Medicaid Expansion’s Impact on Emergency Department Use by State and Payer

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

“…Second, there are differences in the proportion of each state’s population that became eligible for Medicaid in 2014. 24 Massachusetts implemented a partial Medicaid expansion in 2006 and consequently added far fewer residents to Medicaid in 2014. However, this limitation is likely to result in an underestimation of the association of Medicaid expansion with observed trends rather than an overestimation.…”

“…Second, there are differences in the proportion of each state's population that became eligible for Medicaid in 2014. 24 Massachusetts implemented a partial Medicaid expansion in 2006 and consequently added far fewer residents to Medicaid in 2014.…”

“…13,[16][17][18][19][20][21][22][23] However, the evidence on the association between Medicaid expansion and ED use is inconclusive. 18,24 Limited or no cost-sharing for preventive and primary care services could lead to a shift of care from the ED setting to outpatient care, after obtaining new or more generous health care coverage. Recent studies reported that Medicaid expansion was associated with decreases in ED visits among individuals who previously reported barriers to outpatient care and those related to opioid use.…”

“…A recent study analyzing ED visits after Medicaid expansion highlighted the importance of further studies that examine nonemergent ED use. 24 Hence, there remains a need to categorize ED visits by medical urgency because parameters that divert individuals with different conditions from use of EDs might vary. 34 To address this gap in the literature, we estimated the association between the ACA Medicaid expansion and ED visits, stratified by medical urgency of the visits, using a validated algorithm, and compared 2 Medicaid-expansion states with 2 nonexpansion states.…”

“…However, the evidence on the association between Medicaid expansion and ED use is inconclusive . Limited or no cost-sharing for preventive and primary care services could lead to a shift of care from the ED setting to outpatient care, after obtaining new or more generous health care coverage.…”