The Evolving Impact of Medicaid Expansion on Suicide Mortality: Demographic and Method-Specific Effects.

Abstract

Research suggests that Medicaid expansion may lead to population-level reductions in suicide. However, the time-varying impact on suicide rates has not been well characterized, and it is unknown whether potential suicide reductions are limited to specific injury mechanisms. This study examined the evolving effects of Medicaid expansion on state-level suicide rates disaggregated by injury mechanism and across demographic groups. Restricted mortality data for 2005-2021 were obtained from the National Center for Health Statistics. Difference-in-differences approaches with event-study specifications were used to estimate the effects of Medicaid expansion on firearm, nonfirearm, and overall suicide rates among nonelderly adults and demographic subgroups. Analyses were conducted in 2024. Medicaid expansion was associated with 1.01 fewer suicides (95% CI= -1.93, -0.10) and 0.47 fewer firearm suicides (95% CI= -1.05, 0.11) per 100,000 nonelderly adults. The protective effects of expanding Medicaid eligibility grew over time. Among demographic subgroups, reductions were largest for the population aged 18-29 years, including 2.70 fewer suicides (95% CI= -4.55, -0.86) and 1.47 fewer firearm suicides per 100,000 (95% CI= -2.67, -0.27). Expansion was also associated with fewer firearm suicides among adolescents aged 10-17 years (-0.47; 95% CI= -1.05, 0.12). There were no significant reductions in overall suicide among Black individuals (-2.05; 95% CI= -8.22, 4.11), whereas expansion was associated with 0.79 fewer suicides per 100,000 White individuals (95% CI= -1.74, 0.16). Medicaid expansion resulted in fewer suicide deaths, including those involving firearms. These findings suggest that Medicaid expansion was particularly impactful in preventing suicide among young adults.