Medicaid expansion under the Affordable Care Act was found to improve self-reported diabetes management and self-reported health outcomes in patients with type 1 or type 2 diabetes, according to study results published in Diabetes Care.

The passage of the Affordable Care Act in 2010, which intended to reduce uninsured rates, increase preventive care, and improve healthy lifestyle choices, has led to a historic change in the United States healthcare system. In January 2014, states had the option to implement an expansion of Medicaid to all individuals earning <138% of the federal poverty level.

The goal of the current study was to assess the effect of Medicaid expansion on diabetes management for low-income adults through a comparison of Medicaid expansion and nonexpansion states.

The researchers collected data on patients with diabetes from the Behavioral Risk Factor Surveillance System between 2011 and 2016. They used a quasi-experimental method, difference-in-differences modeling, which evaluated the effects of policy implementation by comparing changes in outcomes after Medicaid expansion.

At baseline (2011-2013), 6138 patients (57.9% women) were from Medicaid nonexpansion states, and 6230 patients (53.4% women) were from Medicaid expansion states. The score for self-reported access to health care was significantly higher in the Medicaid expansion group compared with the Medicaid nonexpansion group (1.42 vs 1.33; P =.000), but there were no statistically significant differences for self-reported diabetes management or health status.

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However, after adjusting for several population characteristics, there were significant improvements in Medicaid expansion states in self-reported access to health care (estimated score change, 0.09; P =.023), self-reported diabetes management (estimated score change, 1.91; P =.001), and self-reported health status (estimated score change, 0.10; P =.026) compared with Medicaid nonexpansion states.

Among states with high diabetes rates, a comparison between Medicaid expansion and Medicaid nonexpansion groups showed a significant difference in self-reported access to health care (estimated score change, 0.20; P =.000) and self-reported health status (estimated score change, 0.17; P ≤.000). There was a trend toward better self-reported diabetes management scores (estimated score change, 1.63; P =.055).

The researchers noted that the study had several limitations. Among them were the cross-sectional design, self-reported data, and inclusion of only a subset of indicators for diabetes management.

“[T]he findings of the current study provide policy implications not just for the diabetes care community, but also for policy makers at all levels in America in their efforts toward diabetes management and its control,” concluded the researchers.


Lee J, Callaghan T, Ory M, Zhao H, Bolin JN. The impact of Medicaid expansion on diabetes management [published online October 24, 2019]. Diabetes Care. doi:10.2337/dc19-1173