Ohio’s Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age

Abstract

Objective To examine changes in the prevalence and odds of unmet healthcare needs and healthcare utilization among low-income women of reproductive age (WRA) after Ohio's 2014, ACA-associated Medicaid expansion, which extended coverage to non-senior adults with a family income ≤ 138% of the federal poverty level. Methods We analyzed publically available data from the 2012 and 2015 Ohio Medicaid Assessment Survey (OMAS), a cross-sectional telephone survey of Ohio's non-institutionalized adult population. The study included 489 low-income women in 2012 and 1273 in 2015 aged 19-44 years who were newly eligible for Medicaid after expansion in January 2014. Four unmet healthcare need and three healthcare utilization measures were examined. We fit survey-weighted logistic regression models adjusted for race/ethnicity, working status, and educational attainment to determine whether the odds of each measure differed between 2012 and 2015. Results In 2015, low-income WRA had a significantly lower odds of reporting an unmet dental care need (OR = 0.72, 95% CI 0.54, 0.95), unmet vision care need (OR = 0.68, 95% CI 0.50, 0.93), unmet mental health need (OR = 0.57, 95% CI 0.39, 0.83), and unmet prescription need (OR = 0.39, 95% CI 0.45, 0.80) compared to 2012. There were no significant differences in the odds of seeing a doctor or dentist in the past year or of having a usual source of care for low-income WRA in 2012 and 2015. Conclusions for Practice After Ohio's 2014 Medicaid expansion the odds of low-income WRA having unmet healthcare needs was reduced. Future research should examine outcomes after a longer period of follow-up and include additional measures, such as self-rated health status.

The Impact of the Affordable Care Act on Dental Care: An Integrative Literature Review

“…Similarly, the probability of having had a dental visit in the past year among low-income residents of Medicaid expansion states with dental benefits significantly decreased from 2010 to 2014 [26]. Furthermore, there was no statistical difference in dental care use between the pre-and post-Medicaid expansion period among low-income women aged 19-44 as well as children affected by the ACA's essential health benefits [14,17]. Interestingly, Medicaid expansion increased the probability of dental care use among childless adults [16], [25], while, within Medicaid expansion states that provided dental benefits, the probability of low-income parents having had a dental visit decreased from 2010 to 2014 [25].…”

“…However, among the states that provided dental benefits, the probability of having had a dental visit for low-income parents residing in expansion states decreased from 56.0% in 2010 to 47.9% in 2014 (p < 0.0001) [26]. In addition, there was no statistical difference in dental care use between pre-and post-Medicaid expansion periods among low-income women aged 19-44 [17]. Although children affected by the ACA's essential health benefits increased their dental care usage, for children not affected by affected by the ACA's essential health benefit, the increase was not statistically significant [14].…”

“…In addition, low-income adults who lived in Medicaid expansion states were less likely to get necessary dental care or delaying care than those in the non-expansion states to report being unable, but the difference was not statistically significant (12.5% vs 14.0%, PR = 1.19, CI 0.98-1.43) [18]. However, low-income women who were newly eligible for Medicaid in Ohio had significantly lower odds of reporting an unmet dental care need in 2015 than in 2012 (OR = 0.72, 95% CI 0.54, 0.95) [17]. Adults who were uninsured for some period in the preceding 12 months were much more likely than those with continuous Medicaid coverage throughout that period to report that they delayed receiving or were unable to obtain dental care [24].…”

“…The majority of studies focused on the effect of Medicaid expansion on dental care access and utilization [8,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Only three studies examined dental care utilization among children [14,23,30].…”

Patient care aides: Differences in healthcare coverage, health‐related behaviors, and health outcomes in a low‐wage workforce by healthcare setting

“…As states participating in BRFSS changed over this period and adoption of the Medicaid expansion varied by state, the impact of changes in the healthcare coverage system on health metrics among this low‐wage workforce could not be evaluated in these analyses. Some research has shown improved healthcare access and some health metrics following the implementation of the ACA, particularly in states that expanded Medicaid . However, the results of other studies highlight residual inequities in access to care due to structural issues ranging from the reluctance of some providers to accept Medicaid patients and inability to afford coinsurance, particularly among the working poor, to lack of transportation, childcare, and employer‐provided time off for preventive care visits .…”