Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion

Dmitry Tumin, Eliza W. Beal, Khalid Mumtaz, Don Hayes, Joseph D. Tobias, Timothy M. Pawlik, W. Kenneth Washburn, Sylvester M. Black

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. Study design: Data on LT candidates aged 18 to 64 years, in 2012 to 2013 (pre-expansion) and 2014 to 2015 (post-expansion), were obtained from the United Network for Organ Sharing registry. Change between the 2 periods in the percent of LT candidates using Medicaid was compared between expansion and nonexpansion states. Multivariable logistic regression was used to determine how Medicaid expansion influenced individual LT candidates' likelihood of using Medicaid insurance. Results: The study included 33,017 LT candidates, of whom 29,666 had complete data for multivariable analysis. Medicaid enrollment increased by 4% after Medicaid expansion in participating states. One-quarter of the transplant centers in these states experienced ≥10% increase in the proportion of LT candidates using Medicaid insurance. Multivariable analysis confirmed that Medicaid expansion was associated with increased odds of LT candidates using Medicaid insurance (odds ratio 1.49; 95% CI 1.34, 1.66; p < 0.001). However, the absolute number and demographic characteristics of patients listed for LT did not change in Medicaid expansion states during the post-expansion period. Conclusions: Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
DOIs
StateAccepted/In press - Feb 13 2017

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Patient Protection and Affordable Care Act
Medicaid
Liver Transplantation
Transplants
Liver
Insurance
Insurance Coverage
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion. / Tumin, Dmitry; Beal, Eliza W.; Mumtaz, Khalid; Hayes, Don; Tobias, Joseph D.; Pawlik, Timothy M.; Washburn, W. Kenneth; Black, Sylvester M.

In: Journal of the American College of Surgeons, 13.02.2017.

Research output: Contribution to journalArticle

Tumin, Dmitry ; Beal, Eliza W. ; Mumtaz, Khalid ; Hayes, Don ; Tobias, Joseph D. ; Pawlik, Timothy M. ; Washburn, W. Kenneth ; Black, Sylvester M. / Medicaid Participation among Liver Transplant Candidates after the Affordable Care Act Medicaid Expansion. In: Journal of the American College of Surgeons. 2017.
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abstract = "Background: The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. Study design: Data on LT candidates aged 18 to 64 years, in 2012 to 2013 (pre-expansion) and 2014 to 2015 (post-expansion), were obtained from the United Network for Organ Sharing registry. Change between the 2 periods in the percent of LT candidates using Medicaid was compared between expansion and nonexpansion states. Multivariable logistic regression was used to determine how Medicaid expansion influenced individual LT candidates' likelihood of using Medicaid insurance. Results: The study included 33,017 LT candidates, of whom 29,666 had complete data for multivariable analysis. Medicaid enrollment increased by 4{\%} after Medicaid expansion in participating states. One-quarter of the transplant centers in these states experienced ≥10{\%} increase in the proportion of LT candidates using Medicaid insurance. Multivariable analysis confirmed that Medicaid expansion was associated with increased odds of LT candidates using Medicaid insurance (odds ratio 1.49; 95{\%} CI 1.34, 1.66; p < 0.001). However, the absolute number and demographic characteristics of patients listed for LT did not change in Medicaid expansion states during the post-expansion period. Conclusions: Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list.",
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