COVID-19-related Medicaid enrollment in Medicaid expansion and non-expansion states

Joseph A. Benitez, Lisa Dubay

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Research Objective: To explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, which could also be the case for job losses during the COVID-19 pandemic. Expanded access to Medicaid may insulate some households from long uninsurance gaps due to job loss. Data Source: Phase 1 of the Census Bureau's Experimental Household Pulse Survey covering April 23, 2020–July 21, 2020. Study Design: We compare differences in health insurance coverage source and status linked to recent lob losses attributable to the COVID-19 pandemic in states that expanded Medicaid against states that did not expand Medicaid. Data Collection/Extraction Methods: Our analytical dataset was limited to 733,181 non-elderly adults aged 20–64. Principal Findings: Twenty-six percent of our study sample experienced an income loss between March 13, 2020, and the time leading up to the survey—16% experienced job losses (e.g., layoff, furlough) due to the COVID-19 crisis, and 11% had other reasons they were not working. COVID-linked job losses were associated with a 20 (p < 0.01) percentage-point (PPT) lower likelihood of having employer-sponsored health insurance (ESI). Relative to persons in states that did not expand Medicaid, persons in Medicaid expansion states experiencing COVID-linked job losses were 9 PPT (p < 0.01) more likely to report having Medicaid and 7 PPT (p < 0.01) less likely to be uninsured. The largest increases in Medicaid enrollment were among people who, based on their 2019 incomes, would not have qualified for Medicaid previously. Conclusions: Our findings suggest that expanded Medicaid eligibility may allow households to stabilize health care needs and they should become detached from private health coverage due to job loss during the pandemic. Households negatively affected by the pandemic are using Medicaid to insure themselves against the potential health risks they would incur while being unemployed.

Original languageEnglish
Pages (from-to)1321-1331
Number of pages11
JournalHealth Services Research
Issue number6
StatePublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.


  • COVID-19
  • Medicaid
  • affordable care act
  • health reform
  • state health policy
  • unemployment

ASJC Scopus subject areas

  • Health Policy


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