OBJECTIVES: Evidence suggests Medicaid expansion has improved CVD outcomes, especially among lower SES groups. It remains unclear what the implications are of Medicaid expansion for cost-effectiveness and CVD disparities.

METHODS: A Monte Carlo Markov-chain microsimulation model was developed to examine changes in CVD outcomes as a result of Medicaid expansion and the distributional cost and quality-of-life impacts.

RESULTS: Medicaid expansion was associated with a reduction of 14 (SE: 3) myocardial infarctions, 12 (3 strokes, and 6 (2) CVD deaths per 100,000 person-years compared to no expansion. The largest reductions occurred for lower income and education groups, and Black and Hispanic race/ethnicity groups. Medicaid expansion was considered cost-effective from a healthcare perspective but not cost-effective from a societal perspective; using a value of $100,000 per QALY. The most influential variables for cost-effectiveness were: the increase in total healthcare costs among those who receive Medicaid; the cost of Medicaid administration per enrollee; the discount rate; and the change in systolic blood pressure from receiving Medicaid.. The targeting of Medicaid expansion to lower income groups helped reduce net health disparities according to family income and education.

CONCLUSIONS: Medicaid expansion reduced net health disparities across family income and education groups. It was cost-effective from a healthcare perspective, by reducing out-of-pocket costs for individuals and uncompensated care costs for hospitals, but not cost-effective from a societal perspective.