As of July 2017, 32 states and the District of Columbia had expanded Medicaid eligibility to include nonelderly adults with incomes up to 138% of the federal poverty level, as allowed under the Affordable Care Act (ACA). Literature reviews associating expansion with improvements in health and well-being and other outcomes have been limited by a number of factors: authors have not systematically synthesized data; some studies included non-peer-reviewed publications; and in the case of some outcomes, such as changes in the overall health of the insured, there has not been enough time since the implementation of Medicaid expansion for population-level changes to become evident, according to the authors of a systematic review of 77 peer-reviewed, published studies evaluating the impact of Medicaid expansion on health insurance coverage, access to care, and other ACA goals.

The studies reviewed were published between January 2014 and September 2017. They included a total of 440 analyses, 61% of which showed significant effects of expansion "consistent with" ACA goals and 35% of which found no significant effect. Of the analyses that involved access to care, three-quarters found that insurance coverage improved after expansion. Of the analyses that looked at the use of health services, more than half reported improvements, including increases in the use of primary care, mental health services, and preventive care visits, as well as decreases in the length of hospital stays. Although some studies found increases in the numbers of hospitalizations and ED visits, others found the opposite.

Analyses of health and quality of care-related outcomes identified improvements in glucose monitoring rates and hypertension control and increases in rates of prostate cancer screening and Pap testing. Also reported were lower rates of psychological distress and poor mental health, according to self-report. Of the nine cost-of-care analyses, three-quarters reported increased Medicaid spending, which included increased prescription drug reimbursements.

The authors conclude that although more study is needed, the review illustrates that Medicaid expansion has so far resulted in improvements in access to care, quality of care, and as far as can be determined, health.-EM

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