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Soc Sci Med. 2018 Jul;208:150-157. doi: 10.1016/j.socscimed.2018.01.013. Epub 2018 May 2.

States higher in racial bias spend less on disabled medicaid enrollees.

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Department of Psychology, University of California, Berkeley, United States. Electronic address:
Department of Psychology, Ryerson University, United States.
School of Public Health, University of California, Berkeley, United States.



While there is considerable state-by-state variation in Medicaid disability expenditure, little is known about the factors that contribution to this variation.


Since Blacks disproportionately benefit from Medicaid disability programs, we aimed to gain insight into whether racial bias towards Blacks is one factor that explains state-by-state variation in Medicaid disability expenditures.


We compiled 1,764,927 responses of explicit and implicit racial bias from all 50 states and Washington D.C. to generate estimates of racial bias for each state (or territory). We then used these estimates to predict states' expenditure per disabled Medicaid enrollee. We also examined whether the relationship between racial bias and disabled Medicaid enrollee expenditure might vary according to states' level of income for Whites, income for Blacks, or conservatism.


States with more explicit or implicit racial bias spent less per disabled Medicaid enrollee. This correlation was strongest in states where Whites had lower income, Blacks had higher income, or conservatism was high. Accordingly, these results suggest that racial bias might play a role in Medicaid disability expenditure in places where Whites have a lower economic advantage or there is a culture of conservatism.


This research established correlations between state-level racial bias and Medicaid disability expenditure. Future research might build upon this work to understand the direction of causality and pathways that might explain these correlations.


Disability; Health policy; Intergroup relations; Medicaid; Racial bias

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