Increasing Medicaid coverage eligibility doesn’t affect access to care, use of ED services

Expanding the number of individuals eligible for Medicaid coverage does not erode perceived access to care or increase use of emergency services among adult Medicaid enrollees, according to a study published online April 7 by JAMA Internal Medicine.

While previous research has demonstrated several benefits associated with the less strict Medicaid income eligibility requirements that have been mandated by the Patient Protection and Affordable Care Act, some policy observers have expressed concern over the change. They worry that “the increased demand for care generated by new enrollees, many of whom have limited previous interaction with health care providers, has the potential to erode access to care for individuals already enrolled in Medicaid before an expansion,” explained lead author Chima D. Ndumele, PhD, of the Yale School of Public Health in New Haven, Conn., and colleagues.

The researchers aimed to assess the effects of acquiring Medicaid coverage on those who already have coverage by using a quasi-experimental difference-in-differences (DID) design that examined adults’ self-reported access to care and use of emergency department services.

The study included 1,714 adult Medicaid enrollees in 10 states that expanded Medicaid between June 2000 and October 2009 and 5,097 Medicaid enrollees in 14 bordering control states that didn’t expand Medicaid. Of the states that expanded their program, the mean income eligibility level increased from 82.6 percent to 144.2 percent of the federal poverty level. Income eligibility in the control states remained constant at 77.1 percent of the federal poverty level.

The proportion of adults reporting enrollment in Medicaid increased from 7.2 percent to 8.8 percent in expansion states and from 6.1 percent to 6.4 percent in the matched control states. In the expansion states, the proportion of Medicaid enrollees who reported poor access to care declined from 8.5 percent to 7.3 percent. In the control states, the proportion of enrollees reporting poor access to care remained constant at 5.3 percent.

In terms of emergency department use, the proportion of enrollees who utilized services decreased from 41.2 percent to 40.1 percent in expansion states and from 37.3 percent to 36.1 percent in control states. After the expansions, newly eligible enrollees reported poorer access to care than previously enrolled beneficiaries, but the difference between groups was not statistically significant.

“This study has important implications for policy makers as state Medicaid agencies implement planned coverage expansions,” wrote Ndumele and colleagues. “Our findings should be useful in assessing potential effects for states deciding whether to participate in Medicaid expansions. Also, given our finding that newly eligible populations may face the most pronounced barriers to accessing care in a timely fashion, state Medicaid agencies should be particularly vigilant in efforts to engage newly eligible populations in primary care.”