Introduction
The impact of Medicaid expansion on linkage to care, self-maintenance, and treatment
among low-income adults with diabetes was examined.
Methods
A difference-in-differences design was used on data from the Behavioral Risk Factor
Surveillance System, 2008–2018. Analysis was restricted to states with diabetes outcomes
and nonpregnant adults aged 18–64 years who were Medicaid eligible on the basis of
income. Separate analyses were performed for early postexpansion (1, 2, 3) and late
postexpansion years (4, 5). Analyses were performed from September 2019 to March 2020.
Results
In comparing expansion with control states, low-income residents with diabetes had
similar ages (48.9 vs 49.1 years) and similar proportions who were female (54.4% vs
55.0%) but were less likely to be Black, non-Hispanic (20.8% vs 29.2%, standardized
difference= −16.3%). In expansion states, health insurance increased by 7.2 percentage
points (95% CI=3.9, 10.4), and the ability to afford a physician increased by 5.5
percentage points (95% CI=1.9, 9.1) in the early years, but no difference was found
in late years. Medicaid expansion led to a 5.3-percentage point increase in provider
foot examinations in the early period (95% CI=0.14, 10.4) and a 7.2-percentage point
increase in self-foot examinations in the late period (95% CI=1.1, 13.3). No statistically
significant changes were detected in self-reported linkage to care, self-maintenance,
or treatment.
Conclusions
Although health insurance, ability to afford a physician visit, and foot examinations
increased for Medicaid-eligible people with diabetes, there was no statistically significant
difference found for other care continuum measures.
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Article Info
Publication History
Published online: November 11, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
