Medicaid Patients in Oregon Sought Primary Care, Not Emergency Department Visits, After Program Expansion

Because Medicaid-covered patients tend to have high emergency department (ED) use rates, policymakers expected that Medicaid expansion under the Affordable Care Act (ACA) would result in higher ED use. But following the ACA’s Medicaid expansion in 2014, most patients covered under the program in Oregon sought primary care rather than care in EDs, an AHRQ-funded study in Medical Care found. Researchers used Medicaid enrollment data to identify about 213,000 Oregon patients continuously enrolled in the program during 2014 and 2015. Most newly and returning insured Medicaid enrollees sought primary care rather than ED services, and most became established with primary care, the analysis showed. The highest rate of ED use was among new patients who were continuously insured but lacked an established relationship with a primary care provider. These findings suggest the important role that continuity of care can play in lower ED use, as well as expanded access to health insurance, researchers concluded. Access the abstract.

2019 Oct;57(10):788-794. doi: 10.1097/MLR.0000000000001189.

Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-affordable Care Act Medicaid Expansion?

Holderness H1, Angier H1, Huguet N1, O'Malley J1, Marino M1,2, Springer R1, DeVoe J1.

Author information

1: Department of Family Medicine, Oregon Health & Science University.
2: Department of Public Health, Oregon Health & Science University and Portland State University, Portland, OR.

Abstract

BACKGROUND:

Previous studies suggest the newly Medicaid insured are more likely to use the emergency department (ED) however they did not differentiate between patients established or not established with primary care.

OBJECTIVES:

To understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion (ED, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization.

RESEARCH DESIGN:

A retrospective cohort study.

SUBJECTS:

Adults continuously insured from 2014 through 2015 who were either newly, returning, or continuously insured post-PPACA.

MEASURES:

Site of first and last outpatient visit, established with primary care status, and outpatient care utilization.

RESULTS:

The odds of being established with primary care at their first visit were lower among newly [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.18-0.19] and returning insured (OR, 0.22; 95% CI, 0.22-0.23) than the continuously insured. Continuously insured, new patients with primary care had higher odds of visiting the ED (OR, 2.15; 95% CI, 2.01-2.30) at their first visit than newly or returning insured. Patients established with a single primary care provider in all insurance groups had lower rates of ED visit, whereas those established with multiple primary care providers had the highest ED visit rates.

CONCLUSIONS:

Most newly and returning insured Medicaid enrollees sought primary care rather than ED services and most became established with primary care. Our findings suggest that both insurance and primary care continuity play a role in where patients seek health care services.