Structural determinants of Medicaid enrollment in late life.

objectivesThe objective of the study was to examine whether two state-level measures of policy context and racialized public opinion are differentially associated with Medicaid enrollment among adults aged 50 and above across social locations.

methodsMultilevel logistic regression models were estimated to assess structural and individual factors associated with Medicaid enrollment among adults aged 50 or above using data from 10 waves of the Health and Retirement Study in combination with a Medicaid generosity index (MGI) and a racial resentment (RR) score. Age- and race-stratified models were constructed to examine between- and within-population variation.

resultsA higher MGI is associated with greater enrollment probability for adults aged 50 to 64, whereas greater RR is associated with lower probability across all groups. Both MGI and RR are more strongly associated with enrollment among adults aged 50 to 64 than those aged 65 or above, for racial minorities than for non-Hispanic Whites, and for lower income individuals relative to higher income ones. At every income level, racially minoritized adults have higher enrollment probability than non-Hispanic whites. DISCUSSION: While Medicaid enrollment is inherently income-based, enrollment is conditioned by policy and political context differentially across social groups. Low-income, racial minority individuals are disproportionally represented in the population covered by Medicaid, yet they are also the most likely to benefit-via enrollment and health-from more equal state-level Medicaid implementation. Policymakers must counteract racialized politics by dismantling provisions that burden marginalized groups in seeking health care via Medicaid to promote greater health equity in late life.