Do emergency Medicaid programs improve post-discharge health care access for trauma patients? A statewide mixed-methods study

Abstract

BACKGROUND Hospital presumptive eligibility (HPE) emergency Medicaid programs offset patient bills at hospitalization and can provide long-term Medicaid coverage. We characterized postdischarge outpatient health care utilization among HPE Medicaid trauma patients and identified patient access facilitators and barriers once newly insured. We hypothesized utilization would be increased among HPE trauma patients compared with other HPE patients, but that challenges in access to care would remain. METHODS We performed a convergent mixed methods study of California HPE beneficiaries using a 2016 to 2021 customized statewide longitudinal claims dataset from the Department of Health Care Services. We compared adults 18 years and older with a diagnosis to other HPE patients. Patients were tracked for 2 months postdischarge to evaluate health care utilization: outpatient specialist visits, emergency room (ER) visits, readmissions, and mental health. Thematic analysis of semistructured interviews with HPE Medicaid patients aimed to understand facilitators and barriers to access to care (n = 20). RESULTS Among 199,885 HPE patients, 39,677 (19.8%) had a primary diagnosis of trauma. In the 2 months postdischarge, 40.8% of trauma vs. 36.6% of nontrauma accessed outpatient specialist services; 18.6% vs. 17.2% returned to ED, 8.4% vs. 10.2% were readmitted; and 1.4% vs. 1.8% accessed mental health services. In adjusted analyses, trauma HPE patients had 1.18 increased odds of accessing outpatient specialist services (p < 0.01). Patients cited HPE facilitators to accessing care: rapid insurance acquisition, outpatient follow-up, hospital staff support, as well as ongoing barriers to access (HPE program information recall, lack of hospital staff follow up postdischarge, and difficulty navigating a complex health care system). CONCLUSION Hospital presumptive eligibility Medicaid is associated with higher rates of outpatient specialist visits and fewer readmissions following injury, suggesting improved trauma patient access. Opportunities to improve appropriateness of health care utilization include more robust and longitudinal education and engagement with HPE Medicaid patients to help them navigate newfound access to services. LEVEL OF EVIDENCE Epidemiologic; Level II.