For U.S. residents with health problems, Medicaid benefits eligibility rules can be so powerful that they determine whether a significant percentage of older couples stay married or get divorced.

David Slusky and Donna Ginther, economists at the University of Kansas, have published that finding in a new working paper based on an analysis of data on the effects of the Affordable Care Act Medicaid expansion program.

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The economists published the paper, behind a paywall, on the website of the National Bureau of Economic Research.

The ACA provided money that states could use to offer Medicaid coverage to adults under 65 with incomes up to 138 percent of the federal poverty level, starting in January 2014. Some states took the Medicaid expansion money, and others turned the money down.

Many states still consider assets when deciding whether people ages 65 and older can use Medicaid to pay for nursing home care or other health care.

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But, for adults under 65 using the new Medicaid expansion coverage, the ACA killed asset tests. States now look only at applicants’ income when deciding whether adults under 65 are eligible for Medicaid.

Before January 2014, low-income couples with some assets and one spouse who needed Medicaid health benefits had to divorce for the spouse with the health problems to qualify for Medicaid. Starting in January 2014, those couples could keep their assets and still sign up for Medicaid.

Slusky and Ginther compared what happened to divorce rates for people ages 50 to 64 in states that expanded Medicaid in 2014 with what happened to divorce rates for people in that age group in the states that did not expand Medicaid.

Before the new Medicaid eligibility rules took effect, the divorce rate for people ages 50 to 64 was lower in the “control group” states than in the states that ended up expanding Medicaid.

In 2014 and 2015, after the new eligibility rules took effect, the divorce rate for people in the 50-64 age group jumped in the control group states and fell in the Medicaid expansion states.

Slusky and Ginther adjusted the data for differences in unemployment rates, then compared federal government divorce data for the expansion states and the control-group states. The economists found that Medicaid expansion correlated with a 5.6 percent decrease in divorce prevalence in the 50-64 age group in 2015.

That result suggests that, in the Medicaid expansion states, the new ACA Medicaid eligibility rules cut the medical divorce rate for the people in that age group in the first year after the new rules took effect, the economists conclude.

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