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Trends in the Impact of Medicaid Expansion on the Use of Clinical Preventive Services

  • Suhang Song
    Correspondence
    Address correspondence to: Suhang Song, PhD, Policy, Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Northeast, Mail Stop H21-11, Atlanta GA 30329.
    Affiliations
    Policy, Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy (OADPS), U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

    Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
    Search for articles by this author
  • James E. Kucik
    Affiliations
    Policy, Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy (OADPS), U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
Published:December 24, 2021DOI:https://doi.org/10.1016/j.amepre.2021.11.002

      Introduction

      This study aims to evaluate the trends in the impact of Medicaid expansion on the use of selected recommended clinical preventive services and examine the differences in use by income level over time.

      Methods

      The data were obtained from the 2011–2019 Behavioral Risk Factor Surveillance System and were analyzed in 2021. This study conducted a difference-in-differences analysis of the association between Medicaid expansion and the use of 5 clinical preventive services, including colon/breast/cervical cancer screenings, HIV testing, and influenza vaccination. Annual percentage change was applied to assess the trends in the impact of Medicaid expansion on the use of clinical preventive services.

      Results

      The use of all the 5 clinical preventive services varied over time. In almost every year, the use of 4 clinical preventive services (all but HIV testing) among Medicaid expansion states was higher than that among the nonexpansion states. People with lower income used 4 clinical preventive services (all but HIV testing) less frequently than those with higher income, regardless of their residence in expansion or nonexpansion groups. Among the lower-income group, the use of 5 clinical preventive services increased after Medicaid expansion almost every year, with the use of colon cancer screening and HIV testing reaching statistical significance and the impact of Medicaid expansion in the use of each clinical preventive service kept stable from 2014 to 2019.

      Conclusions

      These findings provide evidence that Medicaid expansion may be associated with sustainably increased use of the selected recommended clinical preventive services among the lower-income population and that Medicaid expansion to reduce financial barriers may be an effective strategy to improve population health.
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