Changes in health insurance coverage and health care access as teens with disabilities transition to adulthood

Background: Pre-ACA, less than 6% of children with disabilities were uninsured, compared with more than 42% of young adults with disabilities ages 19–25. Individuals with disabilities face greater barriers to health care access upon transition into adulthood. Objectives: We examined whether the ACA dependent coverage provision and Medicaid expansion improved the transition from pediatric to adult healthcare systems by reducing the gap in insurance coverage and access to care between teens and young adults with disabilities. Methods: Using cross-sectional data from the 2006–2009 and 2011–2015 National Health Interview Survey (n = 10,136), we estimate the change in insurance coverage and access to care from pre-to post-ACA time periods for teens (ages 13–18) and young adults (ages 19–25) with disabilities in a difference-in-differences model. We completed the same analyses for these groups in Medicaid expansion and non-expansion states. Results: Both teens and young adults with disabilities made significant gains in insurance coverage (4.55 and 8.96% point gains respectively, p < .001) and access to care (4.01 and 3.14% points decline in delayed care due to cost, p < .05) under the dependent coverage provision and Medicaid expansion. Conclusions: Medicaid expansion had a greater impact on both insurance coverage and on access to care than did the dependent coverage provision. The benefits of these changes flowed primarily to young adults with disabilities, reducing the gaps in insurance coverage between teens and young adults, and expanding access to care for both groups, providing a more seamless transition from pediatric to adult health care systems, post-ACA.