The impact of Medicaid expansion on access to care and preventive care for adults with diabetes and depression

Abstract

AimsTo assess if Medicaid expansion is associated with better access to care and increased utilization of preventive care for diabetes-related complications in adults with diabetes and depression. MethodsData were extracted from the Behavioral Risk Factor Surveillance System survey from 2010 to 2017. This is a retrospective cross-sectional study using difference-in-differences analysis to assess the relationship between expansion and access to care and healthcare utilization for Medicaid eligible respondents in expansion states, compared to those in non-expansion states. ResultsMedicaid expansion significantly increased insurance coverage (5.9 percentage points, p < .001) and the likelihood of having a personal doctor (1.9 percentage points, p < .01) for respondents in expansion states. For childless adults, these impacts were larger for having insurance and a personal doctor at 6.3 (p < .001) and 2.9 (p < .01) percentage points, respectively. When excluding the 9 substantial states and DC, these impacts increased further for insurance, having a personal doctor, and the ability to afford costs at 8.2 (p < .001), 1.9 (p < .05), and 2.8 (p < .05) percentage points, respectively. No significant improvements were seen in preventive care utilization. ConclusionsCompared to non-expansion states, Medicaid expansion led to improved access to care for Medicaid eligible adults in expansion states.