Moving opportunistically: Interstate migration after medicaid expansion.

Area of Science:

• Health Economics
• Public Health Policy
• Sociology

Background:

• The Affordable Care Act (ACA) significantly expanded Medicaid eligibility.
• Understanding the impact of state-level policy changes on population migration is crucial for resource allocation and public health planning.

Purpose of the Study:

• To investigate if the selective expansion of Medicaid eligibility under the ACA influenced interstate migration patterns.
• To determine if states with larger Medicaid expansions attracted more in-migration, particularly among targeted populations.

Main Methods:

• Utilized person-level data from the American Community Survey (ACS) spanning 2009-2019.
• Analyzed migration data (moves within the prior 12 months) in relation to state-level Medicaid expansion.
• Focused analysis on specific subpopulations: the general target population, disabled individuals, and parents.

Main Results:

• States with the largest Medicaid expansion margins experienced higher in-migration rates.
• This resulted in an estimated 0.23% annual population growth in the target population, 0.42% for the disabled, and 0.25% for parents.
• Approximately 56,659 interstate moves were linked to Medicaid enrollment growth, concentrated near state borders.

Conclusions:

• Medicaid expansion acts as a potential 'welfare magnet,' influencing the migration of high-needs individuals.
• These migration patterns may lead to undercounting of individuals in government expenditure projections.
• Policy implications include the need to consider migration effects in state-level health insurance benefit planning.