title: Effect of Medicaid Expansions on Health Insurance Coverage and Access to Care among Low-Income Adults with Behavioral Health Conditions.
abstract: OBJECTIVE
  To examine the effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions.
  
  
  METHODS
  Nine years (2004-2012) of individual-level cross-sectional data from a restricted-access version of National Survey on Drug Use and Health.
  
  
  METHODS
  A quasi-experimental difference-in-differences design comparing outcomes among residents in 14 states that implemented Medicaid expansions for low-income adults under the Section §1115 waiver with those residing in the rest of the country.
  
  
  METHODS
  The analytic sample includes low-income adult respondents with household incomes below 200 percent of the federal poverty level who have a behavioral health condition: approximately 28,400 low-income adults have past-year serious psychological distress and 24,900 low-income adults have a past-year substance use disorder (SUD).
  
  
  RESULTS
  Among low-income adults with behavioral health conditions, Medicaid expansions were associated with a reduction in the rate of uninsurance (p < .05), a reduction in the probability of perceiving an unmet need for mental health (MH) treatment (p < .05) and for SUD treatment (p < .05), as well as an increase in the probability of receiving MH treatment (p < .01).
  
  
  CONCLUSIONS
  The ongoing implementation of Medicaid expansions has the potential to improve health insurance coverage and access to care for low-income adults with behavioral health conditions.
authors.affiliation: Department of Health Management & Policy, University of Kentucky College of Public Health, Lexington, KY.
authors.forename: Hefei
authors.initials: H
authors.lastname: Wen
authors.affiliation: Department of Health Policy & Management, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.affiliation: Department of Health Policy & Management, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Cummings
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D011203:Poverty; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: Medicaid; access/demand/utilization of services; mental health; substance abuse