Medicaid accounts for one-fifth of U.S. health care spending and covers more than a quarter of Americans. LDI researchers have examined the services it provides in supporting aging adults, people with disabilities, and children, as well as its role in health crises such as chronic disease and suicide. They have also studied its role in the health care sector and its effects on workers and local economies. Below are select key findings from recent peer-reviewed research, along with expert insights for policymakers considering changes to Medicaid funding in the federal budget.

Making Medicare Affordable

Medicaid supplemental insurance covers most cost-sharing for low-income individuals on Medicare. The loss of eligibility for Medicaid supplemental insurance was associated with lower outpatient care use and fewer prescriptions filled among Black and Hispanic beneficiaries.

Medicaid helps make Medicare affordable for low-income older adults and people with disabilities; without it, many may avoid care, and health disparities will worsen.

Source: Roberts, E.T., Youngmin, K., Hames, A.G., McWilliams, J.M., Ayanian, J.Z., Tipirneni, R. 2023. “Racial and Ethnic Disparities in Health Care Use and Access Associated with Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level.” JAMA Internal Medicine.

---

Imposing Medicaid Work Requirements

Efforts to tie work or community engagement to benefits may reduce participation among those covered by the requirements and among those who are not. While public opinion supports work requirements, it does not support cutting coverage for noncompliance.

The evidence suggests that work requirements in social safety net programs like Medicaid or SNAP introduce costly administrative burdens that reduce participation among those who may need these programs the most.

Sources: Venkataramani, A. S., Bair, E. F., Dixon, E., Linn, K. A., Ferrell, W., Montgomery, M., Strollo, M. K., Volpp, K. G., and Underhill, K. 2019. “Assessment of Medicaid Beneficiaries Included in Community Engagement Requirements in Kentucky.” JAMA Network Open; and, Venkataramani, A. S., Bair, E. F., Dixon, E., Linn, K. A., Ferrell, W. J., Volpp, K. G., and Underhill, K. 2020. “Association Between State Policies Using Medicaid Exclusions to Sanction Noncompliance With Welfare Work Requirements and Medicaid Participation Among Low-Income Adults.” JAMA Network Open; and, Underhill, K., Bair, E. F., Dixon, E. L., Ferrell, W. J., Linn, K.A., Volpp, K.G., and Venkataramani, A.S., 2023. “Public Views on Medicaid Work Requirements and Mandatory Premiums in Kentucky.” JAMA Health Forum.

---

Supporting Safety Net and Rural Hospitals

Medicaid expansion was associated with decreased uncompensated care and increased operating margins at safety net hospitals. Conversely, closures of rural hospitals, many of which rely on Medicaid, are associated with significant reductions in health care sector employment.

Changes in Medicaid revenue may not only threaten the institutions that serve patients at greatest risk for poor health but may also have implications for health care sector employment, especially in rural areas.

Sources: Chatterjee, P. Qi, M., and Werner, R.M. 2021. “Association of Medicaid Expansion With Quality in Safety-Net Hospitals.” JAMA Internal Medicine; and, Chatterjee, P., Lin, Y., and Venkataramani, A.S. 2022. “Changes in Economic Outcomes Before and After Rural Hospital Closures in the United States: A Difference-in-Differences Study.” Health Services Research.

---

Expanding the Long-term Care Workforce

Demand for Medicaid-funded home- and community-based services has grown. However, the workforce to support this demand has lagged. Currently, there is a larger demand for home- and community-based services than there is available workforce, creating a clear opportunity for job expansion.

There is an immense need for workers to care for aging adults who want to age at home. A robustly funded Medicaid program can make that possible and create employment opportunities.

Source: Kreider, A.R., and Werner, R.M., 2023. “The Home Care Workforce Has Not Kept Pace with Growth in Home and Community-Based Services.” Health Affairs.

---

Caregiving for Older Adults and People with Disabilities

Medicaid provides coverage for services that allow older adults and people with disabilities to live in the community. Losing those services could increase nursing home use or unpaid caregiving, impacting the costs to families and the larger economy.

Medicaid covers half of total U.S. spending on long-term services and supports for nearly 6 million enrollees. Changes to that benefit will be felt far and wide—affecting patients, families, health care, and Medicare spending—and will disrupt the labor market and impact tax revenue.

Sources: Coe, N.B., Skira, M.M., and Larson, E.B. 2018. “A Comprehensive Measure of the Costs of Caring for a Parent: Differences According to Functional Status.” Journal of the American Geriatrics Society and Coe, N.B., Goda, G.S., and Van Houtven, C.H., 2023. “Family Spillovers and Long-Term Care Insurance.” Journal of Health Economics.

---

Preventing Suicide

Medicaid is part of a health infrastructure that can help identify and address risk factors for suicide, especially when it integrates data that is collected in silos, such as involvement with the criminal justice system.

We know that Medicaid can be a protective factor against suicide. If you are insured, you can access mental health and substance use services that you can’t afford when you’re not insured.

Source: Candon, M., Fox, K., Jager-Hyman, S., Jang, M., Augustin, R., Cantiello, H., Colton, L., Drake, R., Futterer, A., Kessel, P., Kwon, N., Levin, S., Maddox, B., Parrish, C., Robbins, H., Shen, S., Smith, J. L., Ware, N., Shoyinka, S., & Lim, S. 2023. “Building an Integrated Data Infrastructure to Examine the Spectrum of Suicide Risk Factors in Philadelphia Medicaid.” Administration and Policy in Mental Health and Mental Health Services Research.

---

Supporting Pregnancy Care

Medicaid plays a substantial role in pre-pregnancy care, and the care it provides between pregnancies can reduce future pregnancy complications.

Medicaid takes care of women and infants during important developmental windows, playing a critical role in multigenerational disease prevention.

Source: Gregory, E.F., Passarella, M., Levine, L.D., Lorch, S.A., 2022. “Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women.” Journal of Women’s Health.

---

Addressing the Overdose Crisis

Medicaid innovations, such as mobile and low-barrier treatment of opioid use disorder, are key to reaching and treating people with substance use disorder.

Medicaid plays a fundamental role in combating the overdose epidemic as the largest payor for opioid use disorder treatment in the U.S. We are finally seeing overdose numbers start to decline, sustained access to Medicaid is critical to keeping that trend going.

Source: Lowenstein, M., Abrams, M.P., Crowe, M., Shimamoto, K., Mazzella, S., Botcheos, D., Bertocchi, J., Westfahl, S., Chertok, J., Garcia, K.P., Truchil, R.P., Holliday-Davis, M., Aronowitz, S., 2023. “Come Try It Out. Get Your Foot in the Door: Exploring Patient Perspectives on Low-Barrier Treatment for Opioid Use Disorder.” Drug and Alcohol Dependence.

---

Keeping Kids Covered

Examining coverage changes during and after the COVID-19 pandemic reveals that 12-month and multi-year continuous eligibility policies targeting young children enrolled in Medicaid and CHIP have the potential to improve children’s coverage stability and access to care over time.

Policies that reduce Medicaid-related administrative burdens, like continuous eligibility, can boost enrollment and improve access to care. Policies that increase these administrative burdens—like work requirements and restrictions on coverage—could keep children and adults from accessing the care they need to stay healthy.

Sources: Vasan, A., Kenyon, C. C., Fiks, A. G., and Venkataramani, A. S., 2023. “Continuous Eligibility and Coverage Policies Expanded Children’s Medicaid Enrollment.” Health Affairs; and, Eliason, E., Nelson, D., and Vasan, A., 2025. “Continuous Eligibility Policies and CHIP Structure Affected Children’s Coverage Loss During Medicaid Unwinding.” Health Affairs.

---

Author

---