Value-Based Care News

Medicaid Expansions Improve Coverage, Quality of Care, Economy

States that have expanded their Medicaid programs under the Affordable Care Act have seen increased access to, utilization of, and quality of care.

Medicaid expansion, coverage, quality of care, job growth, utilization

Source: Thinkstock

By Kelsey Waddill

- Medicaid expansions under the Affordable Care Act (ACA) have improved coverage, access to care and coverage, and the economy, according to a recent Kaiser Family Foundation report.

“The literature review provides a useful reference on the effects of expansion at a time when more states are considering expansion, including some through waivers,” KFF said in a statement. “At the same time, the Texas v. U.S. legal challenge to the ACA could roll back the Medicaid expansion as well as other provisions of the health law.”

The report, which served as an update to results from January 2019,pulled together findings from 324 separate studies conducted from January 2014 through June 2019.

During that timeframe, many studies linked Medicaid expansion to improved coverage rates. These studies saw a rise in Medicaid enrollment and a decline in unenrollment in expansion states that was faster than their non-expansion counterparts. Medicaid expansion had a positive impact on vulnerable populations’ coverage across all major races and ethnicities, particularly for rural areas.

But when considering the effects of private coverage and waivers, the studies had mixed results. Some found that expansion led to decline in private coverage generally or in particular groups. Others saw no evidence for the assertion that beneficiaries were disenrolling from private coverage to enroll in Medicaid.

READ MORE: Medicaid Expansion May Close Racial Health Disparities, Care Gaps

Coverage in expansion states did not differ much based on whether or not the state used a waiver to expand. However, some waivers negatively influenced beneficiaries’ access to coverage or care.

Expansion states also saw an improvement in access to and utilization of care, including lessening of health disparities. Beneficiaries were better able to access cancer care, smoking cessation programs, and behavioral health support.

However, there were mixed results on the impacts that expansion had on changes in emergency department visits. While some studies found a decline in usage of the emergency room for lower acuity conditions, others saw increased emergency department visits or no change at all either in the overall traffic or among specific populations.

Studies that found no resultant shift in access, utilization, or disparity linked to Medicaid expansion reasoned that their research may require more time for the effects to become clear.

Other research found that beneficiaries were not well educated on how certain 1115 waiver provisions could help them access additional medical services and experience improved health outcomes.

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Some studies found no connection between Medicaid expansion and greater access and utilization.

Finally, the KFF report outlined evidence that Medicaid expansion may have boosted patient care outcomes.

Quality of care, self-reported health status, and health outcomes were generally higher in expansion states’ Medicaid programs, most studies revealed. In expansion states, beneficiaries saw shorter hospital stays and were more likely to be discharged to rehabilitation facilities.

The report also noted that these statistics work against the general Medicaid stereotype, which associates Medicaid with longer hospital stays and higher in-hospital mortality.

Some studies found that there were no significant differences between the quality of care, self-reporting habits, or health outcomes in expansion states as opposed to non-expansion states. Researchers for these studies suggested more conclusive results may emerge with time, since population health shifts are slow to develop. One study linked Medicaid expansion to increased length of stay for adult trauma patients.

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The report also acknowledged the oft-cited concern that Medicaid expansion can exacerbate physician burnout, but the studies included in the report varied on this point.

Some showed that providers are keeping pace with the expansions. Others indicated that there is no change in providers’ performance. And still other studies stated that the Medicaid expansion negatively influenced provider availability.

Studies also showed improved financial security and healthcare affordability for Medicaid enrollees in expansion states. The expansions were linked to the lessening of care access and economic disparities.

Economically, states achieved some healthcare savings by expanding their Medicaid program, the report found.In expansion states, spending per enrollee dropped, there was less uncompensated care, and some studies made a connection between employment and Medicaid expansion, saying that states with expansion saw higher job growth.

Medicaid expansion, in some cases, led to less uncompensated care costs and better hospital operating margins and financial performance.

However, these savings for providers might be offset by Medicaid shortfalls, other studies suggested.

“A small subset of study findings showed no effects of expansion on certain specific measures within some of these categories,” the KFF report concluded. “Overall, these findings suggest potential for gains in coverage and access as well as economic benefits to states and providers in the remaining non-expansion states that may be considering adopting the expansion in the future.”