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The US Medicaid ProgramCoverage, Financing, Reforms, and Implications for Health Equity

To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Who does Medicaid insure, how is the program financed and delivered, how have policies evolved, and how could reforms address racial and ethnic health equity?

Findings  In 2022, Medicaid insured approximately 80.6 million individuals (56.4% from racial and ethnic minority groups in 2019). In 2020, estimated Medicaid spending was $671.2 billion (16.3% of total US health spending). The proportion of beneficiaries enrolled in Medicaid managed care was 69.5% in 2019, 45 states have pursued 139 Medicaid delivery system reforms from 2003 to 2019, and 38 states and Washington, DC, have expanded Medicaid under the Affordable Care Act. Racial and ethnic health disparities are common within Medicaid, and evidence on the association of Medicaid policies and reforms with achieving racial health equity remains limited.

Meaning  Medicaid is an important source of insurance and accounts for substantial health care spending. Medicaid reforms have expanded coverage and provide further opportunities to reduce disparities and address health inequities.


Importance  Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.

Objective  To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.

Evidence Review  Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.

Findings  Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.

Conclusions and Relevance  Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.

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Article Information

Corresponding Author: Julie M. Donohue, PhD, Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, Pittsburgh, PA 15261 (jdonohue@pitt.edu).

Accepted for Publication: August 5, 2022.

Author Contributions: Drs Roberts and Cole had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Donohue, Cole, Jarlenski, Roberts.

Drafting of the manuscript: Donohue, Cole, Jarlenski, Michener, Roberts.

Critical revision of the manuscript for important intellectual content: Cole, James, Jarlenski, Michener, Roberts.

Statistical analysis: Roberts.

Administrative, technical, or material support: All authors.

Supervision: Donohue.

Conflict of Interest Disclosures: Dr Donohue reported receiving grants from the Pennsylvania Department of Human Services, which administers the Pennsylvania Medicaid program, outside the submitted work. Dr Cole reported receiving grants from the Pennsylvania Department of Human Services and compensation for independent consulting services from AcademyHealth outside the submitted work. Dr Jarlenski reported receiving grants from Pennsylvania Department of Human Services and the Pennsylvania Department of Health related to health equity research outside the submitted work. Dr Michener reported receiving grants from the Robert Wood Johnson Foundation and the Commonwealth Fund during the conduct of the study and outside the submitted work. Dr Roberts reported receiving grants from the Agency for Healthcare Research and Quality (No. K01HS026727) and Arnold Ventures during the conduct of the study. No other disclosures were reported.

Disclaimer: The views expressed are the authors’ own and should not be attributed to the Pennsylvania Department of Human Services or other funding sources disclosed by the authors.

Additional Contributions: Research assistance was provided by Anna Patterson, MPH, RN, Alexandra Glynn, BA, and Stefanie Junker, MPH, from the University of Pittsburgh School of Public Health and helpful comments from K. John McConnell, PhD, Oregon Health & Science University. These Individuals were not compensated for their roles.

US Government Accountability Office. Federal low-income programs: eligibility and benefits differ for selected programs due to complex and varied rules. June 2017. Accessed September 30, 2021. https://www.gao.gov/assets/gao-17-558.pdf
Centers for Medicare & Medicaid Services. Monthly Medicaid & CHIP application, eligibility determination, and enrollment reports & data. Accessed July 22, 2022. https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html
Centers for Medicare & Medicaid Services. National health expenditure data, table 19: national health expenditures by type of expenditure and program: calendar year 2020. Accessed July 22, 2022. https://www.cms.gov/files/zip/nhe-tables.zip
Colello  HJ , Morton  WR . Medicaid eligibility: older adults and individuals with disabilities. December 9, 2019. August 26, 2022. https://crsreports.congress.gov/product/pdf/R/R46111
Goodman-Bacon  A .  Public insurance and mortality: evidence from Medicaid implementation.   J Polit Econ. 2018;126(1):216-262. doi:10.1086/695528 Google ScholarCrossref
Wherry  LR , Miller  S , Kaestner  R , Meyer  BD .  Childhood Medicaid coverage and later-life health care utilization.   Rev Econ Stat. 2018;100(2):287-302. doi:10.1162/REST_a_00677 PubMedGoogle ScholarCrossref
Wherry  LR , Meyer  BD .  Saving teens: using a policy discontinuity to estimate the effects of Medicaid eligibility.   J Hum Resour. 2016;51(3):556-588. doi:10.3368/jhr.51.3.0913-5918R1 Google ScholarCrossref
Brown  CC , Moore  JE , Felix  HC ,  et al.  Association of state Medicaid expansion status with low birth weight and preterm birth.   JAMA. 2019;321(16):1598-1609. doi:10.1001/jama.2019.3678 PubMedGoogle ScholarCrossref
Michener  J .  Fragmented Democracy: Medicaid, Federalism, and Unequal Politics. Cambridge University Press; 2018. doi:10.1017/9781108224987
Gruber  J , Sommers  BD .  Paying for Medicaid: state budgets and the case for expansion in the time of coronavirus.   N Engl J Med. 2020;382(24):2280-2282. doi:10.1056/NEJMp2007124 PubMedGoogle ScholarCrossref
Michener  JD .  Politics, pandemic, and racial justice through the lens of Medicaid.   Am J Public Health. 2021;111(4):643-646. doi:10.2105/AJPH.2020.306126 PubMedGoogle ScholarCrossref
Centers for Medicare & Medicaid Services. Innovation Center strategic direction. Accessed Feb 2, 2022. https://innovation.cms.gov/strategic-direction
Lanford  D , Quadagno  J .  Implementing ObamaCare: the politics of Medicaid expansion under the Affordable Care Act of 2010.   Sociol Perspect. 2016;59(3):619-639. doi:10.1177/0731121415587605 Google ScholarCrossref
Michener  J .  Race, politics, and the Affordable Care Act.   J Health Polit Policy Law. 2020;45(4):547-566. doi:10.1215/03616878-8255481 PubMedGoogle ScholarCrossref
Gee  RE , Shulkin  D , Romm  I .  A blueprint for comprehensive Medicaid reform.   JAMA. 2021;325(7):619-620. doi:10.1001/jama.2021.0013 PubMedGoogle ScholarCrossref
National Association of State Budget Officers. State expenditure report. Accessed July 22, 2022. https://www.nasbo.org/reports-data/state-expenditure-report
US Government Publishing Office. Budget FY 2022: table 15.1: outlays for health programs: 1962-2026. Accessed July 15, 2022. https://www.govinfo.gov/app/details/BUDGET-2022-TAB/BUDGET-2022-TAB-16-1
Medicaid and CHIP Payment and Access Commission. Exhibit 15: Medicaid full-year equivalent enrollment by state and eligibility group, FY 2019 (thousands). Accessed January 15, 2022. https://www.macpac.gov/wp-content/uploads/2015/11/EXHIBIT-15.-Medicaid-Full-Year-Equivalent-Enrollment-by-State-and-Eligibility-Group-FY-2019-thousands.pdf
Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2015. Accessed October 14, 2021. https://www.macpac.gov/wp-content/uploads/2020/07/MACStats-Medicaid-and-CHIP-Data-Book-December-2015.pdf
Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP data book. December 2021. Accessed July 22, 2022. https://www.macpac.gov/wp-content/uploads/2021/12/MACStats-Medicaid-and-CHIP-Data-Book-December-2021.pdf
US Census Bureau. Census Bureau releases analytical report on COVID-19 impact on the 2020 American Community Survey. October 27, 2021. Accessed July 15, 2022. https://www.census.gov/newsroom/press-releases/2021/covid-19-impact-on-2020-acs.html
Kaiser Family Foundation. Medicaid waiver tracker: approved and pending Section 1115 waivers by state. Accessed May 28, 2021. https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/
Primary Care Collaborative. Primary care innovations and PCMH programs by title. Accessed May 28, 2021. https://www.pcpcc.org/initiatives/list
Center for Health Care Strategies Inc. Medicaid accountable care organization programs: state profiles. Accessed February 15, 2022. https://www.chcs.org/resource/medicaid-accountable-care-organization-programs-state-profiles/
Change Healthcare. Value-based care in America: state-by-state. Accessed February 15, 2022. https://www.pcpcc.org/resource/value-based-care-america-state-state
National Academy for State Health Policy. State delivery system and payment reform map. Accessed May 28, 2021. https://www.nashp.org/state-delivery-system-payment-reform-map/#toggle-id-1
Medicaid and CHIP Payment and Access Commission. Delivery System Reform Incentive Payment programs. April 2020. Accessed February 15, 2022. https://www.macpac.gov/publication/delivery-system-reform-incentive-payment-programs/
Centers for Medicare & Medicaid Services. Medicaid.gov. Accessed February 2, 2022. http://www.medicaid.gov
Perez  EO .  Diversity’s Child: People of Color and the Politics of Identity. University of Chicago Press; 2021. doi:10.7208/chicago/9780226799933.001.0001
Congressional Research Service. Medicaid: an overview. Updated February 22, 2021. Accessed February 15, 2022. https://crsreports.congress.gov/product/pdf/R/R43357
Thompson  FJ , Burke  C .  Executive federalism and Medicaid demonstration waivers: implications for policy and democratic process.   J Health Polit Policy Law. 2007;32(6):971-1004. doi:10.1215/03616878-2007-039 PubMedGoogle ScholarCrossref
McMorrow  S , Kenney  GM , Long  SK , Goin  DE .  Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents.   Health Serv Res. 2016;51(4):1347-1367. doi:10.1111/1475-6773.12432 PubMedGoogle ScholarCrossref
Jarlenski  M , Rocco  P , Tipirneni  R , Kennedy  AJ , Gunturi  N , Donohue  J .  Shaping health policy for low-income populations: an assessment of public comments in a new Medicaid waiver process.   J Health Polit Policy Law. 2017;42(6):1039-1064. doi:10.1215/03616878-4193618 PubMedGoogle ScholarCrossref
Centers for Medicare & Medicaid Services. Federal fiscal year (FFY) 2019 statistical enrollment data system (SEDS) reporting. November 10, 2020. Accessed February 15, 2022. https://www.medicaid.gov/chip/downloads/fy-2019-childrens-enrollment-report.pdf
Medicaid and CHIP Payment and Access Commission. Exhibit 14: Medicaid enrollment by state, eligibility group, and dually eligible status, FY 2019 (thousands). Accessed January 15, 2022. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-14.-Medicaid-Enrollment-by-State-Eligibility-Group-and-Dually-Eligible-Status-FY-2019-thousands.pdf
Medicaid and CHIP Payment and Access Commission. Exhibit 19: Medicaid benefit spending per full-year equivalent (FYE) enrollee by eligibility group and service category, FY 2019. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-19.-Medicaid-Benefit-Spending-Per-Full-Year-Equivalent-FYE-Enrollee-by-Eligibility-Group-and-Service-Category-FY-2019.pdf
Medicaid and CHIP Payment and Access Commission. Nursing facilities. Accessed September 15, 2021. https://www.macpac.gov/subtopic/nursing-facilities/
Medicaid and CHIP Payment and Access Commission. Medicaid 101 financing. Accessed September 15, 2021. https://www.macpac.gov/medicaid-101/financing/
Medicaid and CHIP Payment and Access Commission. Exhibit 1: Medicaid and CHIP enrollment as a percentage of the US population. Accessed September 15, 2021. https://www.macpac.gov/publication/medicaid-and-chip-enrollment-as-a-percentage-of-the-u-s-population/
Clemans-Cope  L , Holahan  J , Garfield  R . Medicaid spending growth compared to other payers: a look at the evidence. Kaiser Family Foundation. April 13, 2016. Accessed January 15, 2022. https://www.kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/
Williams  E , Rudowitz  R . The impact of the COVID-19 recession on Medicaid coverage and spending. Kaiser Family Foundation. March 1, 2022. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/the-impact-of-the-covid-19-recession-on-medicaid-coverage-and-spending/#footnote-548447-3
Williams  E , Rudowitz  R , Corallo  B . Fiscal and enrollment implications of Medicaid continuous coverage requirement during and after the PHE ends. Kaiser Family Foundation. May 10, 2022. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/fiscal-and-enrollment-implications-of-medicaid-continuous-coverage-requirement-during-and-after-the-phe-ends/
Franco Montoya  D , Chehal  PK , Adams  EK .  Medicaid managed care’s effects on costs, access, and quality: an update.   Annu Rev Public Health. 2020;41:537-549. doi:10.1146/annurev-publhealth-040119-094345 PubMedGoogle ScholarCrossref
Sparer  M . Medicaid managed care: costs, access, and quality of care. Robert Wood Johnson Foundation. September 2012. Accessed September 15, 2021. https://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf401106
Zuckerman  S , Brennan  N , Yemane  A .  Has Medicaid managed care affected beneficiary access and use?   Inquiry. 2002;39(3):221-242. doi:10.5034/inquiryjrnl_39.3.221 PubMedGoogle ScholarCrossref
Marton  J , Yelowitz  A , Talbert  JC .  A tale of two cities? the heterogeneous impact of Medicaid managed care.   J Health Econ. 2014;36:47-68. doi:10.1016/j.jhealeco.2014.03.001 PubMedGoogle ScholarCrossref
Herring  B , Adams  EK .  Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?   Health Econ. 2011;20(4):446-460. doi:10.1002/hec.1602 PubMedGoogle ScholarCrossref
Draper  DA , Hurley  RE , Short  AC .  Medicaid managed care: the last bastion of the HMO?   Health Aff (Millwood). 2004;23(2):155-167. doi:10.1377/hlthaff.23.2.155 PubMedGoogle ScholarCrossref
Hinton  E , Stolyar  L . Medicaid authorities and options to address social determinants of health (SDOH). Kaiser Family Foundation. August 5, 2021. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/
Medicaid and CHIP Payment and Access Commission. Chapter 3: managed long-term services and supports: status of state adoption and areas of program evolution. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2018/06/Managed-Long-Term-Services-and-Supports-Status-of-State-Adoption-and-Areas-of-Program-Evolution.pdf
Centers for Medicare & Medicaid Services. Long-term services and supports rebalancing toolkit. November 2020. Accessed February 15, 2022. https://www.medicaid.gov/medicaid/long-term-services-supports/downloads/ltss-rebalancing-toolkit.pdf
Medicare Payment Advisory Commission; Medicaid and CHIP Payment and Access Commission. Beneficiaries dually eligible for Medicare and Medicaid. Accessed February 5, 2022. https://www.macpac.gov/wp-content/uploads/2022/02/Beneficiaries-Dually-Eligible-for-Medicare-and-Medicaid-February-2022.pdf
Centers for Medicare & Medicaid Services. Medicare-Medicaid Coordination Office: FY 2019 report to Congress. 2019. Accessed February 15, 2022. https://www.cms.gov/files/document/mmco-report-congress.pdf
Baker  LC , Afendulis  C .  Medicaid managed care and health care for children.   Health Serv Res. 2005;40(5, pt 1):1466-1488. doi:10.1111/j.1475-6773.2005.00427.xPubMedGoogle ScholarCrossref
Ndumele  CD , Cohen  MS , Cleary  PD .  Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.   JAMA Intern Med. 2017;177(10):1445-1451. doi:10.1001/jamainternmed.2017.3766 PubMedGoogle ScholarCrossref
Kaiser Family Foundation. Medicaid delivery system and payment reform: a guide to key terms and concepts. June 2015. Accessed June 1, 2015. https://files.kff.org/attachment/issue-brief-medicaid-delivery-system-and-payment-reform-a-guide-to-key-terms-and-concepts
Centers for Medicare & Medicaid Services. Health Care Innovation Awards. Accessed October 14, 2021. https://innovation.cms.gov/innovation-models/health-care-innovation-awards
McConnell  KJ .  Oregon’s Medicaid coordinated care organizations.   JAMA. 2016;315(9):869-870. doi:10.1001/jama.2016.0206 PubMedGoogle ScholarCrossref
McConnell  KJ , Charlesworth  CJ , Meath  THA , George  RM , Kim  H .  Oregon’s emphasis on equity shows signs of early success for Black and American Indian Medicaid enrollees.   Health Aff (Millwood). 2018;37(3):386-393. doi:10.1377/hlthaff.2017.1282 PubMedGoogle ScholarCrossref
Medicaid and CHIP Payment and Access Commission. Delivery system reform incentive payment programs. April 2020. Accessed July 15, 2022. https://www.macpac.gov/wp-content/uploads/2018/03/Delivery-System-Reform-Incentive-Payment-Programs.pdf
Mohamoud  S , Idala  D , Perez  R , Malomo-Paris  K . Health home program evaluation: CY 2013 to CY 2018. Hilltop Institute, University of Maryland Baltimore County. March 18, 2021. Accessed July 15, 2022. https://www.hilltopinstitute.org/wp-content/uploads/publications/HealthHomeProgramEvaluationCY2013ToCY2018-March2021.pdf
McConnell  KJ , Renfro  S , Chan  BK ,  et al.  Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado.   JAMA Intern Med. 2017;177(4):538-545. doi:10.1001/jamainternmed.2016.9098 PubMedGoogle ScholarCrossref
Shane  DM , Nguyen-Hoang  P , Bentler  SE , Damiano  PC , Momany  ET .  Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa.   Med Care. 2016;54(8):752-757. doi:10.1097/MLR.0000000000000555 PubMedGoogle ScholarCrossref
McGinty  EE , Stone  EM , Kennedy-Hendricks  A ,  et al.  Effects of Maryland’s Affordable Care Act Medicaid Health Home Waiver on quality of cardiovascular care among people with serious mental illness.   J Gen Intern Med. 2020;35(11):3148-3158. doi:10.1007/s11606-020-05690-9 PubMedGoogle ScholarCrossref
McGinty  EE , Kennedy-Hendricks  A , Linden  S , Choksy  S , Stone  E , Daumit  GL .  An innovative model to coordinate healthcare and social services for people with serious mental illness: a mixed-methods case study of Maryland’s Medicaid health home program.   Gen Hosp Psychiatry. 2018;51:54-62. doi:10.1016/j.genhosppsych.2017.12.003 PubMedGoogle ScholarCrossref
Guth  M , Ammula  M . Building on the evidence base: studies on the effects of Medicaid expansion, February 2020 to March 2021. Kaiser Family Foundation. May 6, 2021. Accessed September 15, 2021. https://www.kff.org/medicaid/report/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021/
Kaiser Family Foundation. Status of state Medicaid expansion decisions: interactive map. July 21, 2022. Accessed May 15, 2021. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
Wehby  GL , Lyu  W .  The impact of the ACA Medicaid expansions on health insurance coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.   Health Serv Res. 2018;53(2):1248-1271. doi:10.1111/1475-6773.12711 PubMedGoogle ScholarCrossref
Lee  H , Porell  FW .  The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status.   Med Care Res Rev. 2020;77(5):461-473. doi:10.1177/1077558718808709 PubMedGoogle ScholarCrossref
Baumgartner  JC , Collins  SR , Radley  DC , Hayes  SL .  How the Affordable Care Act has narrowed racial and ethnic disparities in access to health care.  The Commonwealth Fund. January 16, 2020. Accessed August 15, 2021. https://www.commonwealthfund.org/sites/default/files/2020-01/Baumgartner_ACA_racial_ethnic_disparities_db.pdf
Figueroa  JF , Khorrami  P , Bhanja  A , Orav  EJ , Epstein  AM , Sommers  BD .  COVID-19-related insurance coverage changes and disparities in access to care among low-income US adults in 4 southern states.   JAMA Health Forum. 2021;2(8):e212007. doi:10.1001/jamahealthforum.2021.2007 PubMedGoogle ScholarCrossref
Hill  SC , Abdus  S .  The effects of Medicaid on access to care and adherence to recommended preventive services.   Health Serv Res. 2021;56(1):84-94. doi:10.1111/1475-6773.13603 PubMedGoogle ScholarCrossref
Simon  K , Soni  A , Cawley  J .  The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions.   J Policy Anal Manage. 2017;36(2):390-417. doi:10.1002/pam.21972 PubMedGoogle ScholarCrossref
Hendryx  M , Luo  J .  Increased cancer screening for low-income adults under the Affordable Care Act Medicaid expansion.   Med Care. 2018;56(11):944-949. doi:10.1097/MLR.0000000000000984 PubMedGoogle ScholarCrossref
Soni  A , Simon  K , Cawley  J , Sabik  L .  Effect of Medicaid expansions of 2014 on overall and early-stage cancer diagnoses.   Am J Public Health. 2018;108(2):216-218. doi:10.2105/AJPH.2017.304166 PubMedGoogle ScholarCrossref
Miller  S , Johnson  N , Wherry  LR .  Medicaid and mortality: new evidence from linked survey and administrative data.   Quarterly Journal of Economics. 2021;136(3):1783-1829. doi:10.1093/qje/qjab004Google ScholarCrossref
Zewde  N , Eliason  E , Allen  H , Gross  T .  The effects of the ACA Medicaid expansion on nationwide home evictions and eviction-court initiations: United States, 2000-2016.   Am J Public Health. 2019;109(10):1379-1383. doi:10.2105/AJPH.2019.305230 PubMedGoogle ScholarCrossref
Allen  HL , Eliason  E , Zewde  N , Gross  T .  Can Medicaid expansion prevent housing evictions?   Health Aff (Millwood). 2019;38(9):1451-1457. doi:10.1377/hlthaff.2018.05071 PubMedGoogle ScholarCrossref
Callison  K , Walker  B .  Medicaid expansion and medical debt: evidence from Louisiana, 2014-2019.   Am J Public Health. 2021;111(8):1523-1529. doi:10.2105/AJPH.2021.306316 PubMedGoogle ScholarCrossref
Miller  S , Hu  L , Kaestner  R , Mazumder  B , Wong  A . The ACA Medicaid expansion in Michigan and financial health. National Bureau of Economic Research Working Paper Series. Revised March 2020. Accessed September 15, 2021. https://www.nber.org/system/files/working_papers/w25053/w25053.pdf
Zewde  N , Wimer  C .  Antipoverty impact of Medicaid growing with state expansions over time.   Health Aff (Millwood). 2019;38(1):132-138. doi:10.1377/hlthaff.2018.05155 PubMedGoogle ScholarCrossref
Yeung  R .  The effect of the Medicaid expansion on dropout rates.   J Sch Health. 2020;90(10):745-753. doi:10.1111/josh.12937 PubMedGoogle ScholarCrossref
He  Q , Barkowski  S .  The effect of health insurance on crime: evidence from the Affordable Care Act Medicaid expansion.   Health Econ. 2020;29(3):261-277. doi:10.1002/hec.3977 PubMedGoogle ScholarCrossref
Vogler  J .  Access to health care and criminal behavior: short-run evidence from the ACA Medicaid expansions.  SSRN. November 14, 2017. Accessed September 15, 2021. https://ssrn.com/abstract=3042267 doi:10.2139/ssrn.3042267
Fry  CE , McGuire  TG , Frank  RG .  Medicaid Expansion’s spillover to the criminal justice system: evidence from six urban counties.   RSF. 2020;6(2):244-263. doi:10.7758/rsf.2020.6.2.11PubMedGoogle ScholarCrossref
Lindrooth  RC , Perraillon  MC , Hardy  RY , Tung  GJ .  Understanding the relationship between Medicaid expansions and hospital closures.   Health Aff (Millwood). 2018;37(1):111-120. doi:10.1377/hlthaff.2017.0976 PubMedGoogle ScholarCrossref
Hamel  L , Kearny  A , Kirzinger  A , Lopes  L , Brodie  M . KFF health tracking poll: May 2020. Kaiser Family Foundation. May 27, 2020. Accessed July 15, 2022. https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-may-2020/
Grogan  CM , Park  SE .  The racial divide in state Medicaid expansions.   J Health Polit Policy Law. 2017;42(3):539-572. doi:10.1215/03616878-3802977 PubMedGoogle ScholarCrossref
Omi  M , Winant  H .  Racial Formation in the United States. 3rd ed. Routledge; 2014. doi:10.4324/9780203076804
Fording  RC , Patton  DJ .  Medicaid expansion and the political fate of the governors who support it.   Policy Stud J. 2019;47(2):274-299. doi:10.1111/psj.12311 Google ScholarCrossref
Haeder  SF , Sylvester  SM , Callaghan  T .  Lingering legacies: public attitudes about Medicaid beneficiaries and work requirements.   J Health Polit Policy Law. 2021;46(2):305-355. doi:10.1215/03616878-8802198 PubMedGoogle ScholarCrossref
Kaiser Family Foundation. Data note: 5 charts about public opinion on Medicaid. February 28, 2020. Accessed September 15, 2021. https://www.kff.org/medicaid/poll-finding/data-note-5-charts-about-public-opinion-on-medicaid/
Solomon  J . Federal action needed to close Medicaid “coverage gap,” extend coverage to 2.2 million people. Center on Budget and Policy Priorities. May 6, 2021. Accessed September 15, 2021. https://www.cbpp.org/sites/default/files/5-6-21health.pdf
Artiga  S , Orgera  K , Damico  A . Changes in health coverage by race and ethnicity since implementation of the ACA, 2013-2017. Kaiser Family Foundation. February 2019. Accessed September 15, 2021. https://files.kff.org/attachment/Issue-Brief-Health-Coverage-by-Race-and-Ethnicity-Changes-Under-the-ACA
Musumeci  MB . Medicaid provisions in the American Rescue Plan Act. Kaiser Family Foundation. March 18, 2021. Accessed July 15, 2022. https://www.kff.org/medicaid/issue-brief/medicaid-provisions-in-the-american-rescue-plan-act/
Goldman  AL , Sommers  BD .  Among low-income adults enrolled in Medicaid, churning decreased after the Affordable Care Act.   Health Aff (Millwood). 2020;39(1):85-93. doi:10.1377/hlthaff.2019.00378 PubMedGoogle ScholarCrossref
Solomon  J .  Continuous Coverage Protections in Families First Act Prevent Coverage Gaps by Reducing “Churn.” Center on Budget and Policy Priorities; 2020.
Albertson  EM , Scannell  C , Ashtari  N , Barnert  E .  Eliminating gaps in Medicaid coverage during reentry after incarceration.   Am J Public Health. 2020;110(3):317-321. doi:10.2105/AJPH.2019.305400 PubMedGoogle ScholarCrossref
Kumar  NR , Borders  A , Simon  MA .  Postpartum Medicaid extension to address racial inequity in maternal mortality.   Am J Public Health. 2021;111(2):202-204. doi:10.2105/AJPH.2020.306060 PubMedGoogle ScholarCrossref
Thielke  A , Curtis  P , King  V . Addressing COVID-19 health disparities: opportunities for Medicaid programs. Milbank Memorial Fund. June 28, 2021. Accessed September 15, 2021. https://www.milbank.org/publications/addressing-covid-19-health-disparities-opportunities-for-medicaid-programs/
Medicaid and CHIP Payment and Access Commission. Racial and ethnic disparities in Medicaid: an annotated bibliography. April 2021. Accessed September 15, 2021. https://www.macpac.gov/wp-content/uploads/2021/04/Racial-and-Ethnic-Disparities-in-Medicaid-An-Annotated-Bibliography.pdf
Barnett  ML , Clark  KL , Sommers  BD .  State policies and enrollees’ experiences in Medicaid: evidence From a new national survey.   Health Aff (Millwood). 2018;37(10):1647-1655. doi:10.1377/hlthaff.2018.0505 PubMedGoogle ScholarCrossref
Nguyen  KH , Wilson  IB , Wallack  AR , Trivedi  AN .  Racial and ethnic disparities in patient experience of care among nonelderly Medicaid managed care enrollees.   Health Aff (Millwood). 2022;41(2):256-264. doi:10.1377/hlthaff.2021.01331 PubMedGoogle ScholarCrossref
McGregor  B , Li  C , Baltrus  P ,  et al.  Racial and ethnic disparities in treatment and treatment type for depression in a national sample of Medicaid recipients.   Psychiatr Serv. 2020;71(7):663-669. doi:10.1176/appi.ps.201900407 PubMedGoogle ScholarCrossref
Donohue  JM , Jarlenski  MP , Kim  JY ,  et al; Medicaid Outcomes Distributed Research Network (MODRN).  Use of medications for treatment of opioid use disorder among US Medicaid enrollees in 11 states, 2014-2018.   JAMA. 2021;326(2):154-164. doi:10.1001/jama.2021.7374 PubMedGoogle ScholarCrossref
Parekh  N , Jarlenski  M , Kelley  D .  Prenatal and postpartum care disparities in a large Medicaid program.   Matern Child Health J. 2018;22(3):429-437. doi:10.1007/s10995-017-2410-0 PubMedGoogle ScholarCrossref
Lee  H , Hodgkin  D , Johnson  MP , Porell  FW .  Medicaid expansion and racial and ethnic disparities in access to health care: applying the National Academy of Medicine definition of health care disparities.   Inquiry. 2021;58(Jan-Dec):46958021991293.PubMedGoogle Scholar
Centers for Medicare & Medicaid Services. Beneficiary information: race and ethnicity. Accessed October 7, 2021. https://www.medicaid.gov/dq-atlas/landing/topics/single/map?topic=g3m16
State Health & Value Strategies. Collection of race, ethnicity, language (REL) data in Medicaid applications: a 50-state review of the current landscape. May 21, 2021. Accessed July 15, 2022. https://www.shvs.org/resource/collection-of-race-ethnicity-language-rel-data-in-medicaid-applications-a-50-state-review-of-the-current-landscape/
Smithey  A , Patel  S ; Center for Health Care Strategies. Building a culture of health equity from within: spotlight on Virginia Medicaid. June 14, 2021. Accessed September 20, 2021. https://www.chcs.org/building-a-culture-of-health-equity-from-within-spotlight-on-virginia-medicaid/
Office of Minority Health, Centers for Medical & Medicaid Services. Paving the way to equity: a progress report. Accessed September 20, 2021. https://www.cms.gov/files/document/paving-way-equity-cms-omh-progress-report.pdf
Cook  BL .  Effect of Medicaid managed care on racial disparities in health care access.   Health Serv Res. 2007;42(1, pt 1):124-145. doi:10.1111/j.1475-6773.2006.00611.x PubMedGoogle ScholarCrossref
Marton  J , Yelowitz  A , Shores  M , Talbert  JC .  Does Medicaid managed care help equalize racial and ethnic disparities in utilization?   Health Serv Res. 2016;51(3):872-891. doi:10.1111/1475-6773.12396 PubMedGoogle ScholarCrossref
Bindman  AB , Chattopadhyay  A , Osmond  DH , Huen  W , Bacchetti  P .  The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions.   Health Serv Res. 2005;40(1):19-38. doi:10.1111/j.1475-6773.2005.00340.x PubMedGoogle ScholarCrossref
Aizer  A , Currie  J , Moretti  E .  Does managed care hurt health? evidence from Medicaid mothers.   Rev Econ Stat. 2007;89(3):385-399. doi:10.1162/rest.89.3.385 Google ScholarCrossref
Kuziemko  I , Meckel  K , Rossin-Slater  M .  Does managed care widen infant health disparities? evidence from Texas Medicaid.   Am Econ J Econ Policy. 2018;10(3):255-293. doi:10.1257/pol.20150262 Google ScholarCrossref
Swaminathan  S , Ndumele  CD , Gordon  SH , Lee  Y , Trivedi  AN .  Association of Medicaid-focused or commercial Medicaid managed care care plan type with outpatient and acute care.   JAMA Intern Med. 2020;180(12):1672-1679. doi:10.1001/jamainternmed.2020.5408 PubMedGoogle ScholarCrossref
Wallace  J . What does a provider network do? evidence from random assignment in Medicaid managed care. SSRN. May 7, 2019. Accessed August 15, 2021. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544928
Bailit Health. Medicaid managed care contract language: health disparities and health equity. August 2021. Accessed September 20, 2021. https://www.shvs.org/wp-content/uploads/2021/02/SHVS-MCO-Contract-Language-Health-Equity-and-Disparities_August-2021.pdf
Taylor  E , Dyer  MB , Bailit  M . Promoting health equity in Medicaid managed care: a guide for states. Bailit Health. September 9, 2021. Accessed July 15, 2022. https://www.shvs.org/resource/promoting-health-equity-in-medicaid-managed-care-a-guide-for-states/
US Department of Health and Human Services Office of Minority Health. Think Cultural Health. Updated October 2, 2018. Accessed September 30, 2021. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53
Pennsylvania Department of Human Services. Pennsylvania receives grant funding to promote racial equity in pregnancy and child health. September 9, 2021. Accessed July 15, 2022. https://www.media.pa.gov/Pages/DHS_details.aspx?newsid=746
Brooks-LaSure  C , Fowler  E , Seshamani  M , Tsai  D . Innovation at the centers for Medicare and Medicaid Services: a vision for the next 10 years. Health Affairs. August 12, 2021. Accessed August 28, 2021. https://www.healthaffairs.org/do/10.1377/hblog20210812.211558/full/
Agniel  D , Martino  SC , Burkhart  Q ,  et al.  Incentivizing excellent care to at-risk groups with a health equity summary score.   J Gen Intern Med. 2021;36(7):1847-1857. doi:10.1007/s11606-019-05473-x PubMedGoogle ScholarCrossref
Holgash  K , Heberlein  M . Physician acceptance of new Medicaid patients: Medicaid and CHIP Payment and Access Commission. January 24, 2019. Accessed July 25, 2022. https://www.macpac.gov/wp-content/uploads/2019/01/Physician-Acceptance-of-New-Medicaid-Patients.pdf
Gaskin  DJ , Dinwiddie  GY , Chan  KS , McCleary  RR .  Residential segregation and the availability of primary care physicians.   Health Serv Res. 2012;47(6):2353-2376. doi:10.1111/j.1475-6773.2012.01417.x PubMedGoogle ScholarCrossref
Vinekar  K .  Pathology of racism: a call to desegregate teaching hospitals.   N Engl J Med. 2021;385(13):e40. doi:10.1056/NEJMpv2113508 PubMedGoogle ScholarCrossref
Kangovi  S , Mitra  N , Norton  L ,  et al.  Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial.   JAMA Intern Med. 2018;178(12):1635-1643. doi:10.1001/jamainternmed.2018.4630 PubMedGoogle ScholarCrossref
Silver  JK , Bean  AC , Slocum  C ,  et al.  Physician workforce disparities and patient care: a narrative review.   Health Equity. 2019;3(1):360-377. doi:10.1089/heq.2019.0040 PubMedGoogle ScholarCrossref
Howell  EA , Egorova  NN , Janevic  T ,  et al.  Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities.   Obstet Gynecol. 2020;135(2):285-293. doi:10.1097/AOG.0000000000003667 PubMedGoogle ScholarCrossref
Maina  IW , Belton  TD , Ginzberg  S , Singh  A , Johnson  TJ .  A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.   Soc Sci Med. 2018;199:219-229. doi:10.1016/j.socscimed.2017.05.009 PubMedGoogle ScholarCrossref
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