Medicaid Expansion Slows Mental Health Decline In Southern States

Since the Affordable Care Act first gave birth to Medicaid expansion, its success has been a matter of debate, especially when it comes to behavioral health care.

Supporters tout statistics that suggest Medicaid expansion has allowed nearly 11 million more Americans to gain health care coverage. Meanwhile, opponents dispute whether Medicaid expansion has led to better outcomes for beneficiaries, noting that safety net organizations already serve uninsured populations.

However, new research suggests that safety net providers alone aren’t an adequate substitute for insurance coverage. In fact, Medicaid expansion yielded better health benefits for members studied, even those with access to safety net care, the findings suggest.


As such, the study further supports the idea that Medicaid expansion is key to helping behavioral health providers improve access and outcomes, especially because about 19% of people with mental illness are uninsured.

Study implications

In the study, researchers found that low-income Southerners in non-expansion states were more likely to see declining mental and physical health than were those in expansion states. In other words, Medicaid expansion coverage did a better job keeping people mentally and physically healthy.

“Absent expansion, an expected 38.1% of cohort participants in expansion states would have experienced a health status decline,” the authors of the study wrote. “Under expansion, however, 36.3 percent experienced a decline — a reduction of 1.8 percentage points.”


Those findings were published in the January issue of Health Affairs. John Graves, professor at Vanderbilt University School of Medicine, was the study’s main author.

“While Medicaid coverage might not move people to better states of health, what it seems to do is allow people to maintain their current level of health and not experience some kind of precipitous decline in either mental or physical health,” Graves told Behavioral Health Business.

Medicaid expansion allows adults below age 65 who would not traditionally be eligible for Medicaid to gain coverage.

However, it’s optional for states to adopt the expansion. In states that have done so, beneficiaries with incomes of up to 138% of the federal poverty level qualify for coverage.

Medicaid expansion also guarantees a certain level of behavioral health coverage, ensuring beneficiaries have access to mental health and substance use disorder services.

Meanwhile, safety net providers are health care organizations that serve uninsured and underinsured populations. They are often strapped for cash, with funding coming from a mix of private and public sources, such as Medicaid, Medicare, grants and charitable sources.

For the study, researchers reviewed the health of tens of thousands of low-income adults who self-reported their health to the Southern Community Cohort Study (SCCS), which looks at cancer and other major diseases among the poor. The majority of participants were recruited from safety net organizations.

Researchers compared health status before and after Medicaid expansion.

Study participants came from 12 Southern states, which included Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia.

Only four of those states had adopted Medicaid expansion at the time of the study. However, Graves believes non-expansion states would be wise to reconsider.

“These non-expansion states — which tend to cluster at the bottom in terms of health ranking — could potentially materially impact their health ranking by accepting the expansion funds,” he said. “However you accept the funds or whatever you use them for, utilizing that coverage could materially affect the population health of the state.”

Behavioral health providers typically support Medicaid expansion because it creates opportunities for them to extend coverage and access for patients. Polsinelli shareholder Jennifer Evans highlighted some of those opportunities during a recent webinar hosted by the Kansas City, Missouri-based law firm.

“Medicaid is an incredible opportunity for us as regulatory professionals and clinicians to really expand coverage, payment and treatment for behavioral health matters,” Evans said.

Legislative backdrop

The research highlighting Medicaid expansion’s impact comes as the program and the massive health law that allowed for it could be in jeopardy.

On Friday, 20 Democratic states and the U.S. House of Representative urged the Supreme Court to quickly rule on the fate of the Affordable Care Act (ACA), which a lower court previously ruled unconstitutional.

The group hopes the justices will make a decision on the health care law’s constitutionality before the 2020 presidential election.

If Supreme Court deems the ACA unconstitutional, the law and Medicaid expansion could become null and void.

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