Medicaid Policy and Access to Care: Evidence on Utilization, Outcomes, and System Design

Session Submission Type: Panel

Abstract

Medicaid plays a central role in the U.S. safety net, covering over 80 million individuals and shaping access to care for low-income populations. While much of the existing literature focuses on coverage expansions, a growing body of work emphasizes that the design, financing, and administration of Medicaid policies can generate meaningful variation in access, utilization, and outcomes. Recent policy changes, including the expansion of non-traditional benefits, increased reliance on provider financing mechanisms, and the introduction of administrative conditions such as work requirements, have created new opportunities to study how Medicaid influences both health and broader social outcomes. These developments highlight that Medicaid is not a uniform program, but rather a collection of state-level policy choices with heterogeneous effects across populations and domains. Researchers are increasingly leveraging quasi-experimental variation across states and over time, combined with administrative and survey data, to identify the causal impacts of these policies. This panel presents four papers that examine how different dimensions of Medicaid policy affect access to care, health outcomes, and related social behaviors. The first paper studies barriers to digital health access through an analysis of patient portal adoption in Los Angeles County. Using survey data, interviews, and equity-centered frameworks, it documents how structural factors such as digital literacy, language access, and institutional fragmentation limit effective engagement with digital health tools among underserved populations. The second paper evaluates the effects of Medicaid doula coverage mandates on infant health outcomes. Using a state-year panel and a staggered difference-in-differences design, it finds that doula coverage reduces rates of low birth weight and very low birth weight, with larger improvements among disadvantaged groups. The third paper examines the fiscal consequences of Medicaid provider taxes, exploiting staggered adoption across states from 1997 to 2024. The results show that these taxes lead to sustained increases in Medicaid spending, consistent with states using them to draw down additional federal matching funds. The fourth paper analyzes the effects of conditional Medicaid expansion under Georgia’s Pathways program on drug-related arrest patterns. Using state-month data and a difference-in-differences framework, it finds heterogeneous effects across arrest categories, suggesting that administrative burdens and partial coverage expansions may alter interactions with the criminal justice system. Taken together, these papers demonstrate that Medicaid policy influences outcomes well beyond insurance coverage, shaping access to care, health outcomes, system-level incentives, and interactions with other institutions. The panel provides new evidence on the mechanisms through which Medicaid policies operate and informs ongoing debates about program design and reform.

Policy Area

• Health Policy

Chair

• Jaehyun Choi, Indiana University

Discussants

• Pierre K. Alexandre, Florida Atlantic University

• Adam Ira Biener, Lafayette College

Organizer

• Jaehyun Choi, Indiana University

Individual Presentations

• DIGITAL HEALTH INEQUITY: Increasing Use of Digital Health Portals in Los Angeles County - Presenting Author: OMOLOLA ATOLAGBE, University of California - Los Angeles

• Federal Incentives, State Strategy: The Spending Effects of Medicaid Provider Taxes - Presenting Author: Lady Loveday Ikeya, Indiana University

• Work Requirements, Surveillance, and the Street: How Conditional Medicaid Expansion Reshapes Drug-Related Arrest Patterns - Presenting Author: Joanne Constantin, State University of New York (SUNY) Downstate Health Sciences University