Center for Public Policy and Health, College of Public Health, Kent State University, 750 Hilltop Drive, 339 Lowry Hall, P.O. Box 5190, Kent, OH, 44242, USA.
Rebecca D. Considine Research Institute, Akron Children's Hospital, College of Public Health, Kent State University, Kent, USA.
J Community Health. 2021 Dec;46(6):1139-1147. doi: 10.1007/s10900-021-01000-4. Epub 2021 May 13.
Medicaid expansion was ruled optional in 2012 by the Supreme Court, which allowed some states to adopt it while others did not. This study examines the differences in the percent uninsured, healthcare utilization by service type, and clinical quality of care measures at HCH (Healthcare for the Homeless) projects between expansion and non-expansion states. An exploratory state-level retrospective analysis of annual Uniform Data System data limited to HCHs from 2012 to 2019 from 50 states plus Washington DC is presented. Using descriptive statistics and linear mixed models, we found that the percentage of uninsured HCH patients decreased across all states, but the decrease was greater in states that expanded Medicaid compared to states that did not (- 8.23, p < .0.0001). This implies HCH projects can rely less on grants and more on insurance reimbursement. When examining specific service categories, medical services in expansion states increased at a statistically significant rate post expansion as compared to non-expansion states (2.52, p = 0.0085). The percentage of substance use visits were lower in expansion states compared to non-expansion states (- 0.79, p = 0.0267). Finally, there were three preventive clinical quality of care measures at HCH projects that showed significant improvement in expansion states post expansion: colorectal cancer screening, blood pressure control, and diabetes control. Maintaining Medicaid expansion is advantageous given its association with reductions in uninsured, increased medical services utilization, and improvement in some clinical quality of care measures for homeless populations receiving services at HCH projects in expansion states.
2012 年，最高法院裁定医疗补助计划可选择性扩展，允许一些州采用，而另一些州则不采用。本研究考察了在医疗补助计划扩展和非扩展州之间，无保险率、按服务类型划分的医疗利用率以及 HCH（无家可归者医疗保健）项目的临床护理质量措施的差异。本研究对来自 50 个州和华盛顿特区的 HCH 项目 2012 年至 2019 年的年度统一数据系统数据进行了探索性的州级回顾性分析，这些数据仅限于 HCH。使用描述性统计和线性混合模型，我们发现所有州的 HCH 患者无保险率都有所下降，但在医疗补助计划扩展的州下降幅度更大，与没有扩展的州相比（-8.23，p<0.0001）。这意味着 HCH 项目可以减少对赠款的依赖，更多地依赖保险报销。在检查特定的服务类别时，与非扩展州相比，扩展州的医疗服务在扩展后以统计学上显著的速度增加（2.52，p=0.0085）。与非扩展州相比，扩展州的药物使用就诊率较低（-0.79，p=0.0267）。最后，HCH 项目有三个预防临床护理质量措施在扩展州中显示出显著改善：结直肠癌筛查、血压控制和糖尿病控制。鉴于医疗补助计划扩展与减少无保险、增加医疗服务利用率以及改善在 HCH 项目中接受服务的无家可归者的某些临床护理质量措施有关，维持医疗补助计划扩展是有利的。
