Nevada's Medicaid expansion and admissions for ambulatory care-sensitive conditions

Abstract

Objectives: In January 2014, Nevada became 1 of the 32 states that have expanded Medicaid under the Affordable Care Act. As a result of the expansion, 276,400 additional Nevada residents received Medicaid insurance. The objectives of this paper were to examine the impact of Nevada’s Medicaid expansion on changes in rates of hospital admissions for ambulatory care–sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and to examine the racial/ethnic disparities in such rates. Study Design: We used complete inpatient discharge data (for the years 2012, 2013, and 2014, and the first 3 quarters of 2015) from all nonfederal acute care community hospitals in Nevada. Methods: We employed pooled cross-sectional design with a difference-in-differences approach to identify overall and race/ethnicity-specific changes in admissions for ACSCs, adjusted for secular trends unrelated to expansion. We examined admissions for ACSCs among adults aged 18 to 64 years (those most likely to have been affected by the reform) admitted for overall, acute, and chronic ACSC composites in the 24 months before and 21 months after the date on which expansion was implemented. Results: After adjusting for confounders, we found that Hispanic patients with Medicaid were more likely to be admitted for ACSCs after Nevada’s Medicaid expansion (overall quality composite: odds ratio [OR], 1.20; P = .05; chronic quality composite: OR, 1.34; P = .02). Conclusions: This analysis provides evidence that Medicaid expansion may have limited potential to reduce the disparities in rates of hospital admissions for ACSCs. In Nevada, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions.