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Effect of Medicaid Expansion on Workforce Participation for People With Disabilities

Jean P Hall¹, Adele Shartzer¹, Noelle K Kurth¹

¹Jean P. Hall is with the Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, and the Institute for Health and Disability Policy Studies, University of Kansas, Lawrence. Adele Shartzer is with the Urban Institute, Washington, DC. Noelle K. Kurth is with the Institute for Health and Disability Policy Studies, University of Kansas. Kathleen C. Thomas is with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill.

American Journal of Public Health

|December 21, 2016

Abstract

Objectives:

To use data from the Health Reform Monitoring Survey (HRMS) to examine differences in employment among community-living, working-age adults (aged 18-64 years) with disabilities who live in Medicaid expansion states and nonexpansion states.

Methods:

Analyses used difference-in-differences to compare trends in pooled, cross-sectional estimates of employment by state expansion status for 2740 HRMS respondents reporting a disability, adjusting for individual and state characteristics.

Results:

After the Affordable Care Act (ACA), respondents in expansion states were significantly more likely to be employed compared with those in nonexpansion states (38.0% vs 31.9%; P = .011).

Conclusions:

Prior to the ACA, many people with disabilities were required to live in poverty to maintain their Medicaid eligibility. With Medicaid expansion, they can now enter the workforce, increase earnings, and maintain coverage. Public Health Implications. Medicaid expansion may improve employment for people with disabilities.

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