Broader Medicaid eligibility was associated with a significant increase in the use of long-term care — both institutional and at-home services — according to a study published in JAMA Network Open Thursday.

“Increased access to long-term care for newly eligible low-income, middle-aged adults (suggests) that the population covered by the Medicaid expansion may have had unmet long-term care needs before expansion,” a group of researchers from Duke University and the Durham Veterans Affairs Health Care System reported.

The findings come on the heels of federal data released Wednesday showing Medicaid and CHIP enrollment jumped 5.7% — adding more than 4 million beneficiaries — as COVID-19 ravaged the economy between February and June.

Medicaid enrollment had been slowly declining since 2017, accompanied by an increase in the number of uninsured adults and children.

The Affordable Care Act enabled states to expand Medicaid coverage to more people with low incomes, an initiative backed by increased federal funding. As of September, 15 states still had not expanded eligibility, though voters in three of those states voted to do so, according to the Commonwealth Fund.

The researchers behind the JAMA study linked such expansions with increased access to health services, increased quality of medical care delivered and reduced mortality. Their goal was to better understand what increased access might mean for use of long-term care among newly eligible, low-income adults.

They studied about 900 Americans whose data was captured in the national Health and Retirement Study who lived in states that had Medicaid expansion in 2014, comparing their use of home health care or nursing home use against non-eligibles.

They found the ACA-funded Medicaid expansion was associated with a 4.4% percentage increase in the probability of any long-term care use among low-income, middle-aged adults, with increases in home health use up 3.8% and nursing home use up 2.1%.

This article originally appeared on McKnight's Senior Living