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Medicaid Expansion Linked to Better Center Care

January 10, 2017

According to a new study on the first year of Medicaid expansion, led by doctoral student Megan Cole and Dr. Amal Trivedi, four out of eight quality indicators at federally funded health centers improved significantly in states that expanded Medicaid compared to non-expansion states.

As the incoming administration of President-elect Donald Trump and members of the 115th U.S. Congress consider the possibility of revamping or replacing the Affordable Care Act, a new Brown University study finds an association between the law’s expansion of Medicaid and improved care quality at federally funded community health centers that serve more than 20 million predominantly poor residents a year.

“The first year of Medicaid expansion was associated with increases in insurance coverage and improvements in asthma treatment, BMI screening, pap testing and blood pressure control,” wrote the authors of the study in the January 2017 issue of the journal Health Affairs.

In January 2014, the District of Columbia and 25 states extended Medicaid to non-elderly residents with incomes at or below 138 percent of poverty, while 25 states did not (though six more have expanded Medicaid since then). Because many poor people turn to federally funded community health centers for care, the researchers sought to determine what difference Medicaid expansion might be making for them. Their analysis tracked changes in insurance coverage, the number of patients receiving care at health centers, and eight measures of care quality among roughly 20 million people a year who sought care at 1,057 community health centers between 2011 and 2014.

Led by Cole, a doctoral student in Health Services Research, and Trivedi, associate professor of health services, policy and practice, the study not only spanned the time period around expansion, but also compared statistically similar centers in states that expanded Medicaid and states that did not. That method gave the researchers two layers of comparison — before 2014 vs. after, and expansion state vs. non-expansion state — for determining whether the differences they observed might be attributable to Medicaid expansion.

Read more of David Orenstein's article on improved care with medicaid expansion.