Factors Contributing to Long-Term Medicaid Sustainment Among Burn Patients Enrolled via California's Hospital Presumptive Eligibility Program.

objectiveHospital presumptive eligibility (HPE) provides uninsured patients temporary Medicaid coverage at the time of hospitalization and offers a pathway to securing long-term Medicaid coverage in California. This is of particular importance for burn survivors who have ongoing healthcare needs and may experience financial hardship due to acute and long-term recovery service utilization.

methodsUsing Medicaid claims eligibility data, the California Department of Health Care Services Management Information Systems and the Decisions Support System records, patients ages 18-64 with a primary diagnosis of burn were identified. Descriptive characteristics and Pearson's χ2 tests were used to evaluate bivariate relationships between those who sustained Medicaid after 6 months and those who did not. Multivariate logistic regression was used to determine association of various factors with Medicaid sustainment.

resultsOf, 1382 included patients, 73% sustained Medicaid 6 months after HPE enrollment. There were significant differences in Medicaid sustainment between race/ethnicity groups, primary language, TBSA, length of inpatient stay, and need for mechanical ventilation (P = .008) indicating intensive care unit admission. For those who were discharged, multivariate analyses show Spanish speakers and those who did not disclose their language vs English speakers (P = .020 and P < .001 respectively), those who did not disclose race/ethnicity vs white (P = .017), those with <10% TBSA vs 20+% TBSA (P < .001), and those who were discharged home vs those discharged to services (P = .047) were less likely to sustain Medicare. Similar results were observed for all inpatients, except those without concurrent trauma (P = .042) were also less likely to sustain Medicaid.

conclusionsHospital presumptive eligibility enrollment at the time of burn injury hospitalization provides a viable path for patients to obtain long-term Medicaid insurance, but additional support pathways must be identified to support Medicaid sustainment for those who are not English speakers and those who are less likely to require long-term follow-up care (ie, those with lower TBSA and those who are discharged home).