The impact of Medicaid expansion on coverage among those lacking housing basics, 2010-2019

Introduction Housing is a critical social determinant of health, and individuals living in substandard housing often face greater healthcare needs and financial burdens. Expanding health insurance is therefore especially important for this population. However, little is known about whether the Affordable Care Act's Medicaid expansion affected disparities in coverage by housing quality. We examined whether Medicaid expansion improved insurance coverage equitably among low-income individuals living in homes with and without basic housing necessities. Methods Using nationally representative survey data from 2010-2019, we compared changes in insurance coverage before and after expansion in states that expanded Medicaid eligibility vs those that did not. Results Medicaid expansion increased Medicaid coverage by more than 12% points and reduced uninsurance by 6%-7% points relative to non-expansion states among individuals lacking at least one basic housing necessity. However, compared with individuals with complete housing necessities, those lacking at least one basic housing necessity experienced slightly smaller increases in Medicaid coverage and smaller reductions in uninsurance. Conclusion Medicaid expansion improved coverage among individuals facing housing-related disadvantage but did not eliminate disparities. Eligibility-based expansions can extend coverage to structurally disadvantaged populations, but additional efforts to address non-financial barriers may be needed.