Impact of Expanded Medicaid Eligibility on the Diabetes Continuum of Care Among Low-Income Adults: A Difference-in-Differences Analysis

• Type of Material: Article
• Authors: Lily D. Yan, Boston Medical Center; Mohammed Ali, Emory University; Kiersten L. Strombotne, Boston University
• Language: English
• Date: 2021-01-19
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2020.08.013
• Title of Journal or Parent Work: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
• Volume: 60
• Issue: 2
• Start Page: 189
• End Page: 197
• Grant/Funding Information: Lily Yan was supported by Preventive Medicine Residency Training grants (D33 HP 25766 and D33 HP 29243 from Health Resources and Services Administration). Mohammed Ali was partially supported by the Georgia Center for Diabetes Translation Research (grant P30DK111024 from the National Institute of Diabetes and Digestive and Kidney Diseases). Dr. Ali reports a current grant from Merck and Co., the scope of which is outside the submitted work. Kiersten Strombotne has no financial disclosures.
• Keywords: Public, Environmental & Occupational Health; ACCESS; PATIENT; ASSOCIATION; ACA; STATES; Science & Technology; HEALTH-INSURANCE COVERAGE; CASCADE; EXPANSION; Medicine, General & Internal; Life Sciences & Biomedicine; General & Internal Medicine; MANAGEMENT
• Research Categories: Health Sciences, Public Health; Health Sciences, General

Abstract

Introduction: The impact of Medicaid expansion on linkage to care, self-maintenance, and treatment among low-income adults with diabetes was examined. Methods: A difference-in-differences design was used on data from the Behavioral Risk Factor Surveillance System, 2008–2018. Analysis was restricted to states with diabetes outcomes and nonpregnant adults aged 18–64 years who were Medicaid eligible on the basis of income. Separate analyses were performed for early postexpansion (1, 2, 3) and late postexpansion years (4, 5). Analyses were performed from September 2019 to March 2020. Results: In comparing expansion with control states, low-income residents with diabetes had similar ages (48.9 vs 49.1 years) and similar proportions who were female (54.4% vs 55.0%) but were less likely to be Black, non-Hispanic (20.8% vs 29.2%, standardized difference= −16.3%). In expansion states, health insurance increased by 7.2 percentage points (95% CI=3.9, 10.4), and the ability to afford a physician increased by 5.5 percentage points (95% CI=1.9, 9.1) in the early years, but no difference was found in late years. Medicaid expansion led to a 5.3-percentage point increase in provider foot examinations in the early period (95% CI=0.14, 10.4) and a 7.2-percentage point increase in self-foot examinations in the late period (95% CI=1.1, 13.3). No statistically significant changes were detected in self-reported linkage to care, self-maintenance, or treatment. Conclusions: Although health insurance, ability to afford a physician visit, and foot examinations increased for Medicaid-eligible people with diabetes, there was no statistically significant difference found for other care continuum measures.