Comparing health care utilization after hospital discharge in Medicaid managed care versus fee-for-service.

Background: Although managed care organizations (MCOs) insure the majority of Medicaid beneficiaries, contemporary and nationwide data comparing postdischarge utilization between MCOs and Medicaid fee-for-service (FFS) beneficiaries are lacking. Methods: We conducted a cross-sectional study of 1.65 million hospital discharges among Medicaid-only beneficiaries between 2015-2019 and 2021-2022. Multivariable logistic regression, adjusted for patient and utilization characteristics, estimated average marginal effects of MCO vs FFS enrollment on 30-day emergency department (ED) visits, observation stays, readmissions, and follow-up visits between MCO vs FFS beneficiaries. Analyses were stratified by ages 18-49 years and 50+ years. Results: Among young adults, MCO vs FFS enrollment was associated with a lower probability of ED visits (average marginal effect [AME]: -1.2 percentage points [pp]) and a higher probability of follow-up visits (AME: 10.6 pp). Among older adults, MCO enrollment was also associated with a lower probability of ED visits (AME: -2.2 pp) and a higher probability of follow-up visits (AME: 20.4 pp), but a higher readmission risk (AME: 1.6 pp). Conclusion: Associations between Medicaid managed care and greater follow-up and lower ED visits signal effective care coordination, while greater readmission risk for older adults is concerning. This finding may reflect barriers to care continuity and recommended post-acute care in managed care, meriting further investigation to inform solutions.