Utilization of Community Health Centers in Medicaid Expansion and Nonexpansion States, 2013-2014

Abstract

Using electronic health record data, we examined longitudinal changes in community health center (CHC) visit rates from 2013 through 2014 in Medicaid expansion versus nonexpansion states. Visits from 219 CHCs in 5 expansion states and 4 nonexpansion states were included. Rates were computed using generalized estimating equation Poisson models. Rates increased in expansion state CHCs for new patient, preventive, and limited-service visits (14%, 41%, and 23%, respectively, P < .01 for all), whereas these rates remained unchanged in nonexpansion states. One year after ACA Medicaid expansions, CHCs in expansion states saw an influx of new patients and provided increased preventive services.

Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Figure 1. Adjusted visit rates by coverage status and month among CHCs in Medicaid expansion and non-expansion states

Footnote: Rates calculated per 1,000 adult patients across entire study period. GEE Poisson models accounting for temporal correlation within CHCs over time and adjusted for covariates significant at P<.05: percent Hispanic, insurance exchange type, and 2014 minimum wage (uninsured model); percent under age 40, percent non-white race, percent Hispanic, percent ≤138% FPL, and percent with unknown FPL (Medicaid model); percent non-white race, percent Hispanic, percent ≤138% FPL, insurance exchange type, and 2014 minimum wage (commercial model).