Insurance-Related Disparities in Mental Health Status and Care Among Low-Income U.S. Adults, 2019-2023.

The COVID-19 pandemic affected mental health status and care among vulnerable Americans. We examined temporal changes in mental health status and assessed the associations between insurance types and mental health care among low-income U.S. adults. Using the 2019–2023 National Health Interview Survey, we analyzed data from 22,026 adults aged 18–64 with family incomes below 200% of the poverty threshold. Survey-adjusted descriptive statistics and linear probability models controlling for individual characteristics and time were used. Between 2019 and 2023, Medicaid enrollees consistently reported the highest prevalence of poor mental health status compared to adults with private insurance or no insurance. Among those with poor mental health, about 13.1% of Medicaid enrollees, 22.3% of privately insured, and 27.1% of the uninsured reported being unable to afford mental health care in 2023. Compared to Medicaid enrollees, privately insured adults were 2.5 percentage points (pp) less likely to receive counseling (p < 0.001), and the uninsured were 6.9 pp less likely (p < 0.001). Despite efforts to mitigate stress amid major societal disruptions, poor mental health persisted among low-income adults across the pre-pandemic and pandemic periods. This study further highlighted disparities by insurance types, underscoring the critical role of Medicaid in supporting mental health care among low-income adults and the need for policy efforts to reduce financial barriers across all insurance types.