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Related Experiment Video

Updated: Jun 12, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

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Racial Disparities and Personal Responsibility Incentives in Medicaid.

David M Craig¹, Elaine M Hernandez², Elizabeth M Anderson³

¹Department of Interdisciplinary Studies, Indiana University Indianapolis School of Liberal Arts, Indianapolis, Indiana, USA.

Health Services Research

|June 10, 2026

Summary

This summary is machine-generated.

Personal responsibility incentives in Medicaid created significant racial disparities in plan enrollment and benefits. Suspending these incentives reduced disparities, suggesting policy changes are needed for equitable healthcare access.

Keywords:

Medicaid cost‐sharing health insurance enrollment personal responsibility policy evaluation racial disparity

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Area of Science:

Health Services Research
Health Equity
Public Health Policy

Background:

Medicaid personal responsibility incentives may create disparities in healthcare access.
Understanding racial differences in enrollment and benefit comprehensiveness is crucial for health equity.

Purpose of the Study:

To examine how personal responsibility incentives in Medicaid affect enrollment and benefit comprehensiveness for non-Hispanic Black and non-White members.
To assess the impact of suspending these incentives during the COVID-19 Public Health Emergency (PHE) on racial disparities.

Main Methods:

An interrupted time series analysis was used to evaluate trends in racial disparity ratios.
Data from 939,667 non-Hispanic Black and non-Hispanic White adults enrolled in Healthy Indiana Plans (HIP) from 2018-2023 were analyzed.

Main Results:

Before the PHE, non-Hispanic Black members were 23% less likely to be in the more comprehensive HIP Plus plan compared to non-Hispanic White members.
Suspension of incentives during the PHE reduced this disparity, moving towards parity.
An administrative upgrade to HIP Plus plans further increased parity, reaching 0.994.

Conclusions:

Medicaid personal responsibility incentives are linked to significant and lasting racial disparities in enrollment and plan comprehensiveness.
Temporary removal of incentives can decrease disparities, but sustained equitable access requires proactive policy interventions.