Medicaid Expansion and State-Level Insulin Copay Caps

Medicaid Expansion and State-Level Insulin Copay Caps

Alvin Sherman Library

Background: The rising cost of insulin poses a significant public health issue of accessibility among populations with diabetes. Several states have implemented state insulin copay caps (SICC) to mitigate out-of-pocket costs for insured individuals. This study examines the relationship between Medicaid expansion under the Affordable Care Act and the implementation of SICC.

Methods: To determine whether Medicaid expansion is associated with states’ decisions to initiate SICC, we conducted a cross-sectional study among the 50 states and Washington, D.C. We used SICC status data from the American Diabetes Association and state-level demographics data from the Robert Wood Johnson Foundation 2021 County Health Rankings. We used independent samples t-tests to determine whether states with and without SICC differed in terms of demographics. We used Pearson’s χ2 2- tailed tests to analyze differences between states with and without SICC and states that did or did not expand Medicaid. We included variables for which significant differences existed between states with or without SICC in a logistic regression model.

Results: There were no differences in demographics between states with or without SICC. However, there was a relationship between states’ SICC and Medicaid expansion statuses, χ2 (1, N=51) = 4.78, p = .029. Medicaid expansion states had six times the odds of being states with SICC (OR=5.65; 95% CI= 1.06, 29.98).

Conclusion: Medicaid expansion significantly increases the likelihood of states adopting insulin copay caps, suggesting that broader healthcare access may drive policy interventions to improve insulin affordability and reduce health disparities for diabetes patients.