Session: The Role of Medicaid Policy in Promoting Family Stability: Evidence from the ACA Medicaid Expansions (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

Family stability is a protective asset that buffers against environmental insults – such as financial instability, household violence, neighborhood crime, drug use, and impoverishment -- and is critical in overcoming the grand challenges of social work. Unequal access to affordable health insurance is a driving force of inequality in the U.S. that only exacerbates these insults, producing cumulative and pronounced disadvantage. In 2014, the Affordable Care Act offered states the opportunity to expand their Medicaid programs to include all low-income adults under 138% of the Federal Poverty Level (FPL). A little over half of states have expanded, while the other states continue to debate the merit of doing so. In a randomized experiment, Medicaid was found to increase healthcare utilization, improve overall health, reduce depression, and increase financial stability. Accordingly, the aim of this symposium is to examine additional positive benefits of Medicaid that have strong implications for family and household stability: Housing Evictions, Addiction, Child Maltreatment, and Poverty. Our findings intersect three prominent grand challenges -- closing the health gap, ensure healthy development, and reduce extreme economic inequality -- and are discussed in light of the current Medicaid policy debates concerning efforts to further restrict access to Medicaid through work requirements, drug testing, or reducing benefits. Importantly, we provide new evidence to legislators in the 18 states that have yet to expand Medicaid as to the breadth of social improvements observed in the adopting states.

The first paper estimates the effect of early ACA Medicaid expansion in California on per-county per-month housing evictions using a commercial database of 15 states, approximately 24 months before and 24 months after the 2011-2012 insurance expansion. The results suggest 60 fewer evictions per county month after Medicaid expansion, from a previous mean of 177 per county-month, resulting in a reduction of about 9 evictions per 1000 new enrollees per year. The second paper assesses change in insurance coverage for addiction treatment after Medicaid's expansion in 2014. The findings indicate that Medicaid expansion was associated with a 14-point decrease in the percentage of uninsured patients in addiction treatment. The third paper estimates the effect of access to Medicaid on child maltreatment measured as CPS reports and substantiation rate using administrative CPS report data. Findings suggest that Medicaid significantly reduces the number of maltreatment reports by up to 14.31 per month and increases the substantiation rate by 1.02 percentage points. The fourth paper examines the role of Medicaid coverage in reducing the national poverty burden. We find that the ACA expansion significantly reduced the rate of poverty by 1.07 percentage points. Additionally, we find that the program's anti-poverty impact grew over the past decade independently of expansion by shielding beneficiaries from growing out-of-pocket costs. These combined results demonstrate that Medicaid policy is an important consideration when considering objectives to increase family stability and safety.