Variation by State in Use of VHA Services by Medicaid Enrolled Veterans

Objective:  To examine the relationship between Medicaid enrollment and US Veterans’ use of Veterans Health Administration (VHA) services, with an emphasis on variation between states.  

Methods:  In a retrospective study design, we studied Veterans under age 65 who were enrolled in VHA and Medicaid during 2009.  Using data on VHA and Medicaid enrollment and VHA outpatient utilization, we examined predictors of VHA outpatient utilization in Medicaid enrolled months using a population-averaged generalized estimating equation negative binomial regression model.  Key covariates included demographics, socioeconomic factors, distance, and state of residence.

Findings:  We found 241,209 veterans who met our study criteria;  67.26% used outpatient services in VHA facilities in 2009.  Regression results showed that Medicaid-enrolled Veterans in South Dakota, District of Columbia, and Wyoming had the highest predicted number of events per month (2.6, 2.4, and 2.3, respectively);  Veterans in Maine and Oklahoma had the fewest predicted number of VHA events per month (1.1 events each).  Results for covariates will also be presented.

Conclusion:  Two-thirds of veterans dually enrolled in VHA and Medicaid used VHA services during 2009, indicating that the VHA continues to offer a safety net, even for those Veterans who have other coverage options.  These options are increasing due to the new Veterans Choice Act and Medicaid expansion under Affordable Care Act, although expansion varies by state.  This examination of the factors influencing Veterans’ use of VHA services across states provides a baseline by which to assess the differential impact of new initiatives aimed at expanding veterans’ healthcare options.