Association for Public Policy Analysis & Management

For many individuals with disabilities, maintaining health insurance coverage is a top priority. This is especially true for those who are low income and may rely on medical care to manage complex health conditions and stay in the labor force. Some individuals with significant disabilities who are not eligible for employer coverage may apply for federal disability benefits through Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) because of the Medicare and Medicaid coverage respectively offered by each program.  

In this study, we estimate the impact of Medicaid expansions on the number of SSI and SSDI applications using data collected on disability applicants by the Social Security Administration. Our findings will provide important insight into whether the new availability of health insurance coverage changes incentives for individuals with disabilities to apply for SSI and SSDI benefits.

For each state that expanded Medicaid eligibility after 2014 through the ACA, we selected a set of non-expansion states based on their pre-ACA Medicaid policies as potential comparison states. We then matched geographic areas (Public Use Microdata Areas, PUMAs) in each expansion state to those in the potential comparison states, accounting for pre-2014 trends in SSI and SSDI applications, demographics and socioeconomic characteristics to produce a composite comparison “state” that closely resembles the expansion state. Data for the matching model is drawn from SSA records as well as from publicly available survey data.

Using the matched expansion and comparison states, we conduct a difference-in-difference regression estimation approach, to estimate the impact of the ACA Medicaid expansions on SSI and SSDI applications from working-age adults in 2014 and 2015.