Medicaid expansion boosted care quality at health centers, analysis suggests

Federally funded community health centers in Medicaid expansion states saw some quality indicators improve significantly compared to those in nonexpansion states, according to a study published Monday in Health Affairs.

Federally funded community health centers serve more than 20 million predominately poor residents annually. Researchers from Providence, R.I.-based Brown University dove into data from 2011 through 2014 — 25 states and the District of Columbia expanded Medicaid in 2014 — to see the effect Medicaid expansion had on insurance coverage, the number of patients receiving care at the health centers and eight measures of care quality.

They found a relatively greater drop in uninsurance rates for health center patients in expansion vs. nonexpansion states in 2014. They also found a relative increase in Medicaid coverage that was 11.8 percentage points higher in expansion states.

Additionally, care quality at centers in expansion states improved significantly in four measures when compared to nonexpansion states: asthma treatment, BMI screening, Pap tests and blood pressure control. Care quality was defined as the rate at which recommended care was provided.

The researchers posited the quality improvements in expansion states could be linked to two factors:

  • Patients in expansion states were significantly more likely to contribute to the centers' revenue
  • Patients in expansion states were more likely to be able to buy medications they were prescribed and access specialty healthcare

"We found that the expansion was associated with large increases in rates of Medicaid coverage and corresponding declines in uninsurance rates," the study concluded. "Furthermore, among the health centers' patient populations, we found that Medicaid expansion was associated with improvements in four of the eight measures of quality of care that we studied."

The study's authors urged policymakers to consider the consequences of changing aspects of the ACA like Medicaid expansion.

"Repealing Medicaid expansion entirely would have large consequences given that millions of low-income people would lose coverage — particularly those patients who receive care in health centers," said Megan Cole, a doctoral student at Brown and one of the study's authors.

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