Dmitry Tumin1, Eliza W Beal2, Khalid Mumtaz3, Don Hayes4, Joseph D Tobias5, Timothy M Pawlik2, W Kenneth Washburn6, Sylvester M Black7. 1. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: tumin.1@osu.edu. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. 3. Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH. 4. Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. 5. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH. 6. Division of Transplantation, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, OH. 7. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, OH.
Abstract
BACKGROUND: The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. STUDY DESIGN: Data on LT candidates aged 18 to 64 years, in 2012 to 2013 (pre-expansion) and 2014 to 2015 (post-expansion), were obtained from the United Network for Organ Sharing registry. Change between the 2 periods in the percent of LT candidates using Medicaid was compared between expansion and nonexpansion states. Multivariable logistic regression was used to determine how Medicaid expansion influenced individual LT candidates' likelihood of using Medicaid insurance. RESULTS: The study included 33,017 LT candidates, of whom 29,666 had complete data for multivariable analysis. Medicaid enrollment increased by 4% after Medicaid expansion in participating states. One-quarter of the transplant centers in these states experienced ≥10% increase in the proportion of LT candidates using Medicaid insurance. Multivariable analysis confirmed that Medicaid expansion was associated with increased odds of LT candidates using Medicaid insurance (odds ratio 1.49; 95% CI 1.34, 1.66; p < 0.001). However, the absolute number and demographic characteristics of patients listed for LT did not change in Medicaid expansion states during the post-expansion period. CONCLUSIONS: Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list.
BACKGROUND: The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. STUDY DESIGN: Data on LT candidates aged 18 to 64 years, in 2012 to 2013 (pre-expansion) and 2014 to 2015 (post-expansion), were obtained from the United Network for Organ Sharing registry. Change between the 2 periods in the percent of LT candidates using Medicaid was compared between expansion and nonexpansion states. Multivariable logistic regression was used to determine how Medicaid expansion influenced individual LT candidates' likelihood of using Medicaid insurance. RESULTS: The study included 33,017 LT candidates, of whom 29,666 had complete data for multivariable analysis. Medicaid enrollment increased by 4% after Medicaid expansion in participating states. One-quarter of the transplant centers in these states experienced ≥10% increase in the proportion of LT candidates using Medicaid insurance. Multivariable analysis confirmed that Medicaid expansion was associated with increased odds of LT candidates using Medicaid insurance (odds ratio 1.49; 95% CI 1.34, 1.66; p < 0.001). However, the absolute number and demographic characteristics of patients listed for LT did not change in Medicaid expansion states during the post-expansion period. CONCLUSIONS: Candidates for LT became more likely to use Medicaid after the 2014 Medicaid expansion policy came into effect. Enactment of this policy did not appear to increase access to LT or address socioeconomic and demographic disparities in access to the LT wait list.
Authors: Clifford Akateh; Dmitry Tumin; Eliza W Beal; Khalid Mumtaz; Joseph D Tobias; Don Hayes; Sylvester M Black Journal: Dig Dis Sci Date: 2018-03-24 Impact factor: 3.199
Authors: Krystal L Karunungan; Yas Sanaiha; Roland A Hernandez; Holly Wilhalme; Sarah Rudasill; Joseph Hadaya; Joseph DiNorcia; Peyman Benharash Journal: Liver Transpl Date: 2020-12-31 Impact factor: 5.799
Authors: Lauren D Nephew; Kelly Mosesso; Archita Desai; Marwan Ghabril; Eric S Orman; Kavish R Patidar; Chandrashekhar Kubal; Mazen Noureddin; Naga Chalasani Journal: JAMA Netw Open Date: 2020-10-01