ArticleJournal of general internal medicine2024
Did Medicaid Reimbursements Shape the Effects of Medicaid Expansion on Access to Health Care Among the Low-Income Population?
Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic Review of Health Insurance and Survival Among Adolescent and Young Adult Cancer Patients.Journal of adolescent and young adult oncology · 2026Pooled it
- Racial Disparities and Comorbidities: Network Analysis of Maternal Outcomes in Alabama.Journal of racial and ethnic health disparities · 2026Article
- Geriatric Oral Health in the United States: Current Status and Challenges.Geriatrics (Basel, Switzerland) · 2026Review
- Ten high-priority areas for health policy research in 2026-2027.Health affairs scholar · 2026Article
- Primary care workforce structural inertia and Medicaid participation during the COVID-19 pandemic, 2020-2021.Health affairs scholar · 2026Article
- The Evolving Impact of Medicaid Expansion on Suicide Mortality: Demographic and Method-Specific Effects.American journal of preventive medicine · 2026Article
- Attendance patterns in well-child visits across diverse pediatric populations, Midwestern United States.Preventive medicine reports · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood.
objectiveWe examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates.
designUsing a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states.
participants512,744 low-income adults aged 20-64 in the 2011-2019 Behavioral Risk Factor Surveillance System. MAIN MEASURES: Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year. KEY
resultsMedicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states.
conclusionsMedicaid's fee structure should be considered as a factor influencing large-scale coverage expansions.
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