Kentucky’s Medicaid Expansion Showing Early Promise On Coverage And Access To Care

Benitez, Joseph; Creel, Liza; Jennings, J’Aime C.

doi:10.1377/hlthaff.2015.1294

Cited by 49 publications

(53 citation statements)

References 12 publications

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“…[28] In a single-state review of Medicaid expansion, Benitez et al found lower rates of unmet medical needs and fewer people without routine access to healthcare. [19] Proper diagnosis and medical management of comorbidities may result in lower preoperative risk scores.…”

Section: Commentmentioning

confidence: 99%

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Charles

Johnston

Herbert

et al. 2017

The Annals of Thoracic Surgery

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Background Thirty-one states approved Medicaid expansion following implementation of the Affordable Care Act. The objective of this study was to evaluate the impact of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. Methods Data from the Virginia (non-expansion state) Cardiac Services Quality Initiative and the Michigan (expanded Medicaid, April 2014) Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were analyzed to identify uninsured and Medicaid patients undergoing coronary bypass graft and/or valve operations. Demographics, operative details, predicted risk scores, and morbidity and mortality rates, stratified by state and compared across era (Pre-expansion: 18 months before vs. Post-expansion: 18 months after), were analyzed. Results In Virginia, there were no differences in volume between eras; while in Michigan there was a significant increase in Medicaid volume (54.4% [558/1026] vs. 84.1% [954/1135], P<0.001) and corresponding decrease in uninsured volume. In Virginia Medicaid patients, there were no differences in predicted risk of morbidity or mortality (PROMM) or postoperative major morbidities. In Michigan Medicaid patients, a significant decrease in PROMM (11.9% [8.1–20.0%] vs. 11.1% [7.7–17.9%], P=0.02) and morbidities (18.3% [102/558] vs. 13.2% [126/954], P=0.008) was identified. Post-expansion was associated with a decreased risk-adjusted rate of major morbidity (odds ratio, 0.69; 95% confidence interval, 0.51–0.91; P=0.01) in Michigan Medicaid patients. Conclusions Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving healthcare financing, Medicaid expansion may positively impact patient care and outcomes.

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Section: Commentmentioning

confidence: 99%

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Charles

Johnston

Herbert

et al. 2017

The Annals of Thoracic Surgery

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“…Other studies have used survey data to examine the association between the ACA insurance expansions and insurance access or take‐up . Frean, Gruber, and Sommers estimated the relative contributions of different ACA provisions to observed insurance changes, finding that Medicaid enrollment among previously eligible adults accounted for half of the reduction in uninsurance attributable to the Medicaid expansion .…”

Section: Background and Research Objectivesmentioning

confidence: 99%

Changes in hospital service demand, cost, and patient illness severity following health reform

Pickens

Karaca

Gibson

et al. 2019

Health Services Research

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Objective To estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states. Data Sources Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011‐2015, Nielsen Demographic Data, and the American Community Survey. Study Design Retrospective study using fixed‐effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups. Findings In Medicaid expansion states, rates of uninsured inpatient discharges and ED visits fell sharply in many demographic groups. For example, uninsured inpatient discharge rates across groups, except young females, decreased by ≥39 percent per capita on average in expansion states. In nonexpansion states, uninsured utilization rates remained unchanged or increased slightly (0‐9.2 percent). Changes in all‐payer and private insurance rates were more muted. Changes in inpatient costs per discharge were negative, and all‐payer inpatient costs per discharge declined <6 percent in most age/sex groups. The size of the uninsured population eligible for coverage was strongly associated with changes in outcomes. For example, among males aged 35‐54 years in expansion states, there was a 0.793 percent decrease in the uninsured discharge rate per unit increase in the coverage expansion ratio (the ratio of the size of the population eligible for coverage to the size of the previously covered population within an age/sex/payer/geographic group). Conclusions Significant shifts in cost per discharge and patient severity were consistent with selective take‐up of insurance. The “treatment intensity” of expansions may be useful for anticipating future effects.

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“…Notably, the ACA included SUD treatment as an essential health benefit within health plans and expanded parity for SUD care. 16–18 It has reduced the number of uninsured Americans, particularly in Medicaid expansion states, 19,20 and reduced the number of individuals with OUD who lack insurance. 21 However, there remain no requirements that buprenorphine-prescribing physicians (BPPs, or any other medical provider) accept insurance plans for reimbursement of treatment services, raising the possibility that insured individuals cannot use their insurance benefits to pay for care.…”

Section: Introductionmentioning

confidence: 99%

Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

Knudsen

Studts

2018

J Behav Health Serv Res

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Increasing numbers of individuals with opioid use disorder (OUD) are insured by Medicaid. Little is known about whether providers of buprenorphine, an evidence-based OUD pharmacotherapy, accept this type of payment. Data are scant regarding whether Medicaid acceptance varies by physician and state-level characteristics. To address these gaps, national survey data from 1174 buprenorphine-prescribing physicians (BPPs) and state characteristics were examined in a multi-level model of Medicaid acceptance. Only 52.0% of BPPs accepted Medicaid for buprenorphine-related office visits. Specialists in addiction and psychiatry were significantly less likely to accept Medicaid than other specialties, as were BPPs delivering buprenorphine in individual medical practice. Perceived adequacy of Medicaid reimbursement was positively associated with accepting Medicaid. Medicaid acceptance was not associated with states' implementation of the Medicaid expansion. Individuals who are covered by Medicaid may face barriers to accessing buprenorphine treatment, which has high public health significance given the ongoing opioid epidemic.

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Kentucky’s Medicaid Expansion Showing Early Promise On Coverage And Access To Care

Cited by 49 publications

References 12 publications

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Changes in hospital service demand, cost, and patient illness severity following health reform

Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

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