Medicaid expansion and adolescents' readiness for transition to adult health insurance

In participating states, Medicaid expansion under the Affordable Care Act (ACA) increased availability of health insurance to low-income young adults. We examined the impact of Medicaid expansion on low-income families' knowledge of how adolescents ages 12-17 would obtain insurance coverage upon transitioning to adulthood, compared to families in states that did not expand Medicaid. Based on 2016-2019 data from the National Survey of Children's Health, caregivers in Medicaid-expansion states were more likely to report knowing how their adolescents would have continued coverage, compared to caregivers in states that opted out of Medicaid expansion (odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.06, 1.70; p = 0.016). The association was strongest for adolescents currently covered by public insurance (OR: 1.50; 95% CI: 1.10, 2.05; p = 0.011), indicating that expansion of public insurance eligibility among adults can help with planning the transition to adult health care for publicly-insured adolescents.