The effect of Medicaid expansion on the take‐up of disability benefits by race and ethnicity

Abstract

Public disability programs provide financial support to 12 million working‐age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take‐up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take‐up. Using 2009–2020 Current Population Survey data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take‐up among respondents with disabilities living in Medicaid expansion states to respondents with disabilities living in non‐expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take‐up by 10% overall, particularly among White and Hispanic respondents (10% and 21%, respectively). Medicaid expansion increased SSDI take‐up by 8% overall, particularly among White and Black respondents (9% and 11%, respectively). Moreover, we find that Medicaid expansion reduced the probability that respondents with disabilities had employer‐sponsored health insurance by approximately 8%, suggesting that expansion may have reduced job‐lock among the SSDI‐eligible, contributing to the observed increase in SSDI take‐up.

Changes in Health Care Workers’ Economic Outcomes Following Medicaid Expansion

“…On the one hand, the findings may reflect that Medicaid expansion fostered greater agency in job selection among lower-income workers. [39][40][41] Work from the pre-ACA era shows that few people substitute Medicaid for private health insurance coverage voluntarily. 42 On the other hand, Medicaid may also be associated with administrative burdens and narrower network options for beneficiaries relative to private health insurance coverage, resulting in the introduction of additional barriers to care for a population of workers already at-risk of adverse health outcomes.…”