Public Health Insurance and Mortality Among People with Disabilities - People living with disabilities experience worse health outcomes, greater unmet healthcare needs, and higher mortality, yet evidence on the causes of death and how mortality varies across groups remains limited. It is unclear whether health insurance coverage is sufficient to improve healthcare access, utilization, and health for this population. The proposed research will address these gaps by leveraging two sources of variation in Medicaid coverage: Medicaid expansions and state transitions from 209(b) to 1634 status, which automatically enroll eligible Supplemental Security Income recipients in Medicaid. First, we will characterize all-cause and cause-specific mortality among people with disabilities and examine variation by self-reported disability, SSA-defined primary impairment, race and ethnicity, sex, education, and rurality. Second, we will use quasi-experimental methods to estimate how Medicaid expansion and automatic enrollment affect insurance coverage and mortality, while exploratory analyses will examine realized access to care, healthcare utilization, and self-reported health. Third, we will use stratified and machine-learning methods to identify populations that experience larger, smaller, or no changes in coverage, care, and mortality. By linking changes in coverage to downstream changes in care and health, the project will identify where insurance alone is sufficient and where additional supports may be needed. For example, coverage gains without increased healthcare use may point to a need for outreach, navigation, or care coordination, while increased utilization without health improvement may indicate a need to strengthen the quality or continuity of care. Cause-specific mortality findings will also identify the populations and conditions for which evidence-based screening, prevention, treatment, and disease-management services should be prioritized. These findings will help clinicians, health systems, and disability-serving organizations direct resources toward improving health and reducing preventable mortality among people with disabilities.
