Psychological Distress and Enrollment in Medicaid

Abstract

Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. This study compares Medicaid enrollment responses to eligibility expansions by mental health status using a sample of non-elderly adults in both the 2000-2011 Medical Expenditure Panel Survey and the National Health Interview Survey (N = 27,494). The impact of Medicaid income eligibility thresholds (defined as the maximum family income level allowed in each state to be considered eligible for Medicaid) on Medicaid enrollment was estimated from linear regression models allowing for differential enrollment responses by mental and physical health status. Increasing income eligibility thresholds by 100% of the federal poverty level (FPL) was associated with a five-percentage-point increase in the probability of Medicaid enrollment in the non-disabled population under 300% FPL. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act

“…Our findings contribute to the emerging literature on the impact of the ACA (Gonzales et al 2016; Saloner et al 2017), whose findings suggest that access to health insurance and utilization of services has increased (Wherry and Miller 2016), health care related financial burdens have decreased (Ali et al 2016b), and barriers to paying for health services have been reduced (Chen et al 2016). Our findings are consistent with this, in that we found that adults with SPD were more likely to have health insurance coverage and experience lower barriers in accessing treatments after 2014.…”

Antidepressant use and costs among low-education and low-income people with serious psychological distress: evidence from healthcare reform

“…Individuals with mental health problems have historically had disproportionately lower rates of health insurance coverage and experienced significant barriers to accessing needed treatments. [25][26][27][28][29][30][31][32][33][34] We speculate that if insurance coverage is continued, enhancements in treatment of SPD may occur.…”

“…Our findings contribute to the literature on the impact of insurance coverage expansion in 2014, suggesting that low‐income, low‐educational attainment people with SPD who have insurance paid less out‐of‐pocket and used more needed antidepressants in 2014. Individuals with mental health problems have historically had disproportionately lower rates of health insurance coverage and experienced significant barriers to accessing needed treatments . We speculate that if insurance coverage is continued, enhancements in treatment of SPD may occur.…”

Do Racial and Ethnic Disparities in Mental Health Treatment Vary With Underlying Mental Health?

“…Importantly, especially for the purposes of measuring disparities, the K6 scales have been validated in Spanish-speaking populations (Stolk et al, 2014; Valencia-Garcia, 2012). Following previous studies (Gonzales et al, 2017; Kessler et al, 2002; Pirraglia et al, 2011), we derived a three-category variable from the K6 that distinguishes between low (K6 ≤ 6), moderate (7 ≤ K6 ≤ 12), and serious psychological distress (K6 ≥ 13). We then examine how the level of disparities changes at the low, moderate, and serious levels of psychological distress.…”