title: The Effects of Medicaid Eligibility on Mental Health Services and Out-of-Pocket Spending for Mental Health Services.
abstract: OBJECTIVE
  Millions of low-income Americans will gain health insurance through Medicaid under the Affordable Care Act. This study assesses the impact of previous Medicaid expansions on mental health services utilization and out-of-pocket spending.
  
  
  METHODS
  Secondary data from the 1998-2011 Medical Expenditure Panel Survey Household Component merged with National Health Interview Survey and state Medicaid eligibility rules data.
  
  
  METHODS
  Instrumental variables regression models were used to estimate the impact of expanded Medicaid eligibility on health insurance coverage, mental health services utilization, and out-of-pocket spending for mental health services.
  
  
  METHODS
  Person-year files were constructed including adults ages 21-64 under 300 percent of the Federal Poverty Level.
  
  
  RESULTS
  Medicaid expansions significantly increased health insurance coverage and reduced out-of-pocket spending on mental health services for low-income adults. Effects of expanded Medicaid eligibility on out-of-pocket spending were strongest for adults with psychological distress. Expanding Medicaid eligibility did not significantly increase the use of mental health services.
  
  
  CONCLUSIONS
  Previous Medicaid eligibility expansions did not substantially increase mental health service utilization, but they did reduce out-of-pocket mental health care spending.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455.
authors.forename: Ezra
authors.initials: E
authors.lastname: Golberstein
authors.affiliation: Department of Health Policy at the Vanderbilt University School of Medicine.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gonzales
mesh_terms: D000328:Adult; D004608:Eligibility Determination; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D012959:Socioeconomic Factors; D014481:United States
keywords: Medicaid; Mental health services; instrumental variables; out-of-pocket spending