Are Adults in Poor Health More Likely to Enroll in Public Insurance?

Psychological Distress and Enrollment in Medicaid

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.

Uninsurance and its correlates among poor adults with disabilities

States must offer Medicaid coverage to low-income adults with disabilities; however, they have discretion in the design of eligibility criteria and enrollment processes. Using the American Community Survey, we examined the health insurance status of adults enrolled in the Supplemental Security Income (SSI) disability program including (1) the national rate of health insurance coverage; (2) state rates of uninsurance and Medicaid; and (3) the correlates of uninsurance. Uninsurance and Medicaid rates varied across states from 1% to 12% and from 63% to 91%, respectively. Nationally, 5% of the SSI population was uninsured; 77% was enrolled in Medicaid. Limited English proficiency, Black race, lack of U.S. citizenship, and residence in a state that used an enrollment process and/or eligibility criteria distinct from the SSI program were associated with uninsurance. As states streamline Medicaid enrollment processes to meet requirements of the Affordable Care Act, they should consider the needs of this vulnerable population.