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Pent-up demand in an early Medicaid expansion program: Findings from the Low Income Health Program in California
The study followed an observational longitudinal design and included individuals who were enrolled in the first year of LIHP and met the new Medicaid eligibility requirements under the ACA (n=106,540) from five counties that also participated in the Health Care Coverage Initiative (HCCI), the previous program in California. We identified enrollees’ rates of utilization from LIHP claims data and linked them to any existing enrollment and claims data from the previous two years. Using ordinal logistic models with random effects, we estimated the association between previous coverage and individuals’ quarterly rates of evaluation and management (EM) emergency room (ER) visits, and hospitalizations during LIHP. Covariates included demographic characteristics and chronic conditions.
Individuals new to LIHP initially had high rates of ER visits and hospitalizations that then declined over time. The probability of higher rates of ERs visits among new LIHP enrollees declines from 11% to 6%. Those with previous coverage had relatively constant rates of ER use and were less likely to go to ER (5%). A similar trend appears in inpatient hospitalizations. The probability of having high rates of hospitalization among new LIHP enrollees declines from 6% to 2% but is constant among those with previous coverage (2%). At the same time, the rate of EM visits is highest among those who had previous coverage under HCCI and increasing among those new to LIHP.
The results are consistent with the hypothesized increase in EM use and subsequent reduction in ER use after gaining coverage. Lower cost primary care visits were substituted for higher cost ER visits, reducing the strain on emergency departments. Within one year, new, previously uninsured enrollees behaved similarly to those previously covered. The coverage expansion achieved by the Low Income Health Program provides evidence to support the expansion of Medicaid as a way to deal with uninsured population’s previously unmet needs.
Learning Areas:
Provision of health care to the publicPublic health or related public policy
Public health or related research
Social and behavioral sciences
Learning Objectives:
Evaluate the success of California’s Low Income Health Program
Assess the effects of the preventative care model on utilization in the health care safety net
Discuss future impact of the Affordable Care Act on the Medicaid-eligible population
Compare California’s experience with expanding Medi-Cal to one’s own Medicaid program
Keyword(s): Medicaid, Primary Care
Qualified on the content I am responsible for because: I am the lead analyst and major contributing author on this paper and have been working on the Low Income Health Program evaluation for the past year. I have also executed analyses of other federally funded interventions.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.