with income [less than or equal to]138 [...]