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Background and Objectives With the passage of the Affordable Care Act (ACA) in 2009, health care in the United States (US) changed drastically, including elective state-level Medicaid Expansion (ME). While ME has been associated with decreased mortality in participating states, particularly among low income residents, the effect of ME on outcomes after ischemic stroke remain unclear.Methods and Analysis Publicly available data were collected from the Institute for Health Metrics and Evaluation’s Global Burden of Disease (GBD) Compare tool for 50 US states and the District of Columbia for 1990-2023, including estimated rates of mortality, incidence, and prevalence, as well as estimated Years of Life Lost (YLLs) and Years of Life with Disability (YLDs) (combined as disability adjusted life years [DALYs]) per 100,000 people (per 100K). Ages 20-64 were targeted as the population most likely to be affected by ME. Stroke outcomes were analyzed using a staggered difference-in-differences (DiD) model with fixed effects of state and year. Results are reported as aggregate average treatment effect on the treated (ATT). Two way fixed effects (TWFE) models were also computed as a baseline.Results Outcomes were compared for 2009-2023 (at least 5 years before ME at earliest and up to 9 years after) in states that ever expanded Medicaid (n=39). States that did not expand Medicaid over this time were excluded given differing parallel trends for the outcomes of interest. For patients 20-64 years old, there was a statistically significant decrease in ischemic stroke prevalence per 100K after ME (-15.7, p=0.017). Mortality (+0.061, p=0.187) and incidence (+0.299, p=0.425) experienced no significant change. Though there was no overall change in DALYs (+0.062, p=0.965), YLDs had a statistically significant decline over this time (-2.07, p=0.014), whereas YLLs did not (+2.13, p=0.154).Conclusion In the <65 year old population, there was a statistically significant decrease in ischemic stroke prevalence (-15.7 per 100K) and YLDs (-2.07 years per 100K) after ME, implying potential reduced severity of stroke, better rehabilitation, or improved secondary stroke prevention after implementation. Incidence rates are likely to be impacted by long term improvements in primary prevention and for conditions frequently requiring emergent interventions, such as stroke, mortality rates likely depend more on specific systems of care rather than expanded health care access.Disclosures J. Breton: None. C. Fernandez Perez: None. J. Lim: None. N. Nair: None.Abstract E-030 Figure 1(A) Comparison of estimated outcomes for Medicaid Expansion and Non-Medicaid Expansion states from 1990-2023. Red indicates non-Medicaid Expansion and blue indicates states in which Medicaid had been expanded under Affordable Care Act provisions. (B) Event-study plots revealing the effects of Medicaid Expansion on the outcomes of interest