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Medicaid Expansion and Frequent Mental Distress Among U.S. Adults: Staggered DiD Using BRFSS, 2011 to 2024.

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Title: Medicaid Expansion and Frequent Mental Distress Among U.S. Adults: Staggered DiD Using BRFSS, 2011 to 2024.
Authors: Adegoke, Abimbola1,2 (AUTHOR) abimbola.adegoke01@utrgv.edu, Adegoke, Kola1,3 (AUTHOR), Durojaye, Olajide Alfred4 (AUTHOR), Dawodu, Deborah2 (AUTHOR), Aluko, Abiodun Isola5 (AUTHOR), Adekoya, Akorede6 (AUTHOR), Knapp, Kenneth A.3 (AUTHOR)
Source: Inquiry (00469580). 4/13/2026, Vol. 63, p1-12. 12p.
Subject Terms: *Retrospective studies, *Adults, Medicaid law, Risk assessment, Cross-sectional method, Mental health, Psychological distress, Income, Health policy, Scientific observation, Descriptive statistics, Data analysis software, Confidence intervals, Patient Protection & Affordable Care Act, Poverty
Geographic Terms: United States
Abstract: The Affordable Care Act (ACA) allowed states to expand Medicaid eligibility, potentially improving access to care and reducing psychological distress among lower-income adults. However, evidence on population-level mental health effects remains mixed, and conventional two-way fixed-effects difference-in-differences (DiD) estimates can be biased under staggered adoption. This study estimates the effect of Medicaid expansion on frequent mental distress (FMD) among non-elderly adults, with emphasis on lower-income adults. We used Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2024 and restricted the sample to adults aged 18 to 64 years. FMD was defined as ≥14 days of poor mental health in the past 30 days. Medicaid expansion was assigned by state implementation year. For transparent weighting and computational feasibility, we collapsed microdata to state-year prevalence using BRFSS survey weights and applied prespecified minimum cell-size and effective-sample screens (lower-income panel: unweighted N ≥ 150 and Kish n_eff ≥ 50; pooled and higher-income panels: n_eff ≥ 200). We estimated group-time average treatment effects using the Callaway–Sant'Anna staggered DiD framework (csdid), clustered standard errors at the state level, and used pair-balanced observations when panels were unbalanced. Income strata were defined using BRFSS household income categories (lower-income: inc_cat = 1; higher-income: inc_cat ∈ {7,8}) and are interpreted as economic-status proxies rather than Medicaid eligibility. In the lower-income state-year panel (353 state-years), Medicaid expansion was not associated with a statistically significant change in FMD (ATT −0.0125; 95% CI −0.0521 to 0.0271; P =.54). Estimates in the higher-income (656 state-years) and pooled (709 state-years) panels were similarly small and not statistically significant. Event-time estimates indicated modest heterogeneity at selected leads/lags without a consistent post-expansion pattern. Medicaid expansion was not associated with significant reductions in population-level frequent mental distress during 2011 to 2024. Any mental health effects appear modest and heterogeneous across cohorts and follow-up periods, suggesting that insurance expansion alone may be insufficient to shift population psychological distress without complementary behavioral health capacity and upstream social supports. Plain Language Summary: Medicaid expansion under the Affordable Care Act increased health insurance coverage for many low-income adults, which could improve mental health by reducing financial stress and improving access to care. We studied whether Medicaid expansion changed the share of adults reporting "frequent mental distress," defined as 14 or more days of poor mental health in the past 30 days. Using BRFSS data from 2011–2024, we compared changes in frequent mental distress in states that expanded Medicaid to changes in states that had not yet expanded at the same time. Because states expanded in different years, we used an approach designed for staggered policy adoption and estimated effects separately for low-income, high-income, and all adults aged 18–64. Overall, average effects were small and not statistically distinguishable from zero, although some expansion cohorts showed statistically significant changes in certain years after expansion. These results suggest that Medicaid expansion alone may have limited population-level effects on frequent mental distress. [ABSTRACT FROM AUTHOR]
Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Medicaid Expansion and Frequent Mental Distress Among U.S. Adults: Staggered DiD Using BRFSS, 2011 to 2024.
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  Data: <searchLink fieldCode="AR" term="%22Adegoke%2C+Abimbola%22">Adegoke, Abimbola</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<i> abimbola.adegoke01@utrgv.edu</i><br /><searchLink fieldCode="AR" term="%22Adegoke%2C+Kola%22">Adegoke, Kola</searchLink><relatesTo>1,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Durojaye%2C+Olajide+Alfred%22">Durojaye, Olajide Alfred</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dawodu%2C+Deborah%22">Dawodu, Deborah</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Aluko%2C+Abiodun+Isola%22">Aluko, Abiodun Isola</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Adekoya%2C+Akorede%22">Adekoya, Akorede</searchLink><relatesTo>6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Knapp%2C+Kenneth+A%2E%22">Knapp, Kenneth A.</searchLink><relatesTo>3</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Inquiry+%2800469580%29%22">Inquiry (00469580)</searchLink>. 4/13/2026, Vol. 63, p1-12. 12p.
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  Data: The Affordable Care Act (ACA) allowed states to expand Medicaid eligibility, potentially improving access to care and reducing psychological distress among lower-income adults. However, evidence on population-level mental health effects remains mixed, and conventional two-way fixed-effects difference-in-differences (DiD) estimates can be biased under staggered adoption. This study estimates the effect of Medicaid expansion on frequent mental distress (FMD) among non-elderly adults, with emphasis on lower-income adults. We used Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2024 and restricted the sample to adults aged 18 to 64 years. FMD was defined as ≥14 days of poor mental health in the past 30 days. Medicaid expansion was assigned by state implementation year. For transparent weighting and computational feasibility, we collapsed microdata to state-year prevalence using BRFSS survey weights and applied prespecified minimum cell-size and effective-sample screens (lower-income panel: unweighted N ≥ 150 and Kish n_eff ≥ 50; pooled and higher-income panels: n_eff ≥ 200). We estimated group-time average treatment effects using the Callaway–Sant'Anna staggered DiD framework (csdid), clustered standard errors at the state level, and used pair-balanced observations when panels were unbalanced. Income strata were defined using BRFSS household income categories (lower-income: inc_cat = 1; higher-income: inc_cat ∈ {7,8}) and are interpreted as economic-status proxies rather than Medicaid eligibility. In the lower-income state-year panel (353 state-years), Medicaid expansion was not associated with a statistically significant change in FMD (ATT −0.0125; 95% CI −0.0521 to 0.0271; P =.54). Estimates in the higher-income (656 state-years) and pooled (709 state-years) panels were similarly small and not statistically significant. Event-time estimates indicated modest heterogeneity at selected leads/lags without a consistent post-expansion pattern. Medicaid expansion was not associated with significant reductions in population-level frequent mental distress during 2011 to 2024. Any mental health effects appear modest and heterogeneous across cohorts and follow-up periods, suggesting that insurance expansion alone may be insufficient to shift population psychological distress without complementary behavioral health capacity and upstream social supports. Plain Language Summary: Medicaid expansion under the Affordable Care Act increased health insurance coverage for many low-income adults, which could improve mental health by reducing financial stress and improving access to care. We studied whether Medicaid expansion changed the share of adults reporting "frequent mental distress," defined as 14 or more days of poor mental health in the past 30 days. Using BRFSS data from 2011–2024, we compared changes in frequent mental distress in states that expanded Medicaid to changes in states that had not yet expanded at the same time. Because states expanded in different years, we used an approach designed for staggered policy adoption and estimated effects separately for low-income, high-income, and all adults aged 18–64. Overall, average effects were small and not statistically distinguishable from zero, although some expansion cohorts showed statistically significant changes in certain years after expansion. These results suggest that Medicaid expansion alone may have limited population-level effects on frequent mental distress. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=192982129
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        Value: 10.1177/00469580261441768
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      – Code: eng
        Text: English
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      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Medicaid law
        Type: general
      – SubjectFull: Risk assessment
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      – SubjectFull: Cross-sectional method
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      – SubjectFull: Mental health
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      – SubjectFull: Psychological distress
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      – SubjectFull: Income
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      – SubjectFull: Health policy
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      – SubjectFull: Data analysis software
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      – SubjectFull: Confidence intervals
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      – SubjectFull: United States
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      – TitleFull: Medicaid Expansion and Frequent Mental Distress Among U.S. Adults: Staggered DiD Using BRFSS, 2011 to 2024.
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              Text: 4/13/2026
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