The Complex Needs of Medicaid Expansion Enrollees with Very Low Incomes

Access to health care, use of services, and patient outcomes can be complicated by many medical and nonmedical factors. People facing complex challenges such as mental illness, housing insecurity, or substance use, however, are not a homogeneous group; different individuals have different needs.

To understand the needs of people with very low income--no more than 75 percent of the federal poverty level--who enrolled in Medicaid under Minnesota’s expansion of the program prior to the Affordable Care Act.

The authors analyzed data on nondisabled, childless adults in the Minneapolis-St. Paul region who enrolled in Medicaid between 2011 and 2013.

Early Medicaid expansion enrollees in urban Minnesota were largely nonwhite, male, and unmarried and had low educational attainment. In this very poor population, rates of homelessness, substance use, and mental illness were very high. More than 25 percent of adults dealt with two or more of these challenges, while 10 percent experienced all three. Providing access to a range of highly integrated health and social services may be the best way to help these individuals.