Financial impacts of the Medicaid expansion on community health centers

Luo, Qian; Moghtaderi, Ali; Markus, Anne Rossier; Dor, Avi

doi:10.1111/1475-6773.13897

Cited by 7 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tis research also raises related questions regarding the potential impact of the COVID-19 epidemic on the service capacity of CHCs. Specifcally, the pandemic is known to have caused excess reduction in healthcare accessibility and utilization across the board, while demand for primary care services appears to be recovering presently, and the full extent of the efect of the pandemic on the accessibility and utilization patterns is not yet known [65]. Future research may evaluate the diferential impact of the pandemic and expansion on healthcare access and utilization among HC patients.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Medicaid Eligibility on Utilization of Services and Access to Care among Health Center Patients: A Regression Discontinuity Design

Liang,

Tao,

Shi

2023

Health & Social Care in the Community

View full text Add to dashboard Cite

The United States’ Affordable Care Act (ACA) aims to improve access to and quality of care for low-income patients. To do so, it expands Medicaid eligibility from individuals under 100% of the federal poverty level (FPL) to include those under 138% of the FPL. Based on the 2014 Health Center Patient Survey (a nationally representative survey sponsored by the Health Resources and Services Administration (HRSA) (n = 4,380)), this study examined the effects of the Medicaid eligibility on having a usual source of care and the utilization of preventive services among health center patients. A regression discontinuity approach was used to identify the causative impact of Medicaid enrollment on low-income and nonelderly health center patients. Our findings suggest that Medicaid enrollment led to a substantial increase in the probability of both undergoing a routine checkup and having had a fecal occult blood test within the past year. These results indicate that changes to Medicaid policy have the potential to affect vulnerable populations. The evidence we provide supports the importance of maintaining the ACA due to its expanded Medicaid funding.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Medicaid Eligibility on Utilization of Services and Access to Care among Health Center Patients: A Regression Discontinuity Design

Liang,

Tao,

Shi

2023

Health & Social Care in the Community

View full text Add to dashboard Cite

show abstract

“…This study examined the relationship between Medicaid expansion under the Affordable Care Act (ACA) and incomes and benefits for health care workers. Medicaid expansion represents a useful case study given its scope, importance to recent health policy efforts, and its well-established role in improving health care organizations’ finances in expansion states . Although health care organizations may have shared their financial improvements with its workforce with better wages or benefits, those in lower-income occupations may have been less likely to benefit due to long-standing occupational stratification, limited bargaining power, prevalence of contract work, or greater substitutability with workers from non–health care settings .…”

Section: Introductionmentioning

confidence: 99%

“…Medicaid expansion represents a useful case study given its scope, importance to recent health policy efforts, and its well-established role in improving health care organizations' finances in expansion states. [14][15][16][17][18][19][20] Although health care organizations may have shared their financial improvements with its workforce with better wages or benefits, those in lower-income occupations may have been less likely to benefit due to long-standing occupational stratification, limited bargaining power, prevalence of contract work, or greater substitutability with workers from non-health care settings. 1,6,11 Additionally, understanding the spillover effects of Medicaid expansion on low-income health care workers is important given emerging evidence on the relationship between economic circumstances and health outcomes among workers themselves 21 and the patients they serve.…”

mentioning

confidence: 99%

Changes in Health Care Workers’ Economic Outcomes Following Medicaid Expansion

Matta,

Chatterjee,

Venkataramani

2024

JAMA

View full text Add to dashboard Cite

ImportanceThe extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known.ObjectiveTo assess the association between state adoption of the Affordable Care Act’s Medicaid expansion—which led to substantial improvements in health care organization finances—and health care workers’ annual incomes and benefits, and whether these associations varied across low- and high-wage occupations.Design, Setting, and ParticipantsDifference-in-differences analysis to assess differential changes in health care workers’ economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys.ExposureTime-varying state-level adoption of Medicaid expansion.Main Outcomes and MeasuresPrimary outcome was annual earned income; secondary outcomes included receipt of employer–sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits.ResultsThe sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P &lt; .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer–sponsored health insurance and increases in SNAP following Medicaid expansion.Conclusion and RelevanceMedicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.

show abstract

Federally Qualified Health Centers and Performance of Medicare Accountable Care Organizations

Li,

Hou,

McStay

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceFederally qualified health centers (FQHCs) have increasingly participated in the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), one of the most widespread value-based programs. Although FQHCs may strengthen ACOs’ ability to provide affordable care to diverse Medicare beneficiaries, evidence on ACOs’ performance by FQHC participation is limited.ObjectivesTo compare beneficiary characteristics, utilization, expenditure, and quality between ACOs with and without FQHC participation and assess changes in ACO performance after including first FQHCs.Design, Setting, and ParticipantsUsing MSSP public use files, this cross-sectional study compared performance of ACOs that always had FQHC participation with ACOs that never had FQHC participation from January 1, 2016, to December 31, 2022, supplemented with staggered difference-in-differences analyses of ACOs’ first-time inclusion of FQHCs on performance measures. Data analysis was performed from December 1, 2023, to February 29, 2024.ExposureParticipation of FQHCs in the MSSP.Main Outcomes and MeasuresMeasures of ACO-assigned beneficiaries, utilization, expenditure, and quality per ACO-year.ResultsAmong 752 ACOs in the descriptive analysis, 140 ACOs always had at least 1 FQHC participant, whereas 612 ACOs never had FQHC participants. Compared with ACOs that never had FQHC participation, those that always had FQHC participation provided care to more socioeconomically disadvantaged beneficiaries (mean [SD] with dual eligibility, 2035.8 [2110.6] vs 1040.9 [1084.2] person-years; with disability, 3341.1 [3474.9] vs 1705.1 [1664.9] person-years; in racial and ethnic minoritized groups, 3690.6 [4118.4] vs 2515.1 [2762.9] person-years), with fewer primary care visits (mean [SD], 9956.6 [1926.3] vs 10 858.8 [2383.4] per 1000 person-years), more emergency department visits (mean [SD], 771.6 [190.9] vs 657.2 [160.0] per 1000 person-years), and lower levels of several quality measures. In the difference-in-differences analysis, 43 ACOs included FQHCs for the first time. Including first FQHCs was associated with increases of 872.9 dual-eligible (95% CI, 345.9-1399.8), 1137.6 disability (95% CI, 390.1-1885.1), and 1350.8 racial and ethnic minority (95% CI, 447.4-2254.1) person-years, with increases in rates of influenza immunization (5.9 percentage points [pp]; 95% CI, 1.4-10.4 pp), tobacco screening and cessation intervention (11.8 pp; 95% CI, 3.7-20.0 pp), and depression screening and follow-up (8.9 pp; 95% CI, 0.5-17.4 pp). No associations were observed between FQHC inclusion and utilization or expenditure.Conclusions and RelevanceIn this repeated cross-sectional study, MSSP ACOs with FQHC participation served more socioeconomically disadvantaged Medicare beneficiaries than those without FQHC participation. The inclusion of first FQHCs was associated with increased rates of several preventive services without increasing costs. Participation of safety net practices appeared to improve access to ACOs among beneficiaries from underserved communities.

show abstract

Financial impacts of the Medicaid expansion on community health centers

Cited by 7 publications

References 19 publications

The Effect of Medicaid Eligibility on Utilization of Services and Access to Care among Health Center Patients: A Regression Discontinuity Design

The Effect of Medicaid Eligibility on Utilization of Services and Access to Care among Health Center Patients: A Regression Discontinuity Design

Changes in Health Care Workers’ Economic Outcomes Following Medicaid Expansion

Federally Qualified Health Centers and Performance of Medicare Accountable Care Organizations

Contact Info

Product

Resources

About